Wound Tracking Form Weekly

Resident

Room

No.

Present on Admit or In-House

Location of
Wound

Type of Wound

Stage/
Pressure Previous Week

Stage/
Pressure Current Week

Treatments

Treatment

Changed

Improved (I)

Worsening (W)

Comments

A.    Number Residents with Facility Acquired Pressure Injuries: ______________________     % Residents with Facility Acquired Pressure Injury (A÷B) ________

B.    Total Number of All Residents in Census: _______________________

Pressure Injury Stages:  Suspected Deep Tissue Injury: Purple or maroon localized area of discolored intact skin or blood-filled blister.

                                                 Stage   1: Intact skin. Redness that DOES NOT BLANCH. Skin tones may appear red, maroon, blue, purple. Affected area may be warm, boggy or firm.

                                                 Stage   2: Skin is cracked, blistered, sheared or torn. Partial thickness wound. Does not heal with granulation.

                                 Stage 3: Broken skin, deep tissue involvement. Full thickness wound. Muscle, tendon, or bone is NOT visible.

                                 Stage 4: Broken through all layers of tissue. Full thickness wound. Muscle, tendon, or bone may be visible.

                                 Unstageable: Base of ulcer is covered by slough (yellow, tan, grey, green or brown) and/or eschar (tan, brown, or black) in the wound bed.