Ayello EA, Levine JM, Langemo D, Kennedy-Evans KL, Brennan MR, Gary Sibbald R, et al.
Advances in skin & wound care. Date of publication 2019 Mar 1;volume 32(3):109-121.
1. Adv Skin Wound Care. 2019 Mar;32(3):109-121. doi:
10.1097/01.ASW.0000553112.55505.5f.
Reexamining the Literature on Terminal Ulcers, SCALE, Skin Failure, and
Unavoidable Pressure Injuries.
Ayello EA(1), Levine JM, Langemo D, Kennedy-Evans KL, Brennan MR, Gary Sibbald R.
Author information:
(1)Elizabeth A. Ayello, PhD, RN, CWON, ETN, MAPWCA, FAAN • Faculty • Excelsior
College School of Nursing • Albany, New York • President • Ayello Harris &
Associates, Inc • Copake, New York • President • World Council of Enterostomal
Therapists • Co-Editor-in-Chief • Advances in Skin & Wound Care • Philadelphia,
Pennsylvania Jeffrey M. Levine, MD, AGSF, CMD • Associate Clinical Professor of
Geriatrics and Palliative Care • Icahn School of Medicine at Mount Sinai • New
York, New York Diane Langemo, PhD, RN, FAAN • President • Langemo & Associates •
Professor Emeritus and Adjunct Professor • University of North Dakota College of
Nursing • Grand Forks, North Dakota Karen Lou Kennedy-Evans, RN, FNP, APRN-BC •
Wound Consultant • Foothills Rehabilitation Center • Tucson, Arizona Mary R.
Brennan, MBA, RN, CWON • Assistant Director for Wound and Ostomy Care • North
Shore University Hospital • Manhasset, New York R. Gary Sibbald, MD, DSc (Hons),
MEd, FRCPC (Med Derm), ABIM, FAAD, MAPWCA • Professor • Medicine and Public
Health • University of Toronto • Toronto, Ontario, Canada • Director •
International Interprofessional Wound Care Course and Masters of Science in
Community Health (Prevention and Wound Care) • Dalla Lana School of Public Health
• University of Toronto • Project Lead • ECHO Ontario, Wound & Skin Care •
Previous President • World Union of Wound Healing Societies • co-Editor-in-Chief
• Advances in Skin and Wound Care • Philadelphia, Pennsylvania.
GENERAL PURPOSE: To synthesize the literature regarding skin injuries that are
found in patients at the end of life and to clarify the terms used to describe
these conditions.
TARGET AUDIENCE: This continuing education activity is intended for physicians,
physician assistants, nurse practitioners, and nurses with an interest in skin
and wound care.
LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education
activity, you should be better able to:1. Define the terms used to describe
pressure injuries and skin changes at the end of life.2. Discuss the concept of
skin failure as applied to end-of-life skin injuries and implications for
practice.
ABSTRACT: This article synthesizes the literature regarding the concepts of
"terminal" skin injuries that are found in patients at the end of life, including
Kennedy terminal ulcers, Skin Changes At Life's End, Trombley-Brennan terminal
tissue injuries, and skin failure. Also included is a discussion of avoidable and
unavoidable pressure injuries as defined and differentiated by the Centers for
Medicare & Medicaid Services and the National Pressure Ulcer Advisory Panel. To
help clarify the controversy among these terms, a unifying concept of "skin
failure" that may occur with an acute illness, chronic illness, or as part of the
dying process is proposed. This proposed concept of skin failure is etiologically
different than a pressure injury, although pressure injury and skin failure can
occur concomitantly. These proposed concepts require further research and
validated diagnostic criteria. Consensus around appropriate terminology is
essential to reduce confusion among stakeholders and ensure appropriate patient
care.
DOI: 10.1097/01.ASW.0000553112.55505.5f
PMID: 30801349
