Click here for the Wounds UK Home Page June 2005

Pressure ulcer classification New guidance issued by the European Pressure Ulcer Advisory Panel Counting pressure ulcers EPUAP offers practical assistance to resolve the controversy between prevalence and incidence measures.	Welcome to the second e-newsletter devoted to pressure ulcers! Since last month both the Tissue Viability Society and the European Pressure Ulcer Advisory Panel have held their annual conferences giving us much food for thought. This is particularly true when considering two new position statements issued by the EPUAP - one on pressure ulcer epidemiology and the second on classification issues. Highlights from both statements are discussed in this e-newsletter to keep you up to date with the 'leading edge' of thinking in pressure ulcers. The European Pressure Ulcer Advisory Panel is a lot more than a one-off annual conference! The organisation is arranged into a series of working groups which meet during the year and report to the annual conference. Currently there are active working groups on pressure ulcer epidemiology, classification, education, guidelines, nutrition and pressure ulcers with recent proposals for new working groups on shear forces and the challenges of performing clinical trials on pressure ulcers. All EPUAP members are free to join one or more working groups with the facilitators of each group identified on the EPUAP web-site www.epuap.org. Why not consider joining EPUAP and get involved with the working groups to help shape the future of pressure ulcer audit and research across Europe? One of the challenges when organisations prepare for major conferences such as EPUAP and the Tissue Viability Society is the quality of the abstracts submitted for oral or poster presentation. While many submit excellent abstracts giving full details of their study, its results and interpretation, others fail to do justice to what was undoubtedly a worthy piece of work. Preparation of a quality abstract is not difficult but all too often the aims of the study are unclear, the data is not presented and the conclusions extend far beyond what data is shown. Get in touch with Wounds UK or with myself if guidance on abstract preparation is something that would be of value either in this newsletter or in the new Wounds UK journal. As we move towards the summer and the world of pressure ulcers slows down for a few months remember that the European Wound Management association will be meeting in Stuttgart over September 15 to 17th 2005. This is another opportunity to bring pressure ulcers firmly to the fore when the wound care community meet. Future issues of this e-newsletter will bring all the pressure ulcer news from the EWMA event. Michael Clark Editor	Keeping up to date with pressure area care Recent publications on the epidemiology of pressure ulcers

New guidance on pressure ulcer classification has been issued by the European Pressure Ulcer Advisory Panel. The EPUAP issued new guidance upon a key aspect of pressure ulcer classification - the differentiation between superficial wounds caused by mechanical loading and those due to prolonged contact with moisture. These wounds often occur at similar anatomical locations but their prevention and management follow different paths. So if a superficial 'ulcer' was a result of contact with moisture then pressure-redistribution alone may not be sufficient to achieve healing. The EPUAP statement presented during the Open meeting held in Aberdeen in early May, and subsequently published in the EPUAP Review, helps clinicians tell the different between 'true' pressure ulcers and moisture lesions based on several characteristics - anatomical location, shape, colour and edges of the wound, its depth and the presence of necrotic tissue. The position statement also calls for clinicians to try to uncover the causes of the wound through exploration of its history and other patient related factors - for example if the 'pressure ulcer' first appeared as a large and deep lesion, it is unlikely that it is a moisture lesion. This new position statement helps clarify one of the issues related to pressure ulcer classification - where are superficial 'pressure ulcers' not due to pressure. However the relative proportions of grade 2 pressure ulcers that are in fact moisture lesions is not reported in the statement - perhaps future prevalence surveys will be able to provide this answer? The new position statement will be reflected later this year in an updated version of the highly successful software based pressure ulcer classification tool available from EPUAP and shown on their web-site www.epuap.org. The PUCLAS tool was distributed to all delegates at the Aberdeen meeting of the EPUAP and remains a valuable guide to the correct classification of pressure ulcers. Keep reading for: Counting pressure ulcers: EPUAP offers practical assistance to resolve the controversy between prevalence and incidence measures. Keeping up to date with pressure area care Download this newsletter in PDF format Counting pressure ulcers: EPUAP offers practical assistance to resolve the controversy between prevalence and incidence measures. Understanding pressure ulcer epidemiology has long been plagued with confusion regarding the correct use and interpretation of prevalence and incidence data. In a new position statement issued during the recent Open meeting of the European Pressure Ulcer Advisory Panel, practical guidance has been offered regarding the relative strengths and weaknesses of both prevalence and incidence measures. This statement flows from repeated questions to the EPUAP regarding how 'best' to count pressure ulcers. It was long expected that EPUAP would recommend incidence surveys be used, in preference to prevalence audits, if we were to better understand the occurrence and dynamics of pressure ulcers in health care. However the EPUAP recommend that each health care institution undertake a minimum of four prevalence surveys each year with these supplemented by 4 to 8 weeks of incidence data collection in those clinical areas where the prevalence survey highlights a high occurrence of pressure ulcers. Where incidence data is gathered this should be obtained at least daily in acute care. The short duration of incidence data collection was seen as the best way to avoid reductions