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EUROPEAN PRESSURE ULCER ADVISORY PANEL

Abstracts from the New York Meeting, June 2000

THE STATE OF PRESSURE ULCERS AROUND THE WORLD:
COMMON PROBLEMS AND SOLUTIONS
Report of a Meeting held in New York University Medical Center, 23–24 June 2000

Pressure ulcers are a world-wide problem, at least within developed countries with large populations of elderly people. This meeting focused on the common problems faced by all developed health care systems when tackling the prevention and treatment of pressure ulcers. Organized by the Center for Continuing Education in Nursing (New York University) and sponsored by Smith & Nephew, and Ross Products Division (Abbott Laboratories Inc); the meeting provided a forum for discussions between the EPUAP, the US National Pressure Ulcer Advisory Panel (NPUAP) and the Japanese Pressure Ulcer Society. 

Over two days, panels of invited speakers debated the common challenges within prevention and treatment of pressure ulcers. On the first day attention focused upon prevention with three principal topics: risk assessment, guidelines for support surface use, and nutritional care. The second day discussed treatment ranging from methods of debridement, ulcer cleansing and dressing, the measurement of healing and the role of complementary therapies. Throughout the lengthy discussion periods over the two days it was clear that we all face similar challenges that are often exacerbated by the structure of the health care systems within which we work. Increasing communication between the various national and supra-national pressure ulcer groups is vital if we are going to best learn from each other’s initiatives and mistakes, and so develop a universal understanding of what constitutes the causes of pressure ulcers and what represents the best clinical practices in both prevention and treatment. The meeting organised in New York provided the first opportunity for such dialogue to take place between pressure ulcer organisations. Perhaps the EPUAP should consider hosting a follow-up meeting say in two years time?

Selected abstracts from the ‘State of Pressure Ulcers around the World’meeting are reproduced below, with permission.

Risk Assessment:  Which Tool Should You Use
Barbara J. Braden, PhD
Dean, Graduate School, Creighton University, Omaha, NE 68178, USA

In this age of enlightened and educated nurses, we should be using evidence to fashion our practice. However, there is sometimes confusion around the type of evidence that is required for specific types of nursing practice or interventions. In considering a tool for determining risk for pressure ulcer development, there are several types of evidence that one must consider. Reliability and validity are important issues. Paper and pencil rating scales have the best reliability and validity in relationship to risk for pressure ulcer development. With these types of scales, we must be concerned with both construct and predictive validity as well as interrater reliability. Construct validity will be reviewed for the three most commonly used risk assessment scales and the studies performed to determine interrater reliability and predictive validity of the Braden Scale will be summarized. In addition, evidence related to clinical utility is important. A tool that has good clinical utility is able to demonstrate ease of use as well as improved outcomes and decreased or neutral costs with use.

Selected Bibliography
Research Articles related to Braden Scale and Etiological Factors:

  • Bergstrom N, Braden B, Laguzza A and Holman A, (1987). The Braden Scale for predicting pressure sore risk. Nursing Research. 36(4), 205–210.*
  • Bergstrom N, Demuth PJ and Braden B, (1987). A clinical trial of the Braden Scale for predicting pressure sore risk. Nursing Clinics of North America. 22(2), 417–418.*
  • Bergstrom N and Braden BJ, (1992). A prospective study of pressure sore risk among institutionalized elderly. J. of the American Geriatric Society. 40(8), 747–758.
  • Braden BJ and Bergstrom N, (1994). Predictive validity of the Braden Scale for pressure sore risk in a nursing home population. Research in Nursing and Health. 17, 459–470.*
  • Bergstrom N, Braden BJ, Kemp M, Champagne M, and Ruby E, (1996). Multi-site study of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses, and prescription of preventive interventions. J. of the American Geriatric Society, 44(1), 22–30.
  • Bergstrom N, Braden BJ, Boynton P,  Bruch, S, (1995). Using a research-based assessment scale in clinical practice. Nursing Clinics of North America, 30(3), 539–551.
  • Bergstrom N, Braden BJ, Kemp M, Champagne M, and Ruby E, (1998). Reliability and validity of the Braden Scale: A multi-site study. Nursing Research, 47(5), 261-269.
  • Braden, B.J. (1998). The relationship between stress and pressure sore formation. Ostomy/Wound Management, 44(3A), 26S-37S.

Review Articles on Etiology Prevention and Treatment:

  • Braden B and Bergstrom N, (1987). A conceptual schema for the study of the etiology of pressure sores. Rehabilitation Nursing, 12(1), 8–12, 16.
  • Braden BJ and Bergstrom N, (1989). Clinical utility of the Braden Scale for predicting pressure sore risk, Decubitus, 2(3), 44–51.†
  • Richardson GM, Gardener S and Frantz RA. (1998). Nursing assessment: impact on type and cost of intervention to prevent pressure ulcers. J. of Wound Ostomy Continence Nursing, 25(6), 273–280.
  • Xakellis GC, Frantz RA, Lewis A and Harvey P. (1998). Cost-effectiveness of an intensive pressure ulcer prevention protocol in long-term care, Advances in Wound Care, 11(1), 22–9.
  • Horn S, Ashton C and Tracy D. (1994). Prevention and treatment of pressure ulcers by protocol. In Horn S and Hopkins D (Eds.), Clinical Practice Improvement: A New Technology for Developing Cost-Effective Quality Health Care. New York: Faulkner & Gray.

* research reports related to tests of reliability and validity.
† details considerations m assigning specific subscale scores.

Risk Assessment of Pressure Ulcer for Bedfast Elderly in Japan
Hiromi Sanada, PhD, RN, WOCN
School of Health Sciences, Kanazawa University, Japan

One of the problems with pressure ulcers facing elderly Japanese patients is that 60% of all cases1 extend to stage III or IV which are full-thickness wounds. Furthermore, the decrease in tissue tolerance amongst elderly patients augments patients’ discomfort and leads to a lesser quality of life. The lengthy period required to cure increases the caregiver’s burden as well as increasing the cost of pressure ulcer healing. To resolve this problem, we need to better predict the development of pressure ulcers. In this presentation, I introduce risk assessment of pressure ulcer based on our laboratory research, and discuss the future issues of risk assessment for the elderly.

Topics to be discussed:

  1. Epidemiological Data in Japan
    Prevalence of facilities and the homecare setting
    Frequency distribution stages of Pressure Ulcers (PU)
  2. Introduction of the Braden Scale in Japan
    Sensitivity and specificity of the Braden Scale at Kanazawa University Hospital
    The incidence of PU before and after introducing the Braden Scale
  3. Discovery of a New Risk Factor in Japan
    Evaluation of elderly risk factors in Japan
    Relationship between Extreme Bony Prominence (EBP) and PU development
    How to measure the EBP
  4. Future Issues of Risk Assessment in Japan
    Considering a two-step risk assessment
         Step 1.  Underlying factors
         Step 2.  Trigger factors
    Considering EBP as a new risk factor

Reference

  1. Nakajo T, Results of conservative treatments for pressure ulcers in two hospitals. Jpn.J.P.U., 1(2):            235–242, 1999.
 
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