EUROPEAN PRESSURE ULCER ADVISORY PANEL

Development of Consensus upon the
Description of Patient Support Surfaces within Italy

Support surfaces; be they beds, mattresses or cushions, play an important role within pressure ulcer prevention and management. However, the current lack of clarity in our definitions of these devices hampers our ability to compare and contrast different surfaces; for example when should surfaces be termed dynamic or static; pressure-relieving, reducing or redistributing? The lack of common definitions also impacts upon staff training in the correct use of such aids and prevents national (and international) agreement upon the role of support surfaces within pressure ulcer management. At a national level conflicting and confusing classifications may hamper reimbursement while posing challenges when developing product specifications within competitive tenders. These issues prompted AISLeC to initiate a consensus development project to improve the description of support surfaces with the ultimate goal of improving the quality of pressure ulcer prevention and management in Italy. The fruits of this consensus upon terminology and support surface evaluation would be used to assist the national Health Ministry and regional bodies to update their ‘Prosthesis and Devices Tariff Nomenclature’ to provide common descriptions of devices so aiding tender development and staff training in the use of such interventions.

Fig 1 The concensus development group at Livigno, July 2003

The consensus process was designed to represent a wide multi-professional perspective with representatives drawn from nursing, medicine and biomedical engineering. The group were tasked to develop a common terminology to describe support surfaces and to review existing evidence upon their effectiveness. Beyond the review process a series of meetings to review technical issues with members of the Health Ministry and international experts were also planned.

The consensus group met in Livigno in the north of Italy in mid July 2003 with two key objectives; to review existing national and international guidelines on support surface use and to discuss, and refine, the aims of the project with international experts. A series of guidelines were translated into Italian and addressed within work groups – over the 40 hours of the consensus meeting the work groups reviewed translated versions of the EPUAP pressure ulcer guidelines, the US AHCPR guidelines along with pressure ulcer guidelines and consensus statements from Australia, Belgium, Canada, France, Singapore, the UK and the USA. The work of the Cochrane beds and mattresses review group was also considered by the work groups.

Fig 2 The discussions went on well into the evening...

The detailed review conducted by the working groups was complemented by presentations and comments from a number of national and international experts including Dan Bader (UK), Joe Barbenel (UK), Andrea Bellingeri (Italy), Aldo Calosso (Italy), Michael Clark (UK), Carol Dealey (UK), Ornella Forma (Italy) and Andrea Nelson (UK).

Following this initial meeting the process will move to the AISLeC web-site: <www.aislec.it> where a private forum will allow the consensus development group to work together upon the development of the final text. Using the web-site will reduce the need for frequent meetings and so accelerate the development of the consensus statement. The goal is to present the consensus statement during a scientific meeting with Health Ministry and Court for the Citizens’ Rights representation. This meeting will take place between 28 April and 1 May 2004 at Lake Garda during the III° AISLeC Meeting celebrating the first ten years of the Association. Acceptance of the consensus statement after the April meeting will begin to ensure common dialogue between the government, the clinical and scientific communities and product manufacturers. Such dialogue can only serve to improve the quality of this important aspect of pressure ulcer prevention and management. Both the consensus meeting and the presentation of the consensus report (28 and 29 April respectively) will be translated into English.

AISLeC would welcome collaboration with EPUAP members who have been involved with similar initiatives to standardise the definition and evaluation of support surfaces. Through such collaboration we should seek to achieve general harmonisation of product descriptions and evaluation methods across the European Community and wider. If you would like to collaborate please contact us at:

segreteria@aislec.it or abellingeri@venus.it