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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Registration now open for the NPUAP 2015 Biennial Conference!

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:

2014 World Wide Pressure Ulcer Prevention Day

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:

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 for more information on how to register.

  1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.) Cambridge Media; Osborne Park, Western Australia; 2014.

Now Available: New 2014 International Pressure Ulcer Guidelines!

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.

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:

  • Prevention and Treatment of Biofilms
  • Prophylactic Dressings
  • Microclimate Control
  • Medical-Device Related Pressure Ulcers
  • Prevention and Management of Heel Pressure Ulcers
  • Low Friction Fabrics

The Guideline includes updated recommendations and/or research summaries for the following pressure ulcer topics:

  • Etiology
  • Prevalence and Incidence
  • Risk Assessment
  • Skin and Tissue Assessment]
  • Preventive Skin Care
  • Prophylactic Dressings
  • Microclimate Control
  • Fabrics and Textiles
  • Nutrition
  • Repositioning and Early Mobilization
  • Support Surfaces
  • Medical Device Related Pressure Ulcers
  • Pressure Ulcer Classification
  • Wound Assessment
  • Monitoring of Healing
  • Pain Assessment and Treatment
  • Cleansing and Debridement
  • Wound Dressings
  • Assessment and Treatment of Infection and Biofilms
  • Biophysical Agents
  • Surgery

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.

NPUAP announces a productive winter meeting February 28-March 1, 2014

The National Pressure Ulcer Advisory Panel (NPUAP) came together in Baltimore, MD on February 28-March 1 following a very successful Conference February 27 entitled The Unavoidable Outcome: A Pressure Injury Consensus Conference.  Over 65 members participated in the Panel Meeting, representing all facets of patient care and advocacy.  Attendees were hopeful but guarded about the present healthcare environment.  President Aimée Garcia welcomed the Panel members and announced the incoming Officers of NPUAP:

  • President: Margaret Goldberg, RN, MSN, CWOCN
  • Vice President: Laura Edberg, PhD
  • Secretary: Lynn Moore, RD, LD
  • Treasurer: Mary Sieggreen, MSN, CNS, NP, CVN

The Panel reviewed the organization’s Strategic Plan and the reports and recent accomplishments of NPUAP’s three Mission Committees (Educational, Public Policy and Research), including increased collaboration with the Centers for Medicare & Medicaid (CMS) and the National Quality Forum (NQF) and a very well attended Biennial Conference in Houston, Texas.

Looking to the future the Panel reported many initiatives including:

  • 2015 Biennial Conference: February 21-22, 2015 at the Buena Vista Palace in Orlando, FL.
  • Webinar Topics continue to evolve and have been successful.
  • White Papers:  Recidivism/Friction/Clinical Relevance Support Surface Standards are in preparation for publication.
  • World Wide Pressure Ulcer Prevention Day, November 20, 2014:  A taskforce was formed to develop a creative plan for success.

More information on the initiatives listed above can be found the NPUAP website

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

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 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


  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


  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?)


  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.