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.

Page 3 of 712345...Last »

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!

 

NPUAP announces the conclusion of its summer meeting, August 23-24 in Baltimore, MD

Over 60 people participated, representing all facets of patient care and advocacy. Attendees were hopeful but guarded about the present healthcare environment. Following a review of the Strategic Plan, recent accomplishments and project status reports, the group hosted a representative from the Centers for Medicare and Medicaid Services (CMS). The ensuing dialog established the basis for a memorandum of understanding with both short and long term goals.

At his meeting NPUAP welcomed new Corporate Advisory Council (CAC) members Wellsense USA, Inc. and Wound Care Education Institute as well as new Provider Organization Council (POC) member Ernest Health to the Panel. Other meeting highlights were a review of the newly redesigned website (www.npuap.org ) that launched in early July, a drafting of a new position statement regarding pressure ulcers in which cartilage is evident and continuing plans for the 2013 Biennial Conference being held in the Woodlands, TX, February 22-23, 2013.

NPUAP Announces Release of Newly Developed Cartilage Position Statement

NPUAP has a new position statement entitled Pressure Ulcers with Exposed Cartilage are Stage IV Pressure Ulcers. In this position statement, staging for ulcers absent of soft tissue, such as skin over cartilage, is examined. To read this position statement in its entirety please go to: http://www.npuap.org/resources/position-statements/.

NPUAP Call for Poster Abstracts: Deadline October 1, 2012

The National Pressure Ulcer Advisory Panel (NPUAP) invites you to submit an abstract for a poster presentation at our 13th National Biennial Conference scheduled for February 22-23, 2013 in The Woodlands (Houston), Texas.  The top 4 poster presenters will be asked to provide a brief oral presentation during the conference’s general session.

The deadline to submit abstracts is October 1, 2012.  Applicants will be notified of the status of their abstract’s acceptance by November 1, 2012.

Please click on the link below to learn more and to submit your abstract:

http://www.npuap.org/submit-abstract/

Have Your Patients Been Asking About “Bedsores”?

Consumer Reports discussed “Bedsores” along with 7 other “things that should never happen in a hospital” in the August 2012 issue of the magazine. The reader is told that “while there is never an excuse of operating on the wrong body part, there are several less dramatic events that also should never occur” including pressure ulcers. “Bedsores”,  as they are called in the article, is number one on the list. Here is what they said… “These painful wounds, usually on the ankles, back, buttocks, hips or other bony areas, can develop if a patient is left in one position too long. Frequent repositioning and special pads, cushions and mattresses can prevent them. If you see early signs, including patches of skin that have reddened, let the nursing staff know.”

The majority of the article focused on medical harm telling the reader that 1.4 million Medicare recipients  a year are seriously hurt by their hospital care and “what happens to other people is less clear because most hospital errors go unreported and hospitals only report on a fraction of things that can go wrong”.  Ratings of hospital safety are included, provided for the various regions of the US. The full article is at http://www.consumerreports.org/cro/magazine/2012/08/how-safe-is-your-hospital/index.htm.

Pressure Ulcer Treatment Strategies: A Comparative Effectiveness Review

The National Pressure Ulcer Advisory Panel (NPUAP) would like to commend AHRQ for the enormous undertaking of synthesizing available information regarding the treatment of pressure ulcers (PU). In particular, the sources for information were broader than are usually undertaken including soliciting unpublished information from stakeholders. The population of patients with pressure ulcers is very diverse; unlike renal failure or congestive heart failure, there are no reliable lab tests for skin failure and the outcome of a treatment for any individual is also dependent on multiple co-morbidities. The difficulty of this technology assessment is compounded by the fact that healing is a continuum and no one modality is likely to be appropriate from initiation of treatment to wound closure.

This review provides an excellent platform to call for the implementation of certain basic approaches [eg methodology for wound measurement, clinical endpoints, use of consistent staging terminology and perhaps partitioning healing research to partial thickness (Stages I & II) and full thickness (Stages III & IV)] which would allow more accurate comparisons and meta-analyses in the future.

NPUAP recognizes that this document is still in draft format-some of the comments are likely editing-related. There is a concern, however, that the results in the Structured Abstract/Executive Summary will be highlighted without the significant caveats that are presented regarding strength of evidence. For example, if there is only low strength evidence that wound healing is similar with collagen compared to standard care dressings, AHRQ’s own definition suggests that there is low confidence that this evidence reflects the true effect and that further research is likely to change the confidence in the estimate of the effect. A conclusion of further research is warranted’ for the areas with low confidence might convey the message more accurately.

