Click here for the Wounds UK Home Page October 2005

New NICE guideline on pressure ulcer management has been published New version of pressure ulcer classification software is coming soon.	Thinking of Christmas! As we enter October there is a tendency to look forward to Christmas now amazingly only a few short months away; one might well be tempted to ask what happened to 2005? It seems like only yesterday that we were waking on the 1st of January with what seemed a long way to go before we had to think of the Christmas season again. So as we move rapidly towards Christmas what would be on our collective pressure ulcer Christmas gift list for this year? I what would be on mine. If I could have two pressure ulcer related gifts this year the first would be 'strong public, professional and political awareness of pressure ulcers'. While we have relatively strong professional awareness of pressure ulcers for example the brand-new NICE guideline (more on this in this month's news pages) how many members of the public and our politicians would understand what a pressure ulcer was? A couple of years ago EPUAP sent a letter outlining the scale of the problem of pressure ulcers in UK hospitals to all Westminster MP's; of the 600 plus who received this letter only 5 replied (and these simply noted that the letter had been received). If we repeated this exercise but had mentioned clean hospitals and 'superbugs' rather than pressure ulcers then there might have been a different reaction. How do we place pressure ulcers on the public and professional agenda? This will require concerted long-term pressing of the issue on the public in short an effective Public Relations campaign taking time and money to execute. The good news is that such initiatives are being thought of and may become realities in 2006 and beyond. Watch this newsletter for news of attempts to place pressure ulcers at the front of the public's mind. My second Christmas pressure ulcer gift is perhaps more controversial for it would be the creation of a single organisation dedicated to wound care and tissue viability in the UK. While we are divided into several smaller societies and associations we will never have the authority and strong voice needed so that healthcare professionals and others will listen to us. The regular gathering of the chairs of various wound care and tissue viability charities is a welcome start with the next meeting of this forum likely to occur during the Wounds UK conference to be held in Harrogate in November. Coming together into one organisation may be the ideal (at least for me) but won't be achieved overnight. Let's us all look forward to the organisations we belong to working together on mutually beneficial projects aimed at raising the profile of wound care and tissue viability in the UK. If we could meet all or part of these two Christmas wishes in 2006 then I for certain will have a merry festive season! Michael Clark Editor	Keeping up to date with pressure area care Latest references

New NICE guideline on pressure ulcer management has been published On the 28th of September 2005 the National Institute for Health and Clinical Excellence (NICE) released a new clinical practice guideline covering the management of pressure ulcers in primary and secondary care. This marks the third NICE guideline on pressure ulcers and to prevent confusion the new guideline incorporates the recommendations from the initial pressure ulcer prevention guideline which has now been withdrawn. Full copies of the guideline and supporting documentation can be found at http://www.nice.org.uk/page.aspx?o=273175. There are ten documents to inspect - summary guideline recommendations, information to the public, cost analysis and the almost 500 page full guideline document offered in two PDF files of 245 and 219 pages respectively! One of the major recommendations from the new guideline is that all pressure ulcers of a grade 2 or higher severity are to be reported as clinical incidents. The grading of pressure ulcers to be undertaken using the classification developed by the European Pressure Ulcer Advisory Panel. Part of the documentation issued to support the guideline explores the likely cost implications of treating all grade 2 pressure ulcers as clinical incidents. From data collected by the EPUAP it was estimated that each year there might be 94,320 patients with grade 2 pressure ulcers in UK hospitals and that the reporting of these wounds as clinical incidents would consume 1 hour per wound a total of 94320 hours or 0.36 whole-time equivalent staff per trust. In non-acute care the additional work-load imposed by reporting all grade 2 pressure ulcers as clinical incidents was calculated to require 10 extra whole-time equivalent staff each year nationally. The need for additional work equal to 73 whole-time equivalents was considered to be 'likely to be absorbed into the daily routines of current staff, rather than result in more nurses being employed. Consequently it is not felt to have a significant national cost impact'. Do you agree with this - why not let this newsletter know your views upon the content of this new NICE guideline? To help the implementation of the guideline NICE have prepared a presentation aimed at health professionals to underpin the key recommendations in the guideline. This 35 slide set is available to download from the web-site where the guideline can be found. Covering everything from pressure ulcer classification, skin assessment, patient nutrition and support surface use this is useful aid to highlight the recommendations of this new guideline. Keep reading for: New version of pressure ulcer classification software is coming soon. Latest pressure ulcer references Download