in the quality and comprehensiveness of the data often observed during prolonged incidence recording. Practical steps are offered to help clinicians undertake both incidence and prevalence surveys and the EPUAP believe that this new position statement clarifies the respective roles of the two forms of data collection and identifies that to gain maximum information upon the scale of the problem of pressure ulcers both approaches are required. However for many the idea of at least four prevalence surveys each year supplemented with perhaps daily incidence recording when and where required may be daunting! Is this going to be realistic in your place of work, and at what cost? These issues highlight that counting pressure ulcer occurrence is never going to be a simple, easy to complete task. If we want to be clear about the scale of the problem, local 'hot-spots' where prevalence is high and trends in the occurrence of these wounds then investment of time as outlined in the new EPUAP position statement will be required. The position statement illustrates the use of a transparent disk to highlight whether an area of skin exhibits non-reactive erythema. This simple device may be of great value to clinicians involved with pressure ulcers and perhaps one or more commercial organizations might consider providing these aids instead of the ever popular pens and note-pads spirited away from exhibition stands during conferences? While the strategy proposed by the EPUAP may require investments in time and money the full implications and benefits of this new approach will become clearer as EPUAP aims to pilot the methods described in the new position statement. If you would like to be kept informed of the progress of this pilot - or would like to participate then contact Wounds UK or the editor of this newsletter, Michael Clark at clarkm@whru.co.uk. The full position statement is published in the EPUAP Review (2005; Volume 6, issue 2) and will be reproduced in the Journal of Tissue Viability this summer. Keep reading for: Keeping up to date with pressure area care Download this newsletter in PDF format Keeping up to date with pressure area care This month the reference section of this e-newsletter is devoted to recent publications upon the epidemiology of pressure ulcers. This complements the recent statement on pressure ulcer prevalence and incidence issued by the European Pressure Ulcer Advisory Panel. Get in touch if you would like to see specific pressure ulcer topics covered in this section of the e-newsletter. Arboix i Perejamo M, Torra i B, Rueda Lopez J, Soldevilla Agreda JJ, Martinez Cuervo F, Garcia Gonzalez F, et al. Results of the 1st National Study of Prevalence of PU in Spain [Spanish]. Gerokomos 2004;15(3):167-74. Baumgarten M, Margolis D, van Doorn C, Gruber-Baldini AL, Hebel JR, Zimmerman S, et al. Black/White differences in pressure ulcer incidence in nursing home residents. Journal of the American Geriatrics Society 2004;52(8):1293-8. Benbow M. Pressure ulcer incidence reporting. Nursing Standard 2004;18(32):57-60. Bours GJ, Halfens RJ, Candel MJ, Grol RT, Abu-Saad HH. A pressure ulcer audit and feedback project across multi-hospital settings in the Netherlands. International Journal for Quality in Health Care 2004;16(3):211-8. Chauhan VS, Goel S, Kumar P, Srivastava S, Shukla VK. The prevalence of pressure ulcers in hospitalised patients in a university hospital in India. Journal of Wound Care 2005;14(1):36-7. Cole L, Nesbitt C. A three year multiphase pressure ulcer prevalence/incidence study in a regional referral hospital. Ostomy Wound Management 2004;50(11):32-40. Dellefield ME. Prevalence rate of pressure ulcers in California nursing homes: using the OSCAR database to develop a risk-adjustment model. Journal of Gerontological Nursing 2004;30(11):13-21. Groeneveld A, Anderson M, Allen S, Bressmer S, Golberg M, Magee B, et al. The prevalence of pressure ulcers in a tertiary care pediatric and adult hospital. Journal of WOCN 2004;31(3):108-22. Hobbs BK. Reducing the incidence of pressure ulcers: implementation of a turn-team nursing program. Journal of Gerontological Nursing 2004;30(11):46-51. Lahmann NA, Halfens RJG, Dassen T. Prevalence of pressure ulcers in Germany. Journal of Clinical Nursing 2005;14(2):165-72. Langemo DK, Anderson J, Volden C. Uncovering pressure ulcer incidence. previously published in Nursing Management 2003;34(10):54-7. Holistic Nursing Practice 2004;18(1):42-4. Lucassen H. [Study of incidence of decubitus ulcer: skin care with effectiveness]. Pflege Zeitschrift 2004;57(4):232. McLane KM, Bookout K, McCord S, McCain J, Jefferson LS. The 2003 National Pediatric Pressure Ulcer and Skin Breakdown Prevalence Survey: a multisite study. Journal of WOCN 2004;31(4):168-78. Moore Z. Prevalence rates under pressure. World of Irish Nursing 2004;12(2):39-40. Nicastri E, Viale P, Lyder CH, Cristini F, Martini L, Preziosi G, et al. Incidence and risk factors associated with pressure ulcers among patients with HIV infection. Advances in Skin & Wound Care 2004;17(5 Pt 1):226-31. Richards JS, Waites K, Chen YY, Kogos S, Schmitt MM. The epidemiology of secondary conditions following spinal cord injury. Topics in Spinal Cord Injury Rehabilitation 2004;10(1):15-29. Stewart S, Box-Panksepp JS. Preventing hospital-acquired pressure ulcers: a point prevalence study. Ostomy Wound Management 2004;50(3):46-51. Strachan V, Balding C. Raising PUPPS: establishing the prevalence of pressure ulcers in the acute and subacute health sectors in Victoria -- a state-wide methodology model. Primary Intention 2004;12(1):14, 22 passim. Tannen A, Dassen T, Bours G, Halfens R. A comparison of pressure ulcer prevalence: concerted data collection in the Netherlands and Germany. International Journal of Nursing Studies 2004;41(6):607-12. Whittington KT, Briones R. National Prevalence and Incidence Study: 6-year sequential acute care data. Advances in Skin & Wound Care 2004;17(9):490-4. Wolverton CL, Hobbs LA, Beeson T, Benjamin M, Campbell K, Forbes C, et al. Nosocomial pressure ulcer rates in critical care: performance improvement project. Journal of Nursing Care Quality 2005;20(1):56-62. Woodbury MG, Houghton PE. Prevalence of pressure ulcers in Canadian healthcare settings. Ostomy Wound Management 2004;50(10):22-4, 28, 30, 32, 34, 36-8.   Download this newsletter in PDF format