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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 15-03.1
July 17, 2015


TO:
Acute Psychiatric Hospitals
General Acute Care Hospitals
Special Hospitals

SUBJECT:
Reporting of Healthcare Acquired Pressure Ulcers
(This AFL supersedes AFL 08-09 and AFL 10-01)

AUTHORITY:      Health and Safety Code (HSC) section 1279.1(b)(4)(F); Title 22 of the California Code of Regulations (CCR) sections 70717, 70749, 71517 and 71549


All Facilities Letter (AFL) Summary

  • Hospitals are required to report, as adverse events, Stage 3 or Stage 4 pressure ulcers acquired after admission to the hospital, excluding progression from Stage 2 to Stage 3 if Stage 2 was recognized upon admission.
  • This AFL supersedes AFL 08-09 and AFL 10-01, and replaces AFL 15-03, which provided guidance to hospitals for classification and reporting of unstageable pressure ulcers. This AFL clarifies that an unstageable pressure ulcer is not reportable to CDPH unless it is acquired after admission to the hospital. Clarification of HSC section 1279.1(b)(4)(F) will be provided in regulations that are currently under development.

Pursuant to HSC section 1279.1(a), general acute care hospitals, acute psychiatric hospitals, and special hospitals must report an adverse event to the California Department of Public Health (CDPH) no later than five days after the adverse event has been detected, or, if that event is an ongoing urgent or emergent threat to the welfare, health, or safety of patients, personnel, or visitors, not later than 24 hours after the adverse event has been detected. Further, HSC section 1279.1(c) requires the facility to inform the patient or the party responsible for the patient of the adverse event by the time the report is made.

The term "adverse event" includes any one of 28 specified events. HSC section 1279.1(b)(4)(F) states that an "adverse event" includes a Stage 3 or 4 ulcer, acquired after admission to a health facility, excluding progression from Stage 2 to Stage 3 if Stage 2 was recognized upon admission.

Hospitals are required to perform a patient assessment and document the patient’s condition upon admission in the patient’s medical record. (Title 22 CCR sections 70717, 70749, 71517, and 71549.)

Unstageable pressure ulcers are full thickness tissue loss where the actual depth of the ulcer is completely obscured by slough and/or eschar in the wound. Although the true depth of an unstageable pressure ulcer cannot be determined, it is a Stage 3 or 4 pressure ulcer. Therefore, an unstageable pressure ulcer present on admission to a hospital and subsequently staged as a 3 or 4 is not required to be reported by the hospital.

For additional information regarding prevention and treatment as well as the full list of pressure ulcer stages/categories, refer to the National Pressure Ulcer Advisory Panel webpage at:

NPUAP - Educational and Clinical Resources

If you have any questions concerning this letter, please contact your respective District Office.

 

Sincerely,

Original signed by Jean Iacino

Jean Iacino
Deputy Director

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