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.
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.
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/
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.
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.
FOR IMMEDIATE RELEASE
September 18, 2015
Washington, DC – According to the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines; “Pressure Ulcers increase hospital costs significantly. In the US, pressure ulcer care is estimated to approach $11 billion (USD) annually, with a cost of between $500 (USD) and $70,000 (USD) per individual pressure ulcer.”1
The NPUAP defines a pressure ulcer as: “Localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear.”
“Pressure Ulcers are a frequently occurring health problem throughout the world. They are painful, costly, and an often preventable complication for which many individuals are at risk,” as stated in the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines.
The National Pressure Ulcer Advisory Panel (NPUAP) is proud to announce that World Wide Pressure Ulcer Prevention Day is to be celebrated in 2015 on November 19th. This date being the third Thursday in the month of November for 2015. Moving forward each year the third Thursday of November will be designated for this public awareness. The objective of World Wide Pressure Ulcer Prevention Day is to increase national awareness for pressure ulcer prevention and to educate the public on this topic. NPUAP has developed an extensive media materials package appropriate for all healthcare settings and organizations, to download this free material visit: http://www.npuap.org/resources/educational-and-clinical-resources/2015-world-wide-pressure-ulcer-prevention-day/
Seeking to make this year’s event large and visible to the public, the NPUAP welcomes the support of organizations and corporate partners who wish to affiliate with this significant activity.
On this date in November, in honor of World Wide Pressure Ulcer Prevention Day, the NPUAP is pleased to offer a free webinar, hosted by NPUAP Director Dr. Jeffrey Levine, titled “History of Pressure Ulcers & Wound Care: Past, Present and Future.” For more information about this webinar and to register visit: www.npuap.org
The National Pressure Advisory Panel (NPUAP) is an independent, not-for-profit professional organization dedicated to the prevention and management of pressure ulcers. Formed in 1987, the NPUAP Board of Directors is composed of leading experts from different health care disciplines—all of whom share a commitment to the prevention and management of pressure ulcers. The NPUAP serves as a resource to health care professionals, government, the public, and health care agencies; and welcomes and encourages the participation of those interested in pressure ulcer issues through utilization of NPUAP educational materials, participation at national conferences, and support of efforts in public policy, education and research.
Find more information on NPUAP’s goals and activities on our website at www.npuap.org or contact us at npuap@npuap.org.
NPUAP Immediate Past President Margaret Goldberg (far left) and current President Mary Sieggreen (far right) pose with Drs. Diane Langemo, Janet Cuddigan and Joyce Black, recipients of the Kosiak Award, President’s Recognition Award and Thomas Stewart Founder’s Award during the 2015 NPUAP Biennial Conference in Orlando, FL.
2015 Kosiak Award Winner:
Diane Langemo, PhD, RN FAAN
University of North Dakota
2015 Thomas Stewart Founder’s Award Winner:
Joyce Black, PhD, RN, CWCN, FAAN
University of Nebraska Medical Center
President’s Recognition Award Winner:
Janet Cuddigan, PhD, RN, CWCN, FAAN
University of Nebraska Medical Center
For descriptions of these awards and the list of past award winners please visit our Awards page.
New Investigator Award: #41 Prevention and Staging of Pressure Ulcers: Clinical Nurses’ Knowledge in the Community Hospital Setting
Authors: Cindy Barefield, BSN, RN-BC, CWOCN, Kathy Arthurs MSN, RN-BC, RNC-OB, Lenora Chao PT, DPT, CWS
Contribution to the Field Award: #33 Pressure Mapping of Hospital Recliners and Select Seating Surfaces in Healthy Adults
Authors: Stephanie Slayton, PT, DPT, CWS, Paula Morris, PT, DPT, Jason Brinkley, PhD
First Time Presenter: #39 The Efficacy of Goodmark Medical’s Solution Using the BAM Labs® Smart Bed Technology™ in the prevention of Pressure Ulcers
Authors: Jeff A. Beaty, D.H.Ed., Timothy Sauer, Ph.D.
Cindy Barefield (left) accepts the New Investigator Award from NPUAP Director Michelle Deppisch (right).
Stephanie Slayton (left) accepts the Contribution to the Field Award from NPUAP Director Michelle Deppisch (right).
