Report on NPUAP's 8th National Conference
AMID THE EXCITEMENT of the parades of Mardi Gras, The National Pressure Ulcer Advisory Panel (NPUAP) held its 8th National Conference in New Orleans, LA, from February 20 to 22, 2003. The theme of the program was "Pressure Ulcer Report Card: Education, Research, and Public Policy," with NPUAP board members, Mary Ellen Posthauer, RD, CD, LD, as conference chair and Mona M. Baharestani, PhD, RN, NP, CWOCN, CWS, and Joyce Black, PhD, RN, as program cochairs.
NPUAP's immediate past president, Courtney H. Lyder, ND, GNP, FAAN, began the program by summarizing the major findings of the NPUAP's report, "Pressure Ulcers in America: Prevalence, Incidence, and Implications for the Future." The report states that pressure ulcer (PrU) prevalence is approximately 15% and PrU incidence is roughly 7%.
In a separate session, Dr Lyder, who is a consultant to the Centers for Medicare and Medicaid Services (CMS) and Qualidigm (Quality Improvement Organization for Connecticut) and a member of the Medicare Patient Safety Monitoring System (MPSMS), described a new federal project by MPSMS. The MPSMS is developing a national database to examine patient safety in hospitals. Several indicators are being explored, such as adverse drug events and infections. Of interest to this conference, however, was the discussion of one of the newest indicators, the pressure ulcer indicator, which looks at the incidence and prevalence of PrUs in hospitals. Therefore, if a PrU develops in a hospital or progresses in a hospital, it may be considered an error. Dr Lyder noted that CMS is planning to construct a Web site focused on patient safety. He encouraged participants to check CMS's Web site, http://www.cms.gov, in the near future to learn more about this project.
Defining Deep Tisssue Injury
During the meeting, Dr Black noted that the NPUAP is in the process of studying the definitions of deep tissue injury and Stage I PrUs. The work of the Deep Tissue Injury Task Force continues. At present, 158 general review articles and other relevant articles have been identified and evaluated by project leaders to understand how deep tissue injury is considered in published papers. NPUAP hopes that this will initiate recommendations on how clinicians should describe deep tissue injury and how researchers should investigate this topic. Ultimately, this work will provide a foundation for a new NPUAP task force, which will evaluate current NPUAP stage definitions. NPUAP may solicit input on this in the future.
NPUAP's new president, Diane K. Langemo, PhD, RN, recognized 2 outstanding individuals who have made significant contributions to PrU prevention and treatment. Richard M. Allman, MD, of the Center for Aging at the University of Alabama, Birmingham, AL, received the 2003 Kosiak Award, named in honor of Michael Kosiak, MD, for his work on PrU etiology. Thomas P. Stewart, PhD, CEO of Gaymar Industries, Orchard Park, NY, received the new Founders Award, named in his honor. During his acceptance, Dr Stewart paid tribute to past and current NPUAP board members, as well as corporate and collaborating organizations, for their assistance in helping the NPUAP achieve its goals and mission. In keeping with the NPUAP's tradition of providing support for new researchers in the field of PrUs, Michael Ankrom, MD, of Johns Hopkins University School of Medicine, Baltimore, MD, received the 2003 NPUAP research award. Dr Ankrom's research will focus on the caloric and dietary needs of patients with PrUs.
Skin Care Champion
In other sessions, George Xakellis, MD, MBA, reminded clinicians of the importance of creating a skin care team and having a "skin care champion" with leadership commitment and skill to sustain the positive results from implementation of a prevention protocol. Barbara J. Braden, PhD, RN, FAAN, reinforced this concept by challenging participants with the following question: "Isn't it easier to say your care practices are adequate if you can show that you have treatment protocols that increase the intensity of intervention dependent upon the level