PUSH Tool 3.0 — Pressure Ulcer Scale for Healing Calculator

How to Use This Calculator

1. Measure wound length and width in cm after cleaning.
2. Select exudate amount (None/Light/Moderate/Heavy).
3. Select predominant tissue type (Closed/Epithelial/Granulation/Slough/Necrotic).
4. PUSH score (0–17) calculates instantly.
5. Use the Healing Trajectory tab to compare baseline and current scores.
6. Use the Wound Bed tab for tissue and peri-wound skin assessment guidance.

Formula

Example

Frequently Asked Questions

• What is the PUSH tool? ▼
  The PUSH (Pressure Ulcer Scale for Healing) tool is a validated wound measurement instrument developed by the National Pressure Ulcer Advisory Panel (NPUAP, now NPIAP — National Pressure Injury Advisory Panel) and first published in 1997. PUSH Tool 3.0 is the current version (updated 2005) and measures three aspects of a pressure injury: surface area (length × width in cm², scored 0–10 on an ordinal scale), exudate amount (0 = none to 3 = heavy), and tissue type (0 = closed/re-epithelialised to 4 = necrotic tissue/eschar). Total PUSH scores range from 0 (fully healed wound) to 17 (largest, most exudative, most necrotic wound). The tool was designed specifically for serial tracking of wound healing over time — the primary use is not a single-point assessment but the comparison of consecutive scores to determine whether a wound is improving, stalled, or deteriorating. PUSH has been validated not only for pressure injuries but also for venous leg ulcers, and is widely used in wound care nursing as a standardised documentation tool that reduces inter-rater variability in wound assessment.
• How is PUSH used to track wound healing? ▼
  PUSH is designed for serial measurement — assessed at a consistent interval (most commonly weekly) under standardised conditions: the wound is cleaned before measurement, dimensions are taken at the longest axis (length) and the widest perpendicular axis (width), and the same clinician or trained wound care nurse performs consecutive assessments to maximise intra-rater reliability. The initial PUSH score establishes a baseline. Subsequent scores are plotted over time, and the trajectory of change is the key clinical information. A steadily decreasing PUSH score indicates healing. A plateau indicates stalled healing, which should trigger a systematic review of wound care factors: infection, nutrition, offloading adequacy, moisture balance, dressing appropriateness, and underlying medical conditions (hyperglycaemia, venous insufficiency, arterial disease, immunosuppression). An increasing PUSH score indicates wound deterioration and demands urgent reassessment. Institutions typically use PUSH alongside photographic documentation, allowing visual correlation with quantitative tracking. NPUAP recommends PUSH measurement at each wound care assessment.
• What does a declining PUSH score mean clinically? ▼
  A declining PUSH score over serial assessments is the primary validated indicator of wound healing progress. Each of the three PUSH components can contribute to score reduction: area reduction (the most important marker of macroscopic healing and the component with the widest ordinal range, 0–10); reduction in exudate (from heavy to moderate to light to none, reflecting improvement in wound bed moisture balance and vascularisation); and improvement in tissue type (from necrotic or slough to granulation tissue to epithelial tissue to closure, reflecting sequential wound bed preparation and re-epithelialisation). A total PUSH score decrease of 2 or more points over two consecutive weekly measurements generally indicates a healing wound. Wound closure is defined as PUSH = 0. Some wound types have characteristic trajectories: venous leg ulcers may show slow gradual decline over months; pressure injuries in compliant patients with good nutrition may close rapidly; diabetic foot ulcers may stall until offloading is optimised. The rate of PUSH score decline can be used to estimate time to healing for goal-setting and patient communication.
• When should PUSH be measured? ▼
  PUSH should be measured at each formal wound care assessment — the recommended frequency is weekly for actively managed wounds, though more frequent assessment may be appropriate in rapidly changing wounds (e.g., newly debrided wounds, infected wounds under treatment, wounds in critically ill patients). Initial measurement establishes the baseline and guides care planning. In long-term care and home settings, weekly measurement is typically feasible and aligns with dressing change schedules. In acute hospital settings, PUSH measurement at each assessment (which may be more frequent than weekly) provides timely feedback. A consistent measurement time is important: PUSH values vary depending on whether the wound was just cleaned and debrided (which temporarily removes slough and may change exudate assessment) versus measured at the next visit before cleaning. Most protocols specify measuring after cleaning but before new dressing application. Documentation in the medical record should always include the date, the specific wound location, and all three component sub-scores in addition to the total, allowing retrospective analysis of which wound parameter changed. NPUAP recommends pairing PUSH scores with standardised wound photography.
• How is PUSH different from simply measuring wound area? ▼
  While wound area (length × width) is the largest contributor to the PUSH score (with a maximum sub-score of 10 compared to 3 for exudate and 4 for tissue type), PUSH captures two additional dimensions that simple area measurement misses: exudate burden and tissue quality. These dimensions independently reflect wound biology that may change ahead of measurable area reduction. A wound may maintain a similar area for several weeks during the debridement phase while tissue type dramatically improves (moving from necrotic to slough to granulation), representing meaningful biological progress that PUSH captures but simple area measurement does not. Similarly, exudate reduction — reflecting improved vascular and lymphatic function in the wound bed — often precedes significant area reduction. Conversely, a wound that appears to be maintaining stable size may show increasing exudate and worsening tissue quality (slough re-accumulating) that indicates deterioration warranting intervention. The combination of all three components gives a more complete and earlier-warning picture of wound healing trajectory. Wound care guidelines universally recommend multi-parameter wound assessment rather than size alone.

Related Calculators