Jen Alford (left) accepts the First Time Presenter Award on behalf of her colleagues from NPUAP Director Michelle Deppisch (right).
The National Pressure Ulcer Advisory Panel (NPUAP) has updated their previously published Research Priorities for Pressure Ulcer Prevention, Treatment & Policy. The Research Committee compiled this list to help guide researchers and stakeholders in the advancement of science for the prevention and treatment of pressure ulcers and to guide policy development. To review the priorities please see below:
Etiology
Effects of compressive and shear stress and deformation on soft tissue injury associated with DTI and pressure ulcers
Generation of fundamental knowledge on the etiology of pressure ulcer formation and deep tissue injury; precise mechanisms by which damage occurs
Mechanical properties and thresholds of adipose tissue
Role of microclimate in the etiology of pressure ulcers and the characteristics of an optimal microclimate
Role of occlusion of lymphatic vessels in pressure ulcer development
Risk Assessment & Early Detection
Biophysical and biochemical markers as targets for pressure ulcer screening
Development of risk assessment tools that incorporate new research on factors associated with pressure ulcer risk
Investigation of being at risk for pressure ulcers among individual groups; co-morbidities, age (neonate, children, adults, older adults), disparities, genetic influences and other risk factors related to the incidence and prevalence of pressure ulcers and DTI across settings (acute, OR, community acquired); including SCI, bariatrics and End of Life
Potentially unavoidable nature of some pressure ulcers
Prevention
Effectiveness of support surface bottoming out detection methods
Effectiveness of matching heel elevation strategies for pressure ulcer prevention with specific individual’s characteristics (duration and level of immobility, frequency and force of leg movement)
Effectiveness of repositioning regimens for pressure ulcer prevention, in combination with support surfaces in bed; consideration of seated population, outcomes related to use of seat cushions and repositioning regimes
Effects of microenvironment (sanitation, microclimate, microbiology) on incidence and prevalence of pressure ulcers and DTI
Effects of nutritional interventions in the prevention of pressure ulcers and DTI; role of energy, protein, multivitamin and arginine supplementation
Evaluate use of natural sheepskin for pressure ulcer prevention
Frequency of occurrence, risk factors and prevention of pressure ulcers during surgery; incidence as outcome
Frequency of occurrence, risk factors and prevention of pressure ulcers in the Emergency Department (ED); linked to incidence as outcome
Patient literacy and teaching about prevention or treatment
Prevalence and incidence of pressure ulcers and DTI associated with the use of medical devices
Selection of support surfaces for prevention of pressure ulcers based on assessment of patient clinical characteristics and support surface characteristics; in particular populations such as pediatrics, bariatrics, SCI
Use of prophylactic dressings for pressure ulcer prevention
Treatment
Assessment and management of pharmacological and non-pharmacological strategies associated with pressure ulcer pain Time to healing in pressure ulcers (is there a time frame such as exists with diabetic foot ulcers and venous ulcers? i.e. 50% closure in 4 weeks?)
Disparities, co-morbidities, age, genetics and risk factors related to pressure ulcer treatment outcomes
Effectiveness of phototherapy and laser therapy for pressure ulcer treatment with identification of appropriate target population
Effects of nutritional interventions on treatment outcomes of pressure ulcers
Effects of wound dressings on outcome of pressure ulcers
Outcomes effectiveness of support surfaces (features, components & categories) for treatment and healing of partial and full-thickness pressure ulcers
Potential for hyperbaric oxygen therapy for treatment of pressure ulcers
Role of bioburden and biofilms in the treatment and healing of pressure ulcers; best practice for preventing, diagnosing and eradicating biofilm; impact of antibiotic resistant bacteria on healing of pressure ulcers
Role of electrical stimulation of the muscles of individuals with SCI in treatment of pressure ulcers
Role of traditional treatments and medicines as interventions in pressure ulcer treatment
Selection of support surfaces for treatment of pressure ulcers based on assessment of patient clinical characteristics and support surface characteristics; in particular populations such as pediatrics, bariatrics, SCI
Surgical solutions for treatment of pressure ulcers
Policy
Caregivers (physicians, nurses, family etc.) knowledge and interest in pressure ulcer prevention and treatment
Effective implementation of prevention and treatment guidelines
Impact of government regulations on pressure ulcer prevention and treatment; outcomes and cost-effectiveness
Implementation of and outcomes related to the standardization of terminology, tools, and outcomes, ie health care quality metrics
Nurse and physician communication linked to quality measures, patient teaching/literacy as well as disparity/racial groups
Pressure ulcer recurrence rates, consistency in what to call ulcers that recur at the same location/site, how to stage, when is it a new ulcer? When is it just remodeling gone astray?
