Black JM, Edsberg LE, Baharestani MM, Langemo D, Goldberg M, McNichol L, Cuddigan J, National Pressure Ulcer Advisory Panel., et al.
Ostomy/wound management. Date of publication 2011 Feb 1;volume 57(2):24-37.
1. Ostomy Wound Manage. 2011 Feb;57(2):24-37.
Pressure ulcers: avoidable or unavoidable? Results of the
National Pressure Ulcer Advisory Panel Consensus Conference.
Black JM(1), Edsberg LE, Baharestani MM, Langemo D, Goldberg M, McNichol L,
Cuddigan J; National Pressure Ulcer Advisory Panel.
Author information:
(1)University of Nebraska Medical Center, Omaha, Nebraska 68198-5330, USA.
jblack@unmc.edu
Although pressure ulcer (PrU) development is now generally
considered an indicator for quality of care, questions and concerns about
situations in which they are unavoidable remain. Considering the importance of
this issue and the lack of available research data, in 2010 the National Pressure
Ulcer Advisory Panel (NPUAP) hosted a multidisciplinary conference to establish
consensus on whether there are individuals in whom pressure ulcer development may
be unavoidable and whether a difference exists between end-of-life skin changes
and pressure ulcers. Thirty-four stakeholder organizations from various
disciplines were identified and invited to send a voting representative. Of
those, 24 accepted the invitation. Before the conference, existing literature was
identified and shared via a webinar. A NPUAP task force developed standardized
consensus questions for items with none or limited evidence and an interactive
protocol was used to develop consensus among conference delegates and attendees.
Consensus was established to be 80% agreement among conference delegates.
Unanimous consensus was achieved for the following statements: most PrUs are
avoidable; not all PrUs are avoidable; there are situations that render PrU
development unavoidable, including hemodynamic instability that is worsened with
physical movement and inability to maintain nutrition and hydration status and
the presence of an advanced directive prohibiting artificial nutrition/hydration;
pressure redistribution surfaces cannot replace turning and repositioning; and if
enough pressure was removed from the external body the skin cannot always
survive. Consensus was not obtained on the practicality or standard of turning
patients every 2 hours nor on concerns surrounding the use of medical devices
vis-à-vis their potential to cause skin damage. Research is needed to examine
these issues, refine preventive practices in challenging situations, and identify
the limits of prevention.
PMID: 21350270 [Indexed for MEDLINE]
