Updated Research Priorities Identified for Pressure Ulcer Prevention, Treatment & Policy

The National Pressure Ulcer Advisory Panel (NPUAP) has updated their previously published 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:

Etiology

Effects of compressive and shear stress and deformation on soft tissue injury associated with DTI and pressure ulcers

Generation of fundamental knowledge on the etiology of pressure ulcer formation and deep tissue injury; precise mechanisms by which damage occurs

Mechanical properties and thresholds of adipose tissue

Role of microclimate in the etiology of pressure ulcers and the characteristics of an optimal microclimate

Role of occlusion of lymphatic vessels in pressure ulcer development

Risk Assessment & Early Detection

Biophysical and biochemical markers as targets for pressure ulcer screening

Development of risk assessment tools that incorporate new research on factors associated with pressure ulcer risk

Investigation of being at risk for pressure ulcers among individual groups; 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); including SCI, bariatrics and End of Life

Potentially unavoidable nature of some pressure ulcers

Prevention

Effectiveness of support surface bottoming out detection methods

Effectiveness of matching heel elevation strategies for pressure ulcer prevention with specific individual’s characteristics (duration and level of immobility, frequency and force of leg movement)

Effectiveness of repositioning regimens for pressure ulcer prevention, in combination with support surfaces in bed; consideration of seated population, outcomes related to use of seat cushions and repositioning regimes

Effects of microenvironment (sanitation, microclimate, microbiology) on incidence and prevalence of pressure ulcers and DTI

Effects of nutritional interventions in the prevention of pressure ulcers and DTI; role of energy, protein, multivitamin and arginine supplementation

Evaluate use of natural sheepskin for pressure ulcer prevention

Frequency of occurrence, risk factors and prevention of pressure ulcers during surgery; incidence as outcome

Frequency of occurrence, risk factors and prevention of pressure ulcers in the Emergency Department (ED); linked to incidence as outcome

Patient literacy and teaching about prevention or treatment

Prevalence and incidence of pressure ulcers and DTI associated with the use of medical devices

Selection of support surfaces for prevention of pressure ulcers based on assessment of patient clinical characteristics and support surface characteristics; in particular populations such as pediatrics, bariatrics, SCI

Use of prophylactic dressings for pressure ulcer prevention

Treatment

Assessment and management of pharmacological and non-pharmacological strategies associated with pressure ulcer pain 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?)

Disparities, co-morbidities, age, genetics and risk factors related to pressure ulcer treatment outcomes

Effectiveness of phototherapy and laser therapy for pressure ulcer treatment with identification of appropriate target population

Effects of nutritional interventions on treatment outcomes of pressure ulcers

Effects of wound dressings on outcome of pressure ulcers

Outcomes effectiveness of support surfaces (features, components & categories) for treatment and healing of partial and full-thickness pressure ulcers

Potential for hyperbaric oxygen therapy for treatment of pressure ulcers

Role of bioburden and biofilms in the treatment and healing of pressure ulcers; best practice for preventing, diagnosing and eradicating biofilm; impact of antibiotic resistant bacteria on healing of pressure ulcers

Role of electrical stimulation of the muscles of individuals with SCI in treatment of pressure ulcers

Role of traditional treatments and medicines as interventions in pressure ulcer treatment

Selection of support surfaces for treatment of pressure ulcers based on assessment of patient clinical characteristics and support surface characteristics; in particular populations such as pediatrics, bariatrics, SCI

Surgical solutions for treatment of pressure ulcers

Policy

Caregivers (physicians, nurses, family etc.) knowledge and interest in pressure ulcer prevention and treatment

Effective implementation of prevention and treatment guidelines

Impact of government regulations on pressure ulcer prevention and treatment; outcomes and cost-effectiveness

Implementation of and outcomes related to the standardization of terminology, tools, and outcomes, ie health care quality metrics

Nurse and physician communication linked to quality measures, patient teaching/literacy as well as disparity/racial groups

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?

Research into methods of cost/benefit calculations to be applied to compare efficacy of preventative and treatment models

Skills to design case/outcome studies as a decision aid for further research

Skills to design research studies with adequate power and controls to generate data that can be rigorously interpreted

Standardization of patient records and documentation to support research