Research into methods of cost/benefit calculations to be applied to compare efficacy of preventative and treatment models
Skills to design case/outcome studies as a decision aid for further research
Skills to design research studies with adequate power and controls to generate data that can be rigorously interpreted
Standardization of patient records and documentation to support research
NPUAP is pleased to announce that registration is now open for the National Pressure Ulcer Advisory Panel’s (NPUAP) 14th Biennial Conference, New International Pressure Ulcer Guideline: Evidence & Implementation!
For more information about the conference and to register please visit: http://www.npuap.org/events/npuap-2015-national-biennial-conference/
FOR IMMEDIATE RELEASE
October 16, 2014
Washington, DC – According to the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines; “Pressure Ulcers increase hospital costs significantly. In the US, pressure ulcer care is estimated to approach $11 billion (USD) annually, with a cost of between $500 (USD) and $70,000 (USD) per individual pressure ulcer.”1
The NPUAP defines a pressure ulcer as: “Localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear.”
“Pressure Ulcers are a frequently occurring health problem throughout the world. They are painful, costly, and an often preventable complication for which many individuals are at risk,” as stated in the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline.
The National Pressure Ulcer Advisory Panel (NPUAP) is proud to announce that World Wide Pressure Ulcer Prevention Day is to be celebrated on November 20, 2014. The objective of World Wide Pressure Ulcer Prevention Day is to increase national awareness for pressure ulcer prevention and to educate the public on this topic. NPUAP has developed an extensive media materials package appropriate for all healthcare settings and organizations. To download this free material visit: http://www.npuap.org/resources/educational-and-clinical-resources/2014-world-wide-pressure-ulcer-prevention-day/
Seeking to make this year’s event large and visible to the public, the NPUAP welcomes the support of organizations and corporate partners who wish to affiliate with this significant activity.
On November 20 at 2:00 PM Eastern, in honor of World Wide Pressure Ulcer Prevention Day, the NPUAP is pleased to offer a FREE webinar, hosted by Dr. Nancy Bergstrom, titled “Repositioning as a Pressure Ulcer Prevention Strategy: A Multi-site Clinical Trial.” Dr. Bergstrom will introduce findings from the TURN Study conducted at UT Health School of Nursing, where researchers looked at optimal frequency of patient repositioning for pressure ulcer prevention. Stay tuned at www.npuap.org for more information on how to register.
The National Pressure Ulcer Advisory Panel (NPUAP) announces the release of the 2014 Guideline on Prevention and Treatment for Pressure Ulcers: Clinical Practice Guideline.
The NPUAP is pleased to join our international colleagues on the European Pressure Ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA) in releasing the second edition of this prolific research work.
The Guideline was developed using a rigorous scientific methodology to appraise available research and make 575 evidence-based recommendations. In this second edition, a consensus voting process (GRADE) was used to assign strengths of recommendation that indicate the extent to which one can be confident that adherence to a recommendation will do more good than harm, intended to assist the health professional to prioritize interventions. We are pleased to make this guideline available (to clinicians, researchers, consumers and policy makers) through our website. http://www.npuap.org/resources/educational-and-clinical-resources/prevention-and-treatment-of-pressure-ulcers-clinical-practice-guideline/
This second edition of The Guideline combines prevention and treatment recommendations in one expanded guideline. This edition includes newly added sections on emerging fields of interest including:
The Guideline includes updated recommendations and/or research summaries for the following pressure ulcer topics:
The Guideline also includes the NPUAP/EPUAP International Pressure Ulcer Classification system, complete with full Category/Stage descriptions and illustrative photography.
The NPUAP invites you to the 2015 Biennial Conference: February 21-22 at the Buena Vista Palace in Orlando, FL for a more comprehensive understanding of the science and implementation of this 2014 Guideline on Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline.