Recurring pressure ulcers: Identifying the definitions. A National Pressure Ulcer Advisory Panel white paper

Abstract

Currently, there is a lack of consensus regarding the accepted terminology pertaining to the pressure ulcer healing progression and recidivism. This lack of uniformity can negatively impact initiation of treatment pathways, completion of appropriate interventions, clinical documentation, medical coding, patient education, discharge planning and healthcare revenue through out the healthcare system. The purpose of this paper is to introduce a standard nomenclature as it pertains to pressure ulcer healing progression and any recidivism that may occur. The National Pressure Ulcer Advisory Panel has formulated a framework of terms regarding pressure ulcer progression. We also developed a clearer nomenclature for lack of progress and recidivism of pressure ulcers. This document should serve as a starting point for the discussion of the pressure ulcer care, research, and terminology.

Risk factors for hospital-acquired and community-acquired pressure injuries: a multicentre mixed case–control study

“…Unstageable PIs, as defined by the National Pressure Ulcer Advisory Panel (NPUAP), involve full-thickness tissue loss with the wound bed covered by slough or eschar that obscures accurate PI staging 19 20. Clinical nurses evaluated PIs according to the International Pressure Ulcer Classification System (NPUAP, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance) 20 21. The potential related factors were (1) age; age was analysed as a continuous variable; (2) sex; female was encoded ‘1’ and male was encoded ‘2’ for analyses; (3) patient level of care (only for the HAPIs study); based on the patient’s condition and self-care ability, the care level was divided into basic, moderate, intensive and very intensive degrees, which were respectively encoded ‘1’, ‘2’, ‘3’ and ‘4’ for analyses; (4) Braden rating; no risk, at risk, moderate risk and high/very high risk were respectively encoded ‘1’, ‘2’, ‘3’ and ‘4’ for analyses; (5) presence of forced posture (only for the HAPIs study); ‘presence of postures that patients are forced to take to relieve the pain of diseases, including forced sitting posture, forced prone posture and forced side posture, etc.’ was encoded ‘2,’ and others were encoded ‘1’ for analyses; (6) diabetes; a positive diagnosis of diabetes was encoded ‘2’ and a negative diagnosis was encoded ‘1’ for analyses; (6) use of medical devices (only for the HAPIs study); ‘use of medical device causing pressure/shear at skin site, for example, O 2 mask, nasogastric tube’ was encoded ‘2’ and no use of medical devices was encoded ‘1’ for analyses; (7) surgery during hospitalisation (only for the HAPIs study); undergoing surgery during hospitalisation was encoded ‘2’ and not undergoing surgery was encoded ‘1’ for analyses; (8) work experience of responsible nurses (only for the HAPIs study); ‘＜1 year’, ‘≥1 and＜4 years’, ‘≥4 and＜6 years’, ‘≥6 and＜10 years’ and ‘≥10 years’ were respectively encoded ‘1’, ‘2’, ‘3’, ‘4’ and ‘5’ for analyses; (9) existence of PIs or scars from previous PIs (only for the HAPIs study); ‘existence of PIs or scars from previous PIs on admission’ was encoded ‘2’, and others were encoded ‘1’ for analyses.…”

Hospital-acquired pressure ulcers in spinal cord injured patients: time to occur, time until closure and risk factors

“…Time until closure was defined as the number of days from the first observation of the HAPU until assessment of grade 0 with complete epithelialisation was assessed for the first time. 15 Locations were grouped into foot (toe, heel, forefoot, ankle), lower extremity (legs), sitting area (sacrum/coccyx, ischium, trochanter, genitals, groin) and other (back, head etcetera). Reason for admission was categorised into first rehabilitation, readmission for treatment of PU and readmission for other reasons.…”

“…The significant, positive association with time since injury (P = 0.005) is corresponding with results found in literature. 11,15,22 Time until closure The therapeutic goal and principles of treatment usually lead to healing of a PU ulcer during hospitalisation. The rehabilitation team and patients decided for conservative treatment of all HAPUs, even though plastic surgery was easily accessible.…”

“…Closure of a PU has been defined as complete epithelialisation, with a thin, unstable and translucent skin without a fully restored epidermal integrity and stability. 15 There are only few descriptive data on time until closure of HAPUs in SCI patients. 16 Information from other populations is only marginally applicable, as healing of PUs in SCI patients takes more time because of physiological changes in the wound-healing cascade.…”

Spatiotemporal characterization of hydration process of asymmetric polymeric wound dressings for decubitus ulcers

“…Pressure ulcers also known as decubitus ulcers, ischemic ulcers, bed sores, pressure sores, or skin sores are localized injuries of the skin and/or underlying tissue, which often transform into deep craters with exposed muscles or bones. According to the definition presented by a National Pressure Ulcer Advisory Panel (NPUAP), open pressure ulcer is “the absence of epithelium or integument due to localized pressure and/or shear related forces.” Pressure ulcers cause pain, increase the risk of infection and the costs of medical treatment. Pressure ulcers are difficult to heal and together with hospital‐acquired infections (HAI) are the most serious complications of long‐term hospitalized patients .…”