Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Pressure Ulcer Scale for Healing (PUSH) Tool 3.0

The PUSH tool has been validated and found to be responsive to change for use with foot ulcers.

Directions: Observe and measure the pressure ulcer. Categorize the ulcer with respect to surface area, exudate and type of wound tissue. Record a sub-score for each of these ulcer characteristics. Add the sub-scores to obtain the total score. A comparison of total scores measured over time provides an indication of the improvement or deterioration in pressure ulcer healing.

 



LENGTH
X
WIDTH 

(in cm2)

0
0

1
<0.3

2
0.3-0.6

3
0.7-1.0

4
1.1-2.0

5
2.1-3.0




Sub-Score

 

 

6
3.1-4.0

7
4.1-8.0

8
8.1-12.0

9
12.1-24.0

10
>24.0

EXUDATE
AMOUNT

0
None

1
Light

2
Moderate

3
Heavy

    Sub-Score
TISSUE TYPE

0
Closed


Epithelial
Tissue

2
Granulation
Tissue

3
Slough

4
Necrotic
Tissue

  Sub-Score












 
TOTAL SCORE
Length x Width:Measure the greatest length (head to toe) and the greatest width (side to side) using a centimeter ruler. Multiply these two measurements (length x width) to obtain an estimate of surface area in square centimeters (cm2).
Caveat: Do not guess! Always use a centimeter ruler and always use the same method each time the ulcer is measured.
 
Exudate Amount:Estimate the amount of exudate (drainage) present after removal of the dressing and before applying any topical agent to the ulcer. Estimate the exudate (drainage) as none, light, moderate or heavy.
 
Tissue Type:This refers to the types of tissue that are present in the wound (ulcer) bed. Score as a “4” if there is any necrotic tissue present. Score as a “3” if there is any amount of slough present and necrotic tissue is absent. Score as a “2” if the wound is clean and contains granulation tissue. A superficial wound that is reepithelializing is scored as a “1”. When the wound is closed, score as a “0”.
 
4 – Necrotic Tissue (Eschar): black, brown or tan tissue that adheres firmly to the wound bed or ulcer edges and
may be either firmer or softer than surrounding skin.
3 – Slough: yellow or white tissue that adheres to the ulcer bed in strings or thick clumps, or is mucinous.
2 – Granulation Tissue: pink or beefy red tissue with a shiny, moist, granular appearance.
1 – Epithelial Tissue: for superficial ulcers, new pink or shiny tissue (skin) that grows in from the edges or as islands
on the ulcer surface.
0 – Closed/Resurfaced: the wound is completely covered with epithelium (new skin).
 

 

Note. From “Pressure Ulcer Scale for Healing tool (PUSH tool) 3.0,” by National Pressure Ulcer Advisory Panel, 2012. Retrieved from http://www.npuap.org/wp-content/uploads/2012/02/push3.pdf. Reprinted with permission