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/.