EUROPEAN PRESSURE ULCER ADVISORY PANEL

OXFORD, UK
21-23 September 1997

Dr C Andrew Salzberg,
President, National Pressure Ulcer Advisory Panel,
Buffalo, New York,
U.S.A.

The National Pressure Ulcer Advisory Panel (NPUAP) was conceived and formed in 1988 in order to fulfil a need for leadership in pressure ulcer prevention. With a mission to raise awareness and provide information on pressure ulcers, the founding members of the NPUAP began working on a national level in the areas of public policy and education.

The work of the NPUAP began quickly and effectively and today, this still small body of dedicated professionals has been responsible for positively impacting the quality of care for patients at risk for and with pressure ulcers. The mission has expanded to include treatment issues and areas of research.

The success of the organisation is due in large part to the inclusive nature of the organisational design. While not a membership organisation in the traditional sense, the NPUAP has a strong and varied group of supporters which lend multidisciplinary perspective, experience and expertise to all NPUAP programmes and projects. The fifteen member Board of Directors reflects this belief in the holistic approach to pressure ulcer care by including educators, nurses, physicians, researchers, physical therapists, podiatrists, and specialists from a variety of areas. All members have extended individual expertise and experience in pressure ulcer prevention or treatment and collectively they form one of the most highly respected bodies of experts in the nation.

The model of the NPUAP also includes integrating the expertise of the industry and the perspective of other professional groups into the programmes and projects they undertake. This blending of perspectives has ensured that the efforts of the NPUAP have taken into consideration the needs not only of the patient and health care professional, but also the needs of the care givers, and suppliers and manufacturers of pressure ulcer products as they all work together to provide quality care for patients.

During this presentation the organisation structure will be detailed, the historic development of the organisation reviewed, the successes and their impact on pressure ulcer care will be discussed and the management and future goals of the organisation will be defined.

This nationally successful integrated organisational model is presented as an option for meeting the needs of other countries as the leadership looks at positively impacting the quality of care for patients with or at risk for developing pressure ulcers.

VARIABLES ASSOCIATED WITH THE FORMATION OF PRESSURE ULCERATION

Emeritus Professor Terence J Ryan,
Department of Dermatology,
The Churchill Hospital,
Headington,
Oxford OX3 7LJ

Are all pressure sores explained by a quantity of pressure that would induce a sore in any immobile skin?

Is some skin more vulnerable i.e.. prepared or activated? The answer is that the skin is not a homogeneous organ. It is not everywhere cushioned adequately by pressure relieving structures. Its structure and function as well as its metabolic demands varies from site to site from moment to moment.

The skin has memory which is both recent and long term and as a result of its experience reacts to stimuli such as pressure with a range of responses.

This paper will refer to articles on Pressure Urticeria 1, skin expansion 2, skin abrasion (stripping with sellotape) 3, exposure to ultra violet light 4, gravitational effects to illustrate differing vascular epithelial and fibroblast responses 5: Differing that is in respect of structure and function such as exhaustion of fibrolysis, inhibition of protease's, cell turnover, water accumulation, endothelial adhesion etc., etc.

Stage I erythema is not so much a sign demanding pressure relief but a sign of vulnerability which should be amenable to a range of therapies allowing further pressure to be experienced.

References:

• Ryan TJ., Nishioka K and Dawber RP R (1971) - Epithelial-Endothelial interaction in the control of inflammation through fibrinolysis British Journal of Dermatology 84 501-515.
• Ryan TJ (1989) Pressure sores: prevention, management and future research - a medical perspective. Palliative Medicine 3 249-525.
• Stringini L and Ryan TJ., 1996 Wound Healing in Elderly Human Skin. Clinics in Dermatology 14 197-206.
• Ryan TJ, 1976 Skin memory in micro vascular injury. Lloyd Life Medical Publishers 418.Ryan TJ 1989 Biochemical consequences of mechanical factors generated by distension and distortion. Journal of American Academic Medicine 21 115-130.