Other selected areas of concern are:

  • The 2007 NPUAP staging system is a six stage system which includes Unstageable and Suspected Deep Tissue Injury (Executive Summary and Introduction). Research on PU healing is typically limited to Stages I-IV but the NPUAP-EPUAP Clinical Practice Guidelines, 2009 reaffirmed the six stage system.
  • Use of the term vacuum-assisted closure (ES-2) instead of Negative Pressure Wound Therapy (NPWT) is confusing.
  • ES-5 Population and Interventions sections seem to imply that direct research was undertaken rather than that these were selection criteria for the documents that were reviewed.
  • ES-13 Table A Key Outcome is listed as Alternating pressure beds but the conclusion relates to alternating pressure chair cushions.
  • ES-19 and the Key Points (p. 78) related to surgery for pressure ulcers cite independent variables-for example ‘Sacral ulcers have lower recurrence rates after surgery than ischial pressure ulcers.’ The location of the ulcer, whether or not the patient has a spinal cord injury, and whether or not bone debridement is done during surgery are defining characteristics of the patient’s wound.
  • ES-22 cites the review by Reddy (2008) as being the most current, comprehensive evidence about the effectiveness of pressure ulcer treatments. This analysis and recommendations had a concerning degree of selection bias created by limiting reviewed studies to randomized, controlled trials. Not all treatments or interventions are appropriate for this type of study.
  • Page 18 (Results) discusses a study of Air Fluidized beds which apparently backstaged the ulcers. Stage III and IV ulcers do not heal to Stage II. This ‘study’ also failed to provide data for the control group.
  • The Adjunctive Therapy Tables (13-15) starting on page 87 lack the ‘quality’ evaluation in the first column. In addition, the methodology for selecting documents led to a rating of ‘insufficient evidence’ of harm (p 108) for NPWT despite warnings from the FDA in 2009, 2011 and 2012. This should not be construed to imply that NPWT should not be used but rather that it warrants attention and monitoring unlike most topical dressings.

Evaluating the effectiveness of support surfaces for treating pressure ulcers by combining results from distinct studies is hindered by a number of factors including variability among products with similar features (e.g. Low air-loss). Mechanistically, support surfaces affect pressure ulcer treatment by redistributing pressure away from the injured site and creating a microclimate that does not adversely affect the healing process. Low air-loss is a feature of a support surface “that provides a flow of air to assist in managing the heat and humidity (microclimate) of the skin.” (NPUAP-EPUAP Clinical Practice Guidelines, 2009). Notice that the term “low air-loss” refers to a feature and not a category of product. Clearly, if a bed only provided flow of air to the skin without redistributing pressure it would not be an effective support surface. Therefore, the extent to which a surface with low air-loss affects healing is almost certainly also related to how the surface redistributes pressure. A study to isolate the effect of the low airloss feature would need to be conducted on the same mattress with and without the air escaping through the cover. There is no such study in the literature.

The statement in the structured abstract on page v that reads, “there is no overall benefit to low air-loss beds compared to standard foam mattresses” is potentially misleading because the small number of studies conducted did not control for the additional factor of pressure redistribution. Therefore, there is insufficient evidence in the literature to compare surfaces with low air-loss features to foam mattresses without low air-loss features.

The statement in the structured abstract on page v that reads, “different mattress brands are comparable in performance “ is unclear. Does “different mattress brands” refer to only support surfaces with air-fluidized features or all support surfaces? Or, does it follow from the second key point on page 17 referring to alternating pressure beds? If it is the latter, this is a potentially misleading broad generalization.

A comment on page 17 reads, “Currently there is no universally accepted classification of support surfaces.” While this technically correct, there has been broad consensus reached between the US, European, Japanese, and others that the general (nonmutually exclusive) categories of support surfaces are reactive support surface, active support surface, integrated bed system, non-powered, powered, overlay, and mattress. (NPUAP-EPUAP Clinical Practice Guidelines, 2009)

The information contained in the Structured Abstract , Executive Summary and body of the paper is very similar-perhaps it could be condensed to create a less formidable, more useable document. Even the studies rated as ‘good’ frequently have low numbers of patients and many sites; many of the studies resemble pilot studies-further complicating the task. NPUAP would be honored to collaborate with AHRQ in addressing some of the above cited concerns in greater detail than is permitted by the limited commentary section.

This document can serve as a scaffolding on which to build improved information regarding comparative effectiveness of PU treatments through continuous literature review as better quality studies become available.

In summary, we do not find any factual errors or significant oversights. Our comments and suggestions are meant to provide consistency and cohesion to the document. The above correction  will produce a valuable document for clinician and academicians. Thank you for the opportunity to participate in the comment period for ARHQ’s Pressure Ulcer Treatment Strategies: A Comparative Effectiveness Review.