European Pressure Ulcer Advisory Panel

EPUAP: Past, Present and Future

Dr Carol Dealey (EPUAP President Elect)

University Hospital Birmingham NHS Foundation Trust and University of Birmingham

This year, EPUAP is holding its tenth annual meeting. As well as a moment for pride in this achievement, it should also be a time for reflection. The aim of this paper is to both reflect on EPUAP’s journey and to look at the direction in which the society is travelling. This will be undertaken by means of a SWOT analysis to identify our:

• Strengths
• Weaknesses
• Opportunities
• Threats

A major strength of EPUAP is that it is an active society and not just an annual conference. Some of the many activities of EPUAP will be discussed as well as other strengths such our collaboration with our Corporate Sponsors. It is important to also recognise our weaknesses and probably our major weakness is that pressure ulcers are not seen as sufficiently important to attract the levels of major research funding currently available for other disease or conditions. Opportunities and threats must also be taken seriously as they can affect the future considerably.

However, it is not enough just to complete a SWOT analysis, it should be used to inform present action and the future. This paper will conclude by looking at future developments for EPUAP, the most important and exciting of which (in my opinion) is the development of international guidelines with NPUAP. Finally, those of us involved with EPUAP from its inception, must be ready to support those who will take it forward for the next ten years, and maybe ten years after that.

Nutrition and Pressure Ulcers - The work of the EPUAP nutritional working group

J M.M. Meijers¹, J.M.G.A. Schols², P.A. Jackson³, G. Langer⁴, M. Clark⁵ and R.J.G. Halfens¹

1. Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, Maastricht University.
2. Department of General Practice, Maastricht University and Department Tranzo, Tilburg University.
3. School of Nursing and Midwifery, University of Southampton, UK
4. German Centre for Evidence-based Nursing, Martin Luther University, Halle-Wittenberg, Germany.
5. Wound Healing Research Unit, Cardiff University, Cardiff, UK.

Background

Existing guidelines on the prevention and treatment of pressure ulcers until now often give little advice with regard to nutritional interventions in PU (prone) patients. Therefore a multidisciplinary EPUAP working group on nutrition developed in 2004 a nutritional guideline on PU prevention and treatment.

The objectives of the working group after the development of the guideline were:

• to gain insight in the dissemination and implementation process of this nutritional guideline in The Netherlands, Germany and The UK;
• to gain insight in specific nutritional care within total PU care in The Netherlands, Germany and The UK; and
• to study whether nutritional care for PU patients in actual daily practice differs when using a nutritional guideline or not.

Methods

A cross sectional study was carried out in healthcare organizations in the Netherlands (NL), Germany (Ger), and the United Kingdom (UK). A printed standardized questionnaire following Rogers’ model of innovation-decision process was developed, translated, and distributed among 1087 healthcare organizations. Differences between the groups with and without guideline were tested with chi square test and ANOVA analysis.

Results

The response rate was 33% (n = 363). From all respondents 61.4% knew the guideline and 25.1% actually used the guideline in clinical practice (including it’s major topics such as the recommended nutritional screening and assessment).

Of the 363 organizations that participated in the study, 66.1% had nutritional guidelines for PU care available in daily practice. Differences between the two groups (with and without guidelines) were mostly on nutritional screening mainly done at regular intervals in the group with a guideline. In the guideline using group nutritional assessments focused more specifically and targeted on weight, weight history and BMI while nutritional interventions focused more on normal feeding and oral supplements as compared to the group using no guideline. The most important barriers to realize adequate nutritional support for PU (prone) patients in both groups were knowledge and skills, followed by lack of resources.

Conclusions

From these first results it can be concluded that EPUAP’s nutritional guideline has shown a very good dissemination degree among at least the UK and the Netherlands. Furthermore the main differences between the groups with and without a nutritional guideline used in daily practice, were on the areas of nutritional screening and assessment. The most important barriers in nutritional support in PU care were lack of knowledge and skills to perform adequate nutritional care.