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Wound Ostomy Continence Nurses Society (WOCN)
OASIS Guidance Questions and Answers

Q1. (M0464) I have just admitted a patient with a trochanteric pressure ulcer. The ulcer was debrided while the patient was in the hospital and the patient also received IV antibiotics. On admission the ulcer measures 5 cm x 6 cm x 3 cm; there are no areas of tracking or tunneling. The entire wound bed is clean with exposed muscle, but there is no granulation tissue. There is a moderate amount of serous exudate; the surrounding skin is intact. How should I classify the status of this wound for the OASIS items?

A1. (M0464) According to the guidelines published by the WOCN, the evidence described above indicates that the status of this wound may be non-healing because there is no granulation tissue present in the wound bed. The OASIS Team and clinical wound care experts from WOCN are not able to fully assess a specific wound status without actually seeing the wound. For more information about the WOCN guidelines, please contact the WOCN web site at www.wocn.org.

Q2. (M0464) This patient has an ischial pressure ulcer that measures 4 cm x 6 cm x 2 cm; there is a tract/tunnel at 4 o'clock that is 3 cm in depth. The wound bed has a small amount of stringy yellow tissue (about 20%) but is beginning to granulate (about 25% of the wound bed is covered with healthy red tissue that has a "bumpy" surface that looks a lot like raspberries). The edges of the wound are open. There are no signs of infection. How should I classify the status of this wound for the OASIS items?

A2. (M0464) According to the description presented above, the status of this wound may be classified as early/partial granulation because < 25% of the wound bed is covered with avascular tissue, at least 25% of the wound is granulating, the wound edges are open, and there are no signs of infection. There is dead space (a sinus tract) but that does not mean the wound is not healing. The OASIS Team and clinical wound care experts from WOCN are not able to assess a specific wound status without actually seeing the wound. Please contact the WOCN web site at www.wocn.org for further clarification about their guidelines regarding wound healing.

Q3. (M0464) My patient was admitted with a pressure ulcer 7 weeks ago and was initially showing progress. We debrided the wound and treated the infection and he began to granulate. Four to six weeks ago his wound measured 6 cm x 7 cm x 2 cm and he had 40% granulation tissue and no avascular tissue; we classified him as early/partial granulation. However, over the past 4 weeks he has shown no progress even though we have maintained him on an air support surface and his caregivers are turning him regularly. We have also consulted the dietitian who has recommended nutritional supplements, but he has been unable to ingest the recommended amount due to persistent nausea. How should I classify the status of this wound for the OASIS items?

A3. (M0464) According to the description presented in the question, the status of this wound appeared to have been correctly classified as early/partial granulation 4-6 weeks ago, but it may now be classified as non-healing due to persistent failure to progress despite appropriate management. The patient should be referred for medical management of his nutritional compromise since this is a key component of a comprehensive wound management program. The OASIS Team and clinical wound care experts from WOCN are not able to assess a specific wound status without actually seeing the wound. Please contact the WOCN web site at www.wocn.org for further clarification about their guidelines regarding wound healing

Q4. (M0464) This patient was admitted with a Stage 4 pressure ulcer over the trochanter. The wound has now granulated to the surface and currently measures 5 cm x 4 cm; no sinus tracts and no measurable depth. The drainage is serous, and there are no signs of infection. The wound edges are open along most of the wound though there is an area at the inferior aspect where they appear to be closed/curled under. How should I classify the status of this wound for the OASIS items?

A4. (M0464) From the description provided, the status of this wound may be classified as fully granulating because it has granulated to the surface, there is no dead space and no signs of infection, and most of the wound edges are open. The OASIS Team and clinical wound care experts from WOCN are not able to assess a specific wound status without actually seeing the wound. Please contact the WOCN web site at www.wocn.org for further clarification about their guidelines regarding wound healing

Q5. (M0476) My patient has a venous stasis ulcer that measures 3 cm x 4 cm x 0.5 cm; the wound bed has a mix of adherent yellow tissue (40%) and pale, edematous granulation tissue (60%). There is a large volume of yellow-green exudate and a halo of erythema around the wound; the patient is afebrile. How should I classify the status of this wound for the OASIS items?

A5. (M0476) According to the descriptions provided in the question, the status of this wound may be classified as non-healing for two reasons:

The wound bed has more than 25% avascular tissue; and

There are signs/symptoms of infection (large amount of yellow-green exudate and halo of erythema).

The OASIS Team and clinical wound care experts from WOCN are not able to assess a specific wound status without actually seeing the wound. Please contact the WOCN web site at www.wocn.org for further clarification about their guidelines regarding wound healing.

Q6. (M0488) This patient has a surgical incision from an abdominal procedure 7 days ago. There is slight incisional separation along the middle portion of the incision; there is a small amount of serous drainage but no signs of infection; there is no palpable healing ridge. How should I classify the status of this wound for the OASIS items?

A6. (M0488) According to the description of the wound presented in the question, the status of this may be classified as non-healing for two reasons:

There is incisional separation; and

There is no palpable healing ridge.

The OASIS Team and clinical wound care experts from WOCN are not able to assess a specific wound status without actually seeing the wound. Please contact the WOCN web site at www.wocn.org for further clarification about their guidelines regarding wound healing.

Q7. (M0488) My patient is post-op CABG. The sternal incision is well-approximated, and there is new pink skin covering the entire incision. There is a well-defined healing ridge and no signs of infection though there is very mild erythema along the wound borders. How should I classify the status of this wound for the OASIS items?

A7. (M0488) According to the description presented in the question, the status of this wound may be classified as fully granulating, because the incision has completely epithelialized, there are no signs of infection, and there is a well-defined healing ridge. The OASIS Team and clinical wound care experts from WOCN are not able to assess a specific wound status without actually seeing the wound. Please contact the WOCN web site at www.wocn.org for further clarification about their guidelines regarding wound healing.

 

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