this newsletter in PDF format New version of pressure ulcer classification software is coming soon. Some time ago the European Pressure Ulcer Advisory Panel (EPUAP) launched a software package designed to help us classify pressure ulcers reliably and accurately. This package known as PUCLAS (http://www.epuap.org/puclas/) was developed by Tom Defloor in Belgium with contributions from over 50 people involved in pressure ulcer research around Europe. The package tests your knowledge of pressure ulcer classification by showing you a selection of 20 pressure ulcer images and asking you to grade these using eight descriptions ranging from normal skin to 'other lesion' (wound not a pressure ulcer). After each question you receive feedback upon the correct answer to each question. The software package also contains a theory section looking at pressure ulcer classification, reverse staging and the difficulties of observing erythema. Given that following the EPUAP pressure ulcer classification system is now part of NICE's guidance upon pressure ulcers then this software package can only help all of us in the UK to more accurately grade pressure ulcers. Later this year an updated PUCLAS tool will be launched and this newsletter will let you know how to gain access to a copy of the enhanced pressure ulcer classification tool in a future issue. Keep reading for: Latest pressure ulcer references Download this newsletter in PDF format Latest pressure ulcer references This month the newsletter features new publications on pressure ulcers drawn from the data-base listing publications to be added to MEDLINE along with newly identified papers from non-indexed journals. Bergstrom N, Horn SD, Smout RJ, Bender SA, Ferguson ML, Taler G, et al. The national pressure ulcer long-term care study: outcomes of pressure ulcer treatments in long-term care. Journal of the American Geriatrics Society 2005;53(10):1721-9. Chan EY, Tan SL, Lee CK, Lee JY. Prevalence, incidence and predictors of pressure ulcers in a tertiary hospital in Singapore. Journal of Wound Care 2005;14(8):383-4. Amione P, Ricci E, Topo F, Izzo L, Pirovano R, Rega V, et al. Comparison of Allevyn Adhesive and Biatain Adhesive in the management of pressure ulcers. Journal of Wound Care 2005;14(8):365-70. Bliss MR. Pressure ulcer care needs medical input. Journal of Wound Care 2005;14(8):354-5. Graves N, Birrell FA, Whitby M. Modeling the economic losses from pressure ulcers among hospitalized patients in Australia. Wound Repair & Regeneration 2005;13(5):462-7. Nixon J, Cranny G, Bond S. Pathology, diagnosis, and classification of pressure ulcers: comparing clinical and imaging techniques. Wound Repair & Regeneration 2005;13(4):365-72. Moore Z. Pressure ulcer grading. Nursing Standard 2005;19(52):56-64; quiz 66. Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Research Reviews 2005;4(3):422-50. Bergquist S. The quality of pressure ulcer prediction and prevention in home health care. Applied Nursing Research 2005;18(3):148-54. Hampton S, Collins F. Reducing pressure ulcer incidence in a long-term setting. British Journal of Nursing 2005;14(15):S6-12. Bergstrom N. Litigation or redesign: improving pressure ulcer prevention. Journal of the American Geriatrics Society 2005;53(9):1627-9. Voss AC, Bender SA, Ferguson ML, Sauer AC, Bennett RG, Hahn PW. Long-term care liability for pressure ulcers. Journal of the American Geriatrics Society 2005;53(9):1587-92. van Rijswijk L, Lyder CH. Pressure ulcer prevention and care: implementing the revised guidance to surveyors for long-term care facilities. Ostomy Wound Management 2005;Suppl:7-19. Lyder C, van Rijswijk L. Pressure ulcer prevention and care: preventing and managing pressure ulcers in long-term care: an overview of the revised federal regulation. Ostomy Wound Management 2005;Suppl:2-6. Santos VL, Azevedo MA, Silva TS, Carvalho VM, Carvalho VF. [Crosscultural adaptation of the pressure ulcer scale for healing to the portuguese language.]. Revista Latino-Americana de Enfermagem 2005;13(3):305-13. Ashfield T. The use of topical opioids to relieve pressure ulcer pain. Nursing Standard 2005;19(45):90-2. Acaroglu R, Sendir M. Pressure ulcer prevention and management strategies in Turkey. Journal of Wound, Ostomy, & Continence Nursing 2005;32(4):230-7. Kuwahara M, Tada H, Mashiba K, Yurugi S, Iioka H, Niitsuma K, et al. Mortality and recurrence rate after pressure ulcer operation for elderly long-term bedridden patients. Annals of Plastic Surgery 2005;54(6):629-32. Benati G, Delvecchio S, Cilla D, Pedone V. Impact on pressure ulcer healing of an arginine-enriched nutritional solution in patients with severe cognitive impairment. Archives of Gerontology & Geriatrics - Supplement 2001;7:43-7. Thomas DR, Osterweil D. Is a pressure ulcer a marker for quality of care? Journal of the American Medical Directors Association 2005;6(3):228-30. Abel RL, Warren K, Bean G, Gabbard B, Lyder CH, Bing M, et al. Quality improvement in nursing homes in Texas: results from a pressure ulcer prevention project. Journal of the American Medical Directors Association 2005;6(3):181-8. Hickey EC, Young GJ, Parker VA, Czarnowski EJ, Saliba D, Berlowitz DR. The effects of changes in nursing home staffing on pressure ulcer rates. Journal of the American Medical Directors Association 2005;6(1):50-3. Thomas DR, Diebold MR, Eggemeyer LM. A controlled, randomized, comparative study of a radiant heat bandage on the healing of stage 3-4 pressure ulcers: A pilot study. Journal of the American Medical Directors Association 2005;6(1):46-9. Graves N, Birrell F, Whitby M. Effect of pressure ulcers on length of hospital stay. Infection Control & Hospital Epidemiology 2005;26(3):293-7.   Download this newsletter in PDF format