The Purpose and Application of the Pressure Ulcer Scale for Healing (PUSH) Score in Wound Care
The PUSH tool is a validated, responsive, and evaluative instrument designed to monitor and document wound healing progress in pressure ulcers, venous leg ulcers, and diabetic foot ulcers, providing clinicians with a standardized method to assess treatment effectiveness. 1
What is the PUSH Score?
The Pressure Ulcer Scale for Healing (PUSH) tool was originally developed by the National Pressure Ulcer Advisory Panel to track pressure ulcer healing but has since been validated for use with other chronic wounds. 2
The PUSH tool consists of three key components:
- Surface area measurement (length × width) 3
- Exudate amount (none, light, moderate, heavy) 2
- Tissue type (closed, epithelial tissue, granulation tissue, slough, necrotic tissue) 2
These components combine to create a total score ranging from 0 (healed) to 17 (worst possible score). 4
Clinical Applications of the PUSH Score
Monitoring Wound Healing Progress
- PUSH scores decrease significantly over time in healing wounds, making it an effective tool for tracking improvement 1
- The tool can differentiate between healing and non-healing wounds, with significant differences in scores evident as early as week 1 of treatment 3
- Regular assessment using PUSH helps clinicians determine if current interventions are effective or if treatment plans need modification 5
Standardizing Documentation
- PUSH provides a standardized method for documenting wound status across different healthcare settings and providers 2
- The tool facilitates communication between healthcare professionals about wound progress 5
- It creates a consistent record of wound healing that can be tracked over time 1
Treatment Decision Support
- Increasing PUSH scores prompt clinicians to reassess patients and treatment approaches (75% of surveyed clinicians confirmed this utility) 5
- The tool helps identify stalled healing, allowing for timely intervention adjustments 3
- PUSH scores can be used to evaluate the effectiveness of various treatment strategies, including nutritional interventions for pressure ulcers 6
Validated Uses Across Different Wound Types
- Pressure Ulcers: Originally developed and validated for pressure ulcers (Stages II-IV) 2
- Venous Leg Ulcers: Studies have confirmed PUSH is effective for monitoring healing trends in venous ulcers 4
- Diabetic Foot Ulcers: Research validates PUSH as responsive for tracking diabetic foot ulcer progress 1
Practical Implementation
- The PUSH tool is considered easy to use and teach to others 5
- Most clinicians (79% in surveys) agree that PUSH requires an appropriate amount of time to complete 5
- The tool is reliable for consistent assessment across different providers 5
Limitations and Potential Improvements
- The current PUSH tool lacks wound depth information, which many clinicians identify as an area for improvement 5
- Some clinicians suggest improvements to the size subscale (59%), tissue type subscale (49%), and exudate amount subscale (32%) 5
- While sensitive to change, some modifications could enhance its clinical value 3
Clinical Significance in Treatment Outcomes
- In polymorbid malnourished older adults with pressure ulcers, the PUSH score has been used to demonstrate significant improvements with nutritional interventions 6
- The tool shows strong correlation (r = .66) between total PUSH score and wound surface area, confirming its validity as a measurement tool 1
- PUSH scores can account for 31-39% of the variance in wound healing over 6-12 weeks, making it a clinically meaningful assessment 2
Best Practices for Implementation
- Use PUSH consistently at regular intervals to track wound progress over time 3
- Document all three components (size, exudate, tissue type) for most accurate assessment 2
- Consider supplementing PUSH with additional measurements (such as depth) for more comprehensive wound assessment 5
- Incorporate PUSH scores into the overall wound management plan to guide treatment decisions 1