Pressure ulcers can't always be prevented. That's the official word from the National Pressure Ulcer Advisory Panel (NPUAP), which met at a conference in February at the Johns Hopkins Medical Center in Baltimore, Maryland. The multidisciplinary voting panel, comprising 24 experts in pressure ulcer prevention and treatment, unanimously agreed that some patient situations make pressure ulcers unavoidable. Examples include patients who refuse to cooperate with repositioning and those with hemodynamic instability that precludes turning or repositioning. In addition, the panel agreed, a condition called "skin failure" can occur.

The term pressure ulcer (also known as bedsore or decubitus ulcer) is defined as a localized injury to the skin or underlying tissue (or both), usually over a bony prominence, as a result of pressure or pressure in combination with shear. Several contributing factors are associated with the development of these ulcers-not all of which are under the control of caregivers, according to the NPUAP.

The voting panelists agreed on a revised definition of "unavoidable skin ulcers," as follows:

Unavoidable means that the individual developed a pressure ulcer even though the provider had evaluated the individual's clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with individual needs, goals, and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate.

Expert consensus on this issue is significant for nurses because they're typically the first professionals to examine any skin lesion and are primarily responsible for preventive care. The development of pressure ulcers is commonly seen as a direct reflection of the quality of nursing care. Indeed, the occurrence of pressure ulcers in long-term care facilities and nursing homes has often been viewed as evidence of neglect and has increasingly been the subject of litigation.

Visit http://www.npuap.org for the panel's position statement on staging. A full report of the NPUAP's consensus conference is forthcoming.-Laura Wallis