Chapter 15 Skin Integrity Figure 15.3 cont. Pressure Ulcer Scale for Healing (PUSH Tool 3.0) Instructions for Using the PUSH Tool To use the PUSH Tool, the pressure ulcer is assessed and scored on the three elements in the tool:

● Length × Width → scored from 0 to 10 ● Exudate Amount → scored from 0 (none) to 3 (heavy) ● Tissue Type → scored from 0 (closed) to 4 (necrotic tissue)

bottom of the tool. × width, a centimeter ruler measurement is made of the greatest head to toe diameter. A

second measurement is made of the greatest width (left to right). Multiply these two measurements to get square centimeters and then select the corresponding category for size on the scale and record the score.

Step 2: Estimate the amount of exudate after removing the dressing and before applying any topical agents. Select the corresponding category for amount and record the score.

Step 3: Identify the type of tissue. Note: if there is ANY necrotic tissue, it is scored a 4. Or, if there is ANY slough, it is scored a 3, even though most of the wound is covered with granulation tissue.

Step 4: Sum the scores on the three elements of the tool to derive a total PUSH score.

Step 5: Transfer the total score to the Pressure Ulcer Healing Graph. Changes in the score over time provide an indication of the changing status of the ulcer. If the score goes down, the wound is healing. If it gets larger, the wound is deteriorating.

Source: Reprinted with permission from National Pressure Ulcer Advisory Panel. http://www.npuap.org/resources/educational-and- clinical-resources/push-tool/instructions-for-using-the-push-tool/.

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