At follow up assessment, it is necessary to judge whether the wound has improved or deteriorated and to decide the most appropriate treatment.

Normal Healing Process

Inflammation phase	Granulation phase
Necrotic tissue is present in the wound bed. Edema and swelling are noted in surrounding tissue.	Reddening of the wound bed. Disappearance of swelling in the wound bed.

Methods for assessment

Color Classification
Quantified Classification: PSST/PUSH 3.0 Tools

Color Classification

Outline
The healing process of pressure ulcers is classified into the following four colors:.

Black	Yellow	Red	White
A black scab is formed on the wound surface. The skin and subcutaneous tissue are necrotic.	Yellow necrotic tissue, poor granulation, and pus is present on the wound surface after the removal of the black scab. Note that the risk of infection is at its greatest due to the large volume of exudate present.	Necrotic tissue and poor granulation tissue have been removed, and good red granulation tissue is present.	Epithelialization begins at wound margins as red granulation tissue gradually fills tissue defects. This epidermis is characteristically whitish compared to its surrounding skin.

Key Points

1. Select the most appropriate treatment according to the stage of the pressure ulcer.
2. The above is the classification of a deep pressure ulcer (involving the corium, papillary layer or deeper tissues).
   Note This does not apply to shallow pressure ulcers..

Quantified Classification

• PSST Tool

• PSST was developed by Dr. Barbara Bates-Jensen in 1992, to quantify the wound healing process.
• Thirteen items are scored 1-5 points. The total becomes 13-65 points, and the higher the score, the worse the state of the pressure ulcer.
• PSST consists of a score card and an explanatory.
• Barbara Bates-Jensen reported that its reliability and validity have already been confirmed.
• Evaluation using PSST is performed once a week, or when changes are observed.

• PUSH 3.0 Tool

• PUSH 3.0 is a scale developed to quantitatively measure the wound healing process.
• It was developed by the NPUAP as a simple and reliable tool for long-term follow-up of pressure ulcers.
• The validity of this scale, consisting of 3 items, has been confirmed, and it is now being promoted for wider use.
• Evaluation using this scale is performed at least once a week or when the general condition of the patient or the wound has deteriorated.
• Registration is required in order to use this tool. Refer to the home page of NPUAP (http://www.npuap.org/) for further details.