The Skin Failure
Shared Interest Group
A focused professional community for wound care clinicians advancing the recognition, assessment, documentation, and research of skin failure in post-acute and end-of-life care settings.
Skin Failure is Underrecognized and Consequential
Skin failure refers to the deterioration of skin integrity that can accompany severe illness and end-of-life decline. Unlike pressure injuries caused by external forces, skin failure reflects systemic physiologic compromise, and the distinction matters clinically, legally, and for patient care quality.
Despite growing evidence and evolving clinical frameworks, skin failure remains inconsistently defined, documented, and differentiated from other wound etiologies across post-acute settings. The result: unnecessary litigation, regulatory scrutiny, and missed opportunities for appropriate palliative care planning.
The Skin Failure SIG brings together the wound care community to change that.
- Kennedy Terminal Ulcers (KTU) and end-of-life skin changes
- Skin Changes at Life's End (SCALE): evidence and assessment
- Trombley-Brennan Terminal Tissue Injuries (TB-TTI)
- Differentiating skin failure from pressure injuries and MASD
- CMS survey readiness, MDS coding, and care planning implications
- Emerging research and evolving clinical consensus
Skin failure is recognized as an unavoidable skin change in some individuals experiencing multiorgan failure, systemic hypoperfusion, or end-of-life decline. Evidence supports its distinction from pressure injuries in specific clinical contexts.
Key frameworks include the SCALE (Skin Changes at Life's End) consensus document, NPIAP position statements, and emerging interdisciplinary research on Kennedy Terminal Ulcers and end-of-life tissue injury patterns.
All clinical discussions in the SIG are evidence-based and peer-reviewed. This page is for educational purposes and does not constitute medical advice.
SIG Details
PAWSIC Skin Failure Codes Position Paper
The Case for ICD-10-CM Diagnostic Codes for Skin Failure
Read PAWSIC’s position on the development of diagnostic codes for skin failure, informed by the work of the Skin Failure Shared Interest Group.
Endorse the Position Paper →“The Post Acute Wound and Skin Integrity Council (PAWSIC) recognizes skin failure as an increasingly identified clinical phenomenon associated with systemic physiologic compromise. The absence of dedicated diagnostic codes for skin failure within ICD-10-CM creates challenges for patient-centered care, documentation, communication, quality measurement, and research. PAWSIC supports the development of an ICD-10-CM skin failure code framework that reflects contemporary clinical practice while allowing for continued scientific refinement as evidence evolves.”
PAWSIC Position Statement on Skin Failure Codes, Version 1.0, page 2.
What You'll Find in the Skin Failure SIG
A curated space for focused collaboration, not general wound care discussion.
Peer Forum Discussions
Ask clinical questions, share challenging cases (fully de-identified), and get perspectives from wound care specialists, DONs, palliative care clinicians, and researchers across care settings.
Evidence & Resources
Curated research, SCALE consensus documents, NPIAP position statements, clinical assessment tools and documentation templates specific to skin failure and end-of-life skin changes.
Webinar & CE Content
Access to PAWSIC's skin failure webinar library, including CE-eligible recordings on Kennedy Terminal Ulcers, SCALE, end-of-life documentation, and regulatory survey readiness.
Survey & Compliance Guidance
Practical discussion threads on MDS coding, care planning documentation, F686 survey tags, and communicating skin failure findings to surveyors, families, and interdisciplinary teams.
Expert Networking
Connect directly with PAWSIC board members, advisory committee clinicians, and nationally recognized wound care experts who specialize in skin failure and end-of-life care.
Shape the Research Agenda
As PAWSIC's inaugural SIG, members have a direct role in identifying practice gaps, proposing position statement topics, and advancing PAWSIC's advocacy work on skin failure standards.
This SIG is for You If You Care About Skin Failure
Anyone involved in wound care, palliative care, hospice, post-acute settings, or regulatory compliance is welcome to join.
Meet the Chairs
The Skin Failure SIG is led by nationally recognized wound care clinicians, researchers, and legal nurse consultants with decades of specialized expertise.
Join Premium & Access
the Skin Failure SIG
PAWSIC Premium Membership includes immediate access to the Skin Failure SIG, CE/CME-eligible courses, all community SIG spaces, and exclusive events.
Not sure yet? Start with a free membership and upgrade anytime.
