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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Pressure Ulcer Incidence Density as a Quality Measure

Incidence density is the best quality measure of pressure ulcer prevention programs, according to the National Pressure Ulcer Advisory Panel (NPUAP).  Pressure ulcer incidence density is a computation based on the number of in-patients who develop a new pressure ulcer(s) divided by 1000 patient days.  Using the larger denominator of patient days allows  fair comparisons between institutions of all sizes. Incidence is a commonly reported measure; however it is computed by counting the number of patients with newly acquired pressure ulcers and dividing that number  by the number of patients examined for pressure ulcers over a given period of time. Smaller facilities can appear to have a higher percentage of patients with ulcers because there are fewer patients in the denominator.  For example, 5 patients with ulcers out of  100 patients assessed equals a 5% incidence.  The same number of patients with ulcers (5) among 500 patients assessed is only 1%.  Using patient days as the denominator stabilizes the result. Many state reporting systems and hospital acquired conditions (e.g., CAUTI) currently use incidence density.

The facility or hospital  acquired pressure ulcer (FAPU or HAPU) rate counts a “new case of pressure ulcers” when an ulcer is identified and there is no documentation of the ulcer in the medical record at the time of admission.  NPUAP supports the use of this measure as a proxy measure of incidence for use within an agency, but recognizes the potential for errors in reporting due to reliance on the medical record. FAPU/HAPU rates can also be artificially inflated when individuals  with ulcers are counted more than once in sequential measurement.  For example, a  person with a pressure ulcer is counted each month as a new case. And finally, FAPU/HAPU rates do not account for the size of the facility.

Prevalence may sometimes be used as another measure of quality. Prevalence describes the number of  patients with pressure ulcers at a specific  time and includes both cases of pressure ulcers that began in the facility as well as  cases of pressure ulcers that existed before admission. Prevalence is best used to examine the burden of pressure ulcers for a facility when providing wound care staff and supplies. NPUAP does not support the use of prevalence as a quality measure because it includes cases of pressure ulcers that did not develop in the facility, therefore inflating the number.

The National Pressure Ulcer Advisory Panel (NPUAP) has released the 254-page, 24 chapter  monograph, entitled Pressure Ulcers: Prevalence, Incidence and Implications for the Future.  It was authored by 27 experts from the NPUAP and invited specialists and edited by NPUAP Alum Barbara Pieper, PhD, RN, CWOCN, ACNS-BC, FAAN. This “must-have” reference book examines pressure ulcer prevalence and incidence and hospital acquired rates among all clinical settings and populations as well as the state of pressure ulcers in America over the last decade. Among the topics covered in the monograph are the effects of local and national efforts aimed at the reduction of pressure ulcer incidence and prevalence. This second edition includes new chapters on suspected deep tissue injury, intraoperatively acquired pressure ulcers and new evidence specific to medical device-related pressure ulcers. The focus was expanded beyond the United States to include international incidence and prevalence research.

The NPUAP’s previous monograph was published 10 years ago and has been a trusted reference worldwide. Now, building upon its success and the very latest in evidence-based practices, the NPUAP is proudly releasing a mew edition.  To purchase your copy of the monograph please click on the following link http://www.npuap.org/online-store/.

NPUAP Announces New Pressure Ulcer Registry

The NPUAP Conference The Unavoidable Outcome: A Pressure Injury Consensus Conference, held on February 27 at Johns Hopkins University, included over 250 participants representing multiple countries and 25 stakeholder organizations from around the world, including the Centers for Medicare & Medicaid Services (CMS).  Rigorous discussion of consensus items based on the State of the Science document provided to attendees concluded with consensus on many important factors related to unavoidable pressure ulcers.  These items will provide the foundation for the NPUAP’s Pressure Ulcer Registry, the first database of its type to allow clinicians to input cases of pressure ulcers in an effort to provide statistically significant rigorous analysis of the variables associated with the development of unavoidable pressure ulcers.  Stay tuned at www.npuap.org for more information on this important Registry.

Updated RN Competency-Based Curriculum

NPUAP is proud to announce that the original Registered Nurse Competency-Based Curriculum that was released in 2009 has been updated.

For more information about the Curriculum and to access the document please click HERE.

World Wide Pressure Ulcer Prevention Day – November 21, 2013

Please join the National Pressure Ulcer Advisory Panel (NPUAP) in the promotion of World Wide Pressure Ulcer Prevention Day on November 21, 2013!  To download the NPUAP PU Prevention Day sign please click HERE.

Research Priorities Identified for Pressure Ulcer Prevention, Treatment & Policy

The National Pressure Ulcer Advisory Panel (NPUAP) has identified 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:

HIGH RESEARCH PRIORITY – Cost of Pressure Ulcer Care in the United States

Prevention

  1. 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)
  2. Effects of nutritional interventions in the prevention of pressure ulcers and DTI
  3. Effects of microenvironment (sanitation, microclimate, microbiology) on incidence and prevalence of pressure ulcers and DTI
  4. Effects of compressive and shear stress and deformation on soft tissue injury associated with DTI and pressure ulcers
  5. Effect of turning and repositioning schedules on pressure ulcer and DTI prevention outcomes
  6. Prevalence and incidence of pressure ulcers and DTI associated with the use of medical devices
  7. Generation of fundamental knowledge on the etiology of pressure ulcer formation and deep tissue injury
  8. Patient literacy and teaching about prevention or treatment

Treatment

  1. Surgical solutions for treatment of pressure ulcers
  2. Selection of support surfaces based on assessment of patient clinical characteristics and support surface characteristics
  3. Effects of wound dressings on outcome of pressure ulcers
  4. Role of bioburden and biofilms in the treatment and healing of pressure ulcers
  5. Effects of nutritional interventions on outcomes of pressure ulcers
  6. Disparities, co-morbidities, age, genetics and risk factors related to outcomes of pressure ulcers
  7. Assessment and management of pain associated with pressure ulcers
  8. 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?)

Policy

  1. Standardization of patient records and documentation to support research
  2. Impact of government regulations on pressure ulcer management
  3. Standardization of terminology, tools, and outcomes, ie health care quality metrics
  4. Effective implementation of prevention and treatment guidelines
  5. Effective dissemination of implementation of prevention and treatment guidelines
  6. Skills to design research studies with adequate power and controls to generate data that can be rigorously interpreted
  7. Skills to design case/outcome studies as a decision aid for further research
  8. Caregivers (physicians, nurses, family etc.) knowledge and interest in pressure ulcer prevention and treatment
  9. Nurse and physician communication linked to quality measures, patient teaching/literacy as well as disparity/racial groups
  10. 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?
  11. Research into methods of cost/benefit calculations to be applied to compare efficacy of preventative measures

NPUAP announces the conclusion of its Biennial Conference, February 22-23, 2013 in The Woodlands (Houston), TX

March 8, 2013

The 13th NPUAP International Biennial Conference “Deep Tissue Injury: State of the Science” included over 400 participants representing 14 countries. The 2-day program focused on the clinical, basic science and translational endeavors representing all facets of pressure ulcer diagnosis and treatment. A parallel track engaged clinicians and thought leaders in consensus building designed to codify what is known about deep tissue injury as well as identifying issues that should receive attention.

The awards banquet highlighted the work of many in the field. Recipients included Laura Edsberg, PhD and Mary Ellen Posthauer, RD, CD, LD for the Kosiak Awards, Shilpa Krishnan received the Roberta Abruzzese Award, Barbara Pieper, PhD, FNP, CWOCN, ACNS-BC received the President’s Special Recognition Award, and JoAnn Maklebust, MSN, RN, ACNS-BC, ACON, FAAN received the Lifetime Achievement Award.  The keynote presenters were CMS Deputy Chief Medical Officer Dr. Shari M. Ling and Stella Mandl from the CMS Office of Clinical Standards and Quality.

On April 17 NPUAP will be holding a webinar to share the results of the Consensus Conference.  For more information about this webinar please click HERE.

Updated NPUAP Pressure Ulcer Monograph Now Available

The National Pressure Ulcer Advisory Panel (NPUAP) recently released the   254-page, 24 chapter  monograph, entitled Pressure Ulcers: Prevalence, Incidence and Implications for the Future, which was authored by 27 experts from the NPUAP and invited specialists and edited by NPUAP Alum Barbara Pieper, PhD, RN, CWOCN, ACNS-BC, FAAN. This must-have reference book examines pressure ulcer prevalence and incidence and hospital acquired rates among all clinical settings and populations as well as the state  of pressure ulcers in America over the last decade. Among the topics covered in the monograph are the effects of local and national efforts aimed at the reduction of pressure ulcer incidence and prevalence. This second edition includes new chapters on suspected deep tissue injury, intraoperatively acquired pressure ulcers and new evidence specific to medical device-related pressure ulcers. The focus was expanded beyond the United States to include international incidence and prevalence research.

The NPUAP’s previous monograph was published 10 years ago and has been a trusted reference worldwide. Now, building upon its success and the very latest in evidence-based practices, the NPUAP is proudly releasing an updated edition.  To purchase your copy of the monograph please click on the following link to be redirected to the NPUAP Online Store.

Letter to the Editor, Ostomy Wound Management

The NPUAP has submitted a letter to the editor of OWM in response to an article in the August 2012 issue entitled “Using Temperature of Pressure-related Intact Discolored Areas of Skin to Detect Deep Tissue Injury: An Observational, Retrospective, Correlational Study” by KJ Farid et al.

Please click HERE to view the letter.

Pressure Ulcer Awareness Day is November 16, 2012

The National Pressure Ulcer Advisory Panel has declared that November 16 is Pressure Ulcer Awareness Day.  Health Care Professionals in the US and other countries worldwide are working to increase the awareness of pressure ulcer risk, methods to prevent pressure ulcers and the cost in treating these wounds.

NPUAP is asking all health care professionals and health care organizations to declare November 16th as a day to increase awareness through flyers, posters and messages in public media. “Over 2.5 million US residents develop pressure ulcers every year” says Dr. Aimée Garcia, NPUAP President. She adds “There are more patients who develop pressure ulcers than who develop cancer every year. The impact of pressure ulcers on the patient, the providers who try to prevent these wounds and the payers for health care has been underestimated for years.”

To view the Pressure Ulcer Awareness Day Proclamation please click HERE.

Registration is now open for the 2013 NPUAP Biennial Conference

Registration is now open for the National Pressure Ulcer Advisory Panel’s (NPUAP) 13th Biennial Conference, Deep Tissue Injury: The State of the Science.  The conference will be held February 22-23, 2013 at The Woodlands Waterway Marriott Hotel in The Woodlands (Houston), Texas.

For information about the conference and to register please click HERE!