Wagner Classification of Diabetic Foot Ulcers

Diabetic Foot Ulcers (DFUs) are estimated to occur in 15% of all diabetics. DFUs are a major and costly problem. The Agency for Healthcare Research and Quality (AHRQ) discusses the cost in “Economic burden of diabetic foot ulcers and amputations.” In this article AHRQ says the costs for Medicare FFS beneficiaries who had a prevalent DFU had a mean reimbursement for all Medicare services 31.6 thousand dollars (median: $15.2) in 2006, 33.1 thousand dollars ($15.9) in 2007, and 35.1 thousand dollars (16.7) in 2008.

It is important, then, that the home health nurse properly treats and documents the progress, or lack thereof, of the Diabetic Foot Ulcer. A tool suggested by Palmetto GBA is the Wagner Classification of Diabetic Foot Ulcers. In the Palmetto GBA Jurisdiction 11 (J11) Home Health Workshop they present the Wagner Classification of Diabetic Foot Ulcers.

• Grade 0 is no ulcer but a high risk foot. PGBA identifies this as a patient with pre-ulcerative lesions, healed ulcers, or the presence of a bony deformity. 
•  Grade 1 is a superficial ulcer involving the full skin thickness but not the underlying tissues. It does not extend into the subcutaneous tissue.
• A Grade 2 ulcer is a deep ulcer extending through the subcutaneous tissue. It may expose bone, tendon, or ligaments but does not involve the underlying bone or an abscess.
• The Grade 3 ulcer is a deep ulcer involving cellulitis or abscess and often osteomyelitis.
• A Grade 4 ulcer is one with gangrene of a digit or localized gangrene.
• The Grade 5 ulcer involves gangrene of the foot. It requires disarticulation.

Proper grading of the diabetic foot ulcer can drive the treatment and result in improved outcomes. It also provides a standardized format for communication between nursing staff as well as nurses and the treating physician.

Source: homehealthconsulting.wordpress.com