European Pressure Ulcer Advisory Panel
A fitting celebration: Ten Years of EPUAP Activity in Europe
Delegates at the 2007 EPUAP conference were treated to a varied programme giving an insight into current and future developments in pressure ulcer management Tracy Cowan, Deputy Editor/Production Editor, Journal of Wound Care (reproduced with JWC’s permission)
The European Pressure Ulcer Advisory Panel (EPUAP) celebrated its tenth anniversary by holding its annual meeting in Oxford, the place of its birth a decade ago. Delegates from Europe, the US, Japan, Israel and southern Africa met to discuss this year’s theme, which was appropriately - Ten Years of Progress: the present and the future in pressure ulcer prevention and management.
All aspects of current EPUAP activity were discussed. Carol Dealey, President Elect, overviewed the organisation’s achievements over the past 10 years and proclaimed that, in her opinion, the most exciting future development is its collaborative work with the National Pressure Ulcer Advisory Panel (NPUAP) to develop truly international guidelines on pressure ulcer prevention and management. These will be launched next summer.
Meanwhile, Judith Meijers, from Maastricht University, outlined research results showing how the EPUAP nutrition guideline on pressure ulcer prevention and treatment has affected practice. A survey of 1087 health-care organisations in the UK, Netherlands and Germany showed that, one year after the guidelines’ launch, more than half of the respondents (n = 363) were aware of them, with one in four applying them to practice. Full results were published in JWC in May 2007 (16:5, 201-205).
One of the main conference themes was heel pressure ulcers. Jeannie Donnelly and Mark Collier, from Northern Ireland and Lincolnshire respectively, outlined the key results of their research on this topic.
Jeannie reiterated her findings, discussed previously (JWC, 2006, 15:9, 411), that devices that remove pressure from the heels are more effective in preventing ulceration than those that partially redistribute pressure. She also cited some of the qualities an ‘ideal’ heel protector would need.
Mark gave us an insight into his progress on his PhD on whether ABPI can be incorporated into assessment, in order to predict which patients are at risk of developing heel pressure ulcers. He drew attention to the challenges of embarking on such a major project, in terms of patient identification and recruitment, and data collection. However, this research is now well underway and Mark is looking forward to the final data collection and analysis.
Another key theme was shear. This was timely, given that the Shear Force Initiative, which aims to identify how shear influences pressure ulcer formation (JWC, 2007, 16:5, 209), was also meeting at the conference.
Cees Oomens, from Eindhoven, the Netherlands, took this as a cue to discuss the differences between shear force, normal force and friction at the body/support surface interface. Dan Bader discussed how room temperature and humidity can influence friction and skin breakdown, concluding that in certain conditions controlling the humidity induced by air-support systems can have beneficial effects. Finally, Karlien Ceelen described how a computerised theoretical model compared well with magnetic resonance imaging in measuring tissue deformation in the tibialis anterior region of a rat hind limb.
The Japanese Perspective
A highlight of the conference (the evening jazz boat trip on the Thames aside!) was the six papers from a Japanese delegation outlining their country’s contribution to pressure ulcer management.
Hiromi Sanada described the recent trends in Japan. Chief among these is that, one year after the Japanese government started fining hospitals that do not have a pressure ulcer management policy in place, a large survey recorded a significant reduction in prevalence. In a further effort to improve care, the government is introducing a reimbursement system for each high-risk patient admitted to a hospital that employs a full-time nurse whose responsibilities include pressure ulcer management.
Delegates were also treated to an in-depth account of the DESIGN pressure ulcer assessment tool, which is widely used in Japan. Meanwhile Makoto Takahashi and Takehiko Ohura returned to the near ubiquitous theme of shear, discussing different approaches to measuring shear force and the current clinical evidence on deep tissue injury, external force undermining and residual shear force.
Next year’s EPUAP meeting will be held in Bruges, Belgium on 3-6 September 2008.
- The evening jazz boat trip on the Thames, at Oxford.