Click here for the Wounds UK Home Page August 2005

Pressure ulcers: separating facts from fantasy Twenty-five years and still moving forward The Tissue Viability society looks forward to it's 25th anniversary	Isn't technology marvelous! You know how it is - a fast approaching deadline but a blank sheet of paper - and to avoid staring at the lack of words on the page you turn to the computer and explore! Sitting here in the UK summer listening to the rain and trying to develop this editorial I distracted myself by looking at Google - let's find out about pressure ulcer conferences in 2005. This in theory should have been an easy task highlighting half-a-dozen or so key meetings. However the search found 118,000 relevant pages. Now that is a lot of information! The flood gets bigger if you look for pages that just cover pressure ulcers now the search returns 718,000 web-sites with 627 images of wounds, assessment charts, and photographs of researchers and so on. We live and function in this information rich environment which is a long way removed from the early 1980's when I began my interest in pressure ulcers. Then we physically had to enter a library to find publications and word processing, digital slides and all the electronic tools we now use everyday were great rarities. Things have changed, and changed rapidly. However this is not going to turn into an editorial about the 'good old days' or the need to embrace new technology but I would like to simply pose a question. If you are a consumer of health care and entered 'pressure ulcer' into your search engine just which of the 718,000 pages are you going to use to identify a current or potential problem and how to overcome it? The internet is almost a level playing field and the latest evidence-linked guidelines from respected national or international bodies sit alongside personal opinions and a wide variety of commercial claims. How is the individual searching for information upon pressure ulcers to know which views are worth reading and which sites to ignore? Is there a role for our societies and associations to develop a hit-list of informative and reliable web-sites that convey useful and accurate pressure ulcer information? To prevent confusion a single list of useful web-sites would be required asking each association to work in partnership to mutually agree the included sites and the excluded. This would not be difficult to achieve and would probably be of great benefit to the public seeking to know more about pressure ulcers. If we all move forward together then we can help cut through the vast swathes of unhelpful information to clear a path to those beacons in the internet that offer constructive, evidence based guidance upon pressure ulcer prevention and treatment. Michael Clark Editor	Keeping up to date with pressure area care Recent publications upon support surfaces and pressure ulcers

Pressure ulcers: separating facts from fantasy. We are all aware of the vagueness that surrounds our interest in pressure ulcers - for all that we write and talk upon this topic we remain ignorant of one key piece of information - just how many people experience these wounds each year within the National Health Service. Our government may not agree with such a statement. Recently in an answer to questions upon pressure ulcers the government reported that in UK hospitals in 2001-02 15,292 people had pressure ulcers with this total rising in subsequent years to 17178 (2002-03) and to 18087 in 2003-04. The full text of the government's response to pressure ulcers is available on the Tissue Viability Society web-site www.tvs.org.uk. While this information is useful to have it fails to tell the whole story for these figures only include patients where pressure ulcers were recorded using the appropriate diagnosis code. How many people experience pressure ulcers but this is not recorded as a reason for an in-patient episode? The numbers provided by the government can be expanded (Clark 2004) with the number of in-patient days following admission to hospital due to pressure damage being 75328 (2002-03) representing 0.14% of all hospital bed days in that year. When all medical problems that prompted hospital admissions in 2002-03 were ranked by the number of bed days they consumed, then admissions to hospital due to pressure ulcers were the 140th most significant burden upon in-patient care. All of these figures obscure reality. We know there are many more patients affected by pressure ulcers than get included when diagnosis codes are gathered. It is time for the true picture of the scale of pressure damage to be identified - this would mean a standard classification scheme, standard methods of collecting (probably) prevalence data and a commitment to provide the resources to enable a representative survey of pressure ulcers to be developed. Who is going to provide these resources? The government who appear relaxed with the incomplete data they already have? Or will the resources flow from the increasingly squeezed budgets of the National Health Service? Or can this be undertaken as a collective - the associations and the wound care industry working together? One concern raises itself when looking at the government's view on the number of people affected by pressure ulcers; year on year it is rising regardless of the benchmarking, clinical guidelines and multiprofessional teamwork that the government set store by! Does this mean that preventive care is failing to reduce the burden of pressure ulcers? Or does it mark a sicker UK population receiving health care? Or are the increased numbers just an increased willingness to include pressure ulcers when providing diagnosis codes? Without data we will never know the answer to this question. Clark M. Pressure ulcers: Have we overlooked valuable data? International Wound Journal, 2004, 1(2): 143. Keep reading for: Twenty-five years and still moving forward. Keeping up to date with pressure area care Download this newsletter in PDF format Twenty-five years and still moving forward. Next year marks the 25th anniversary of the Tissue Viability Society; probably the longest established association in this field world-wide. To mark 25 years the Tissue Viability Society will host a major conference on pressure ulcers at the National Motorcycle Museum in Birmingham over the 26th and 27th of April 2006. The conference title 'Applying the Pressure - Raising the profile of tissue viability' brings the Tissue Viability Society almost full-circle for pressure ulcers formed a key interest of the members of the Society in its early days and perhaps its most successful conferences have considered pressure damage as a main theme? The conference programme will be publicized early in the autumn but already speakers have agreed to participate from the UK, mainland Europe and the United States. A call for oral presentations and posters is already in place with abstracts to be submitted to the Tissue Viability Society office tvs@dial.pipex.com by the 30th November 2005. Full details of the call for papers can be seen on the TVS web-site www.tvs.org.uk. Keep reading for: Keeping up to date with pressure area care Download this newsletter in PDF format Pressure Ulcer References This month's reference list looks at recent publications upon support surfaces and pressure ulcers. Already in 2005 25 new publications have considered the role of support surfaces but many of these are reviews or product reports - we remain lacking in primary data! Butcher M. Prevention and management of superficial pressure ulcers. British Journal of Community Nursing 2005;Suppl:S16. Edsberg L, Geyer MJ, Zulkowski K. The NPUAP Support Surface Initiative. Advances in Skin & Wound Care 2005;18(3):164-6. Maklebust J. Choosing the right support surface. Advances in Skin & Wound Care 2005;18(3):158-61. Brienza DM, Geyer MJ. Using support surfaces to manage tissue integrity. Advances in Skin & Wound Care 2005;18(3):151-7. Legood R, McInnes E. Pressure ulcers: guideline development and economic modelling. Journal of Advanced Nursing 2005;50(3):307-14. Hampton S. Importance of the appropriate selection and use of continence pads. British Journal of Nursing 2005;14(5):265-6. Bell J. The role of pressure-redistributing equipment in the prevention and management of pressure ulcers. Journal of Wound Care 2005;14(4):185-8. Hampton S. SimCair: a simple mattress system to support pressure ulcer prevention. British Journal of Nursing 2005;14(7):409-10. Clark M. Changing pressure-redistributing mattress stocks: costs and outcomes. British Journal of Nursing 2005;14(6):S30-2. Fries JM. Critical rehabilitation of the patient with spinal cord injury. Critical Care Nursing Quarterly 2005;28(2):179-87. Purvis K, Pearman A. How the use of electric profiling beds can reduce the prevalence of pressure ulcers. Professional Nurse 2005;20(8):46-8. Wedge C, Gosney M. Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery. Journal of Clinical Nursing 2005;14(4):473-8. Gunningberg L. Are patients with or at risk of pressure ulcers allocated appropriate prevention measures? International Journal of Nursing Practice 2005;11(2):58-67.   Download this newsletter in PDF format