Overview
NPUAP is involved in an initiative for developing standardized guidelines of support surface testing. The Support Surface Standards Initiative (S3I) is a three-year project that will culminate in the development of uniform terminology, test methods and reporting standards for support surfaces. A short description and timeframe of the S3I is as follows:
Who can participate
The S3I is an open process so all interested parties are invited. The success of the initiative will depend on active participation of all stakeholder groups including consumers, clinicians, researchers, scientists, healthcare providers manufacturers, and policy makers.
To sign up for the initiative please fill out the form below:
A list serve has been set up through the University of Pittsburgh to facilitate communication among SSI participants. To subscribe to the list send a message to: npuap-sss-request@list.pitt.edu with the word "subscribe" in the body of the message. Once you're part of the ListServe you may post messages by sending mail to: npuap-sss@list.pitt.edu. The procedure to unsubscribe is the same as it is to subscribe except the command would be "unsubscribe".
Any other correspondence may be directed to David Saunders , 202-521-6789.
Summary
The National Pressure Ulcer Advisory Panel (NPUAP) proposes to coordinate the development of a uniform terminology, test methods and reporting standards for support surfaces. The guidelines will provide an objective means for evaluating and comparing support surface characteristics. Test methods and reporting standards will improve the process of selection and procurement. Clinicians, patients and other users would benefit from having product information and test data presented in a consistent manner. In essence, standards will empower consumers. Standards will also serve as a product development guide for manufacturers and enhance quality assurance in the manufacturing process.
NPUAP has worked out a three-year plan for developing the proposed support surface test methods. Working groups will be formed in the areas of Terms and Definitions, Tissue Integrity, and Device Safety and Lifespan. Test methods will evaluate pressure redistribution, temperature and moisture control, friction, life expectancy, failure modes, and flammability.
The success of the Support Surface Standards Initiative (S3I) depends on active participation and representation of manufacturers, consumers, clinicians, researchers, healthcare providers, and policy makers is necessary.
Background information
In a recent NPUAP monograph, Pressure ulcers in America: Prevalence, incidence, and implications for the future, it was found that estimates for cumulative incidence and prevalence of pressure ulcers in long-term care range from 3.1% to 23.9% and 2.3% to 28%, respectively. Moreover, the national cost to treat pressure ulcers is estimated at between $1.68 billion and $6.8 billion annually. Given the rapidly increasing number of adults in the U.S. achieving elder status, effective prevention and care of pressure ulcers is imperative. Pressure ulcer prevention and treatment has become an important health policy issue. Healthy People 2010, our government's plan for health policy, contains a goal to significantly reduce pressure ulcer incidence during this decade.
The need for standardized support surface test methods
Support surfaces are an integral part of any plan of care for the prevention and treatment of pressure ulcers. A wide array of surfaces, including overlays, mattresses and beds, are available in the United States. Having a variety of choices is clinically important, but choosing from the many alternatives is complicated by the lack of information about support surface characteristics and the inconsistent manner in which this information is reported. A means to measure and compare support surface characteristics will facilitate this process.
The medical model of support surface provision involves several parties including the patient, his/her health care practitioners, a vendor who sells the technology, and the manufacturer of the technology. All these parties will benefit from the development of support surface standards with the patient benefiting most directly. Clinicians are the patient's primary source of information about support surfaces and they have an obligation to provide adequate information upon which to base an informed support surface selection. To date, much of the advice regarding products available from clinicians is anecdotal; it is a sum of their clinical experience and information garnered from manufacturers and vendors. The range of products on the market places a heavy burden on clinicians to keep abreast of new technology, so they would benefit from a mechanism to objectively match a support surface's characteristics to the needs of their patients. Vendors would benefit from standards by being able to clearly describe products across manufacturers in a manner understood by clinicians and patients. Cushion testing standards would aid manufacturers by guiding new product development and redesign of existing products. Standards would provide a means of product comparison, thereby targeting gaps in market needs. In addition, standards will promote quality assurance within manufacturing processes.
There are tradeoffs to many support surface features, so the purpose of standards is not to evaluate which surface is better or worse, rather, standards will place characteristics along a continuum to allow people to determine an appropriate clinical match. Because no one support surface is best for all people, standards will help define performance and characteristics to make selection more informed.
Why NPUAP?
The NPUAP is uniquely suited to coordinate the development of support surface test methods because it is viewed as the authority on pressure ulcer care in the U.S. The NPUAP is an independent, not-for-profit organization comprised of leading professionals representing various disciplines, all of who share a commitment to the prevention and management of pressure ulcers. As an independent authority on pressure ulcer care in the U.S., the NPUAP can coordinate a committee comprised of researchers, clinicians, policy-makers and manufacturers to develop voluntary support surface performance standards in the United States. Also, this committee should work in conjunction with the European Pressure Ulcer Advisory Panel Support Surface Work Group in the development of international standards.
Plan of Operation
The ability of a support surface to meet users' needs is multi-factorial. This project will focus on the tissue integrity and safety effects of support surfaces. A recent collection of professionals, researchers and industry representatives identified important characteristics that should be considered when selecting support surfaces (Krouskop & van Rijswijk, Ostomy Wound Management 1995;41(1):34-45). These characteristics—along with others—will be considered by the NPUAP S3I.
- Fail safety
- Flammability of the product
- Infection control
- Life expectancy of the product
- Patient and product friction
- Pressure redistribution
- Skin moisture & temperature control
Sub-committees (Working Groups)
The success of the Support Surface Initiative depends on active participation and adequate funding. Representation and participation by manufacturers, consumers, clinicians, researchers, healthcare providers, and policy makers is necessary. Working groups consisting of these stakeholders will be formed with the following general areas of responsibility:
The working groups would meet formally and informally in order to develop design and performance requirements, test methods, and information disclosure requirements.
- Terms and Definitions
- Tissue Integrity
- Device Safety and Lifespan
Timeline
The development and validation process is expected to require three years of continuous effort. This estimate is based upon experience with the ISO/ANSI wheelchair cushion standards and the amount of support surface research completed to date.
Timetable of important activities and milestones
| January 10, 2002 | Initial S3I Meeting - Define scope of the project; Organize working groups; Identify and assign tasks |
| January 2002 thru May 2002 |
Establish S3I infrastructure and communication; Identify test laboratories and variables; develop initial test methodologies; terminology and test literature review |
| June 1, 2002 | 2nd S31 Working Group Meetings at WOCN |
| April/May 2002 | Spring Working Group Meetings at SAWC or WOCN |
| Spring 2002 thru Spring 2003 |
Continue development and validation of test methodologies; initial draft of terminology and definitions document |
| Fall 2002 | Fall Working Groups Meetings (ClinSymp or Medtrade); Petition ANSI and ISO to establish committees toward the development of support surface standards. Edit initial draft |
| Spring 2003 | Spring Meetings; Review and edit 2nd draft of the Guidelines; Institute ANSI/ISO committees |
| October 28, 2002 | 3rd Working Group Meeting in Atlanta at Medtrade |
| Fall 2002 thru Spring 2003 |
Continue test methods validation; write first draft of the Guidelines; write and submit manuscripts to journals |
| Fall 2003 and Spring 2004 |
Fall and Spring Meetings |
| Spring 2003 | Write final draft of the Guidelines following ANSI/ISO procedures |
| Fall 2004 | Fall Meetings; Final editing and voting on support surface guidelines |