---
title: Wound Tracking Form Weekly
description: "Facility: _________________________________________________________   Unit: ____________________    Date: _______________________   Resident Room No. Present on Admit or In-House   Location of Wound T"
---

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# Wound Tracking Form Weekly

**Facility: _________________________________________________________   ****Unit: **____________________    **Date:** _______________________

 

| **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** |   |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
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|   A.    Number Residents with Facility Acquired Pressure Injuries: ______________________     % Residents with Facility Acquired Pressure Injury (A÷B) ________   B.    Total Number of All Residents in Census: _______________________   Wound Type Key: 1 Pressure Injury 2 Surgical 3 Venous Stasis 4 Arterial Ulcer 5 Skin Tear 6 Abrasion 7 Laceration 8 Diabetic Ulcer 9 Burn 10 Other   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. |  |  |  |  |  |  |  |  |  |  |

[![CTA-PINK](https://56632.fs1.hubspotusercontent-na1.net/hub/56632/hubfs/CTA-PINK.png?width=220&height=70&name=CTA-PINK.png)](https://56632.fs1.hubspotusercontent-na1.net/hubfs/56632/DRAFT%20Weekly%20Wound%20Tracking%20Form%2011.6.20.docx)

 