News

The NPUAP serves as a resource to health care professionals, government, the public, and health care agencies.  The three mission committees of the NPUAP (Public Policy, Education, and Research) are active in a variety of endeavors including webinars, creation of a reference database, and a number of public policy initiatives.

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Attorneys Agree: NPUAP’s New Staging System Does Not “Wound” Providers

Washington, D.C. [January 26, 2017] – In a recent article in The National Law Review by Michael Denning and Jessica Klaus of Heyl, Royster, Voelker & Allen, P.C., the National Pressure Ulcer Advisory Panel’s (NPUAP) new 2016 Pressure Injury Staging System is celebrated as “a much needed clarification for medical professionals.”

The authors explain, “It is important that providers of pressure injury treatment take note of these recent changes and incorporate the new terminology and staging system into their diagnoses and treatment moving forward.” As Denning and Klaus note, the new staging system has been updated to provide health care providers and professionals with a “clarifying staging system to better address the different types of skin wounds commonly seen by medical professionals.”

Created by leading scientific experts on pressure injuries, the new 2016 Pressure Injury Staging System will lead to more accurate and earlier diagnosis of pressure injuries, allow for more appropriate patient care, and decrease patient suffering. Widespread adoption of the new staging system will benefit medical and legal professionals alike, and the individuals they serve.

The decision to research and produce a new staging system was motivated by NPUAP’s deeply held belief that medical organizations must remain vigilant with analyzing and incorporating the latest in science into their systems. NPUAP’s Biennial Conference, which takes place in New Orleans, Louisiana, March 10-11, 2017, will provide a forum for scientific discussion on the latest advancements in pressure injury treatment and diagnosis. The two-track conference will focus on skin changes at end of life, case study presentations, implementation of the 2016 Staging System and quality measures.

For more information on the conference and the new staging system, visit www.npuap.org.

National Pressure Ulcer Advisory Panel Meets with CMS to Discuss Identification and Treatment of Pressure Injuries

PRESS CONTACT: Arafel Buzan, abuzan@douglasgould.com, 646-214-0514, ext. 219

Successful meeting brings together NPUAP’s pressure injury experts, CMS representatives

Washington, D.C. [January 17, 2017] – Last week, The National Pressure Ulcer Advisory Panel (NPUAP), which serves as the leading scientific voice for improved patient outcomes in pressure injury prevention and treatment, met with the Centers for Medicare & Medicaid Services (CMS) to discuss their new 2016 Pressure Injury Staging System, initially launched in April 2016.

The collaborative discussion between CMS and NPUAP included the NPUAP’s 2016 Staging System, clarifying each stage based on recent research and expert clinical consensus, improving the accuracy of pressure injury staging, and further clarification of deep tissue pressure injuries. The NPUAP believes that the new system will allow health care providers to identify and treat pressure injuries earlier and more accurately.

The 2016 Pressure Injury Staging System is the combined result of extensive scientific research and collaboration with national and international providers. “For over three decades NPUAP has worked diligently to be able to bring the very best recommendations based on the most current science to bedside care,” shared Mary Sieggreen, President, NPUAP.

As a nonprofit organization with a primary focus on pressure injuries, NPUAP was careful that patient care was central to every step of the new staging system’s development. “Patient care starts with prevention and diagnosis,” shared Dr. Laura Edsberg, Treasurer, NPUAP, “health care providers rely on staging systems to diligently incorporate new scientific research so providers can give their patients the most effective care.”

NPUAP and CMS will continue to collaborate and share scientific expertise. In just a few weeks, a CMS representative will be speaking at NPUAP’s Biennial Conference, which takes place in New Orleans, Louisiana, March 10-11, 2017. The two-track conference will focus on skin changes at end of life, case study presentations, implementation of the 2016 Staging System and quality measures.

About NPUAP

The National Pressure Ulcer Advisory Panel (NPUAP) is the nation’s leading scientific expert on pressure injury prevention and treatment. Our goal is to ensure improved patient health and to advance public policy, education, and research.

JAN 2 DEADLINE TO SUBMIT YOUR ABSTRACT – NPUAP Biennial Conference!

The National Pressure Ulcer Advisory Panel (NPUAP) invites you to submit an abstract for a poster presentation at our 2017 Biennial Conference, Pressure Injury: Advancing the Vision, scheduled for March 10-11, 2017 in New Orleans, LA.

The deadline to submit abstracts is Monday, January 2, 2017. Applicants will be notified of the status of their abstract’s acceptance by January 17, 2017.

Please click on the following link to learn more and to submit your abstract: https://www.surveymonkey.com/r/2017BiennialAbstracts

Please save the date:
NPUAP’s 2017 Biennial Conference
Pressure Injury: Advancing the Vision
Friday-Saturday, March 10-11, 2017
New Orleans, LA

To find out more about the Biennial Conference, please visit our website: http://www.npuap.org/events/2017-npuap-biennial-conference/

State Proclamations for Pressure Injury Awareness Day!

The NPUAP has been reaching out to each state requesting they declare the 3rd Thursday of every November as Pressure Injury Awareness Day. To date the following states have issued proclamations: Arizona, Delaware, Illinois, Indiana, Georgia, Michigan, Minnesota, Nevada, New Jersey, North Carolina, Utah, Virginia, Washington, DC and Wisconsin.

The various state proclamations can be found below:

 

 

Governmental Agencies and Professional Organizations Support NPUAP’s Pressure Injury Staging System

FOR IMMEDIATE RELEASE
August 30, 2016

Governmental Agencies and Professional Organizations Support NPUAP’s Pressure Injury Staging System

Washington, DC – The NPUAP revised the Pressure Injury Staging System following a consensus conference in April. The response to the changes has been positive. To date, The Joint Commission (TJC) has adopted the new terminology and CMS has been in discussions with the NPUAP to incorporate the new terminology. The rollout of the changes will be controlled by these agencies. The National Database of Nursing Quality Indicators (NDNQI) is also changing their materials to use the new terminology with changes to be in place by 2017. Changes to Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and Logical Observation Identifiers Names and Codes (LOINC) are being explored. NPUAP is also working to introduce the changes into the ICD-11 payment codes.

In addition, the Wound Ostomy Continence Nurses (WOCN) Society, the Canadian Association of Enterostomal Therapists (CAET), the Pan Pacific Pressure Injury Alliance (PPPIA) of Australia, the Hong Kong Enterostomal Nurses Association, the New Zealand Wound Care Society, the Wound Healing Society of Singapore, and the Academy of Nutrition and Dietetics have publicly endorsed the changes.

NPUAP recognizes that making changes in literature and electronic medical records is time consuming and costly. Because the changes to the 6 stages of pressure injury were changes only to title and wording – what was a stage II is still a stage 2 and the treatment has not changed – the changes within local facilities need not be made in a hurried manner. The pressure injury terminology changes can be made when routine updates of the policies, procedures and EMR documentation are done within institutions and organizations..

The National Pressure Ulcer Advisory Panel is a multidisciplinary group of experts in pressure injury. The NPUAP serves as the authoritative voice for improved patient outcomes in pressure injury prevention and treatment through public policy, education and research. Contact NPUAP at npuap@npuap.org.

Clinician Scholarship Available to Attend the NPUAP S3I Meetings: Deadline Oct 1

The NPUAP Support Surface Standards Initiative (S3I) is pleased to offer a Clinical Scholarship to attend the S3I research meeting and provide a clinical perspective.

Please CLICK HERE for the Clinical Scholarship application. For more information about the Support Surface Standards Initiative and the NPUAP please visit: http://www.npuap.org/resources/support-surface-standards/support-surfaces-standards-initiative/.

The scholarship submission deadline is October 1, 2016.

WOCN Society and Academy of Nutrition and Dietetics Support New Staging System and Terminology

Please click HERE to view a letter of support regarding the new NPUAP staging system and terminology from WOCN Society’s President, Carolyn Watts, MSN, RN, CWOCN.

Please click HERE to view a letter of support of the new NPUAP staging system and terminology from the Academy of Nutrition and Dietetics’ President, Lucille Beseler, MS, RDN, LDN, CDE, FAND.

New Pressure Injury Staging Illustrations Now Available

The NPUAP is pleased to announce that the new pressure injury staging illustrations are now available!

Please visit the following website to download the images: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations/

National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury

FOR IMMEDIATE RELEASE
April 13, 2016

Washington, DC – The term “pressure injury” replaces “pressure ulcer” in the National Pressure Ulcer Advisory Panel Pressure Injury Staging Systemaccording to the NPUAP. The change in terminology more accurately describes pressure injuries to both intact and ulcerated skin. In the previous staging system Stage 1 and Deep Tissue Injury described injured intact skin, while the other stages described open ulcers. This led to confusion because the definitions for each of the stages referred to the injuries as “pressure ulcers”.

In addition to the change in terminology, Arabic numbers are now used in the names of the stages instead of Roman numerals.  The term “suspected” has been removed from the Deep Tissue Injury diagnostic label. Additional pressure injury definitions agreed upon at the meeting included Medical Device Related Pressure Injury and Mucosal Membrane Pressure Injury.

The updated staging definitions were presented at a meeting of over 400 professionals held in Chicago on April 8-9, 2016.   Using a consensus format, Dr. Mikel Gray from the University of Virginia adeptly guided the Staging Task Force and meeting participants to consensus on the updated definitions through an interactive discussion and voting process.  During the meeting, the participants also validated the new terminology using photographs.

Dr. Laura Edsberg from Daemen College in Buffalo, NY and Dr. Joyce Black from the University of Nebraska Medical Center in Omaha served as co-chairs of the Staging Task Force appointed by the NPUAP Board of Directors. Task force members included Margaret Goldberg, MSN, RN, CWOCN from Delray Wound Center, Florida, Laurie McNichol, MSN, RN, CWOCN, CWON-AP, from Cone Health in Greensboro, NC, Lynn Moore, RDN, from Nutrition Systems, Mississippi and Mary Sieggreen, MSN, CNS, NP, CVN, from Detroit Medical Center.

Pressure injuries are staged to indicate the extent of tissue damage. The stages were revised based on questions received by NPUAP from clinicians attempting to diagnose and identify the stage of pressure injuries.  Schematic artwork for each of the stages of pressure injury was also revised and will be available for use at no cost through the NPUAP website in approximately 12-24 hours (http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations/).

The updated staging system includes the following definitions:

Pressure Injury:
A pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.

Stage 1 Pressure Injury: Non-blanchable erythema of intact skin
Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.

Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis
Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel.  This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).

Stage 3 Pressure Injury: Full-thickness skin loss
Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds.  Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Stage 4 Pressure Injury: Full-thickness skin and tissue loss
Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss
Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.  If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e. dry, adherent, intact without erythema or fluctuance) on the heel or ischemic limb should not be softened or removed.

Deep Tissue Pressure Injury: Persistent non-blanchable deep red, maroon or purple discoloration
Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin.  This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface.  The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Stage 3 or Stage 4). Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic conditions.

Additional pressure injury definitions.

Medical Device Related Pressure Injury:
This describes an etiology.
Medical device related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure injury generally conforms to the pattern or shape of the device. The injury should be staged using the staging system.

Mucosal Membrane Pressure Injury:  Mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury. Due to the anatomy of the tissue these injuries cannot be staged.

More information will be forthcoming on teaching points for the new stages and the rationale for some of the changes in the staging system.

The National Pressure Ulcer Advisory Panel is a multidisciplinary group of experts in pressure injury. The NPUAP serves as the authoritative voice for improved patient outcomes in pressure injury prevention and treatment through public policy, education and research.  Contact NPUAP at npuap@npuap.org.

Congratulations to the NPUAP Research Mini-Grant Awardees!

NPUAP congratulates the awardees of the two 2015 Research Mini Grants:

Professor Lisa Kellogg-Tucker, Duke-NUS Graduate Medical School Singapore
Effect of Bacteria and Oxidative Stress on Pressure Ulcers

Yi-Ting Tzen, PhD, University of Illinois at Chicago
Perfusion Biomarkers for Ulcer Risk Assessment in SCI

The NPUAP Research Committee congratulates the Mini Grant recipients of 2015-16 and recognize the clinical significance of these research studies in providing quality care to individuals for the prevention and treatment of pressure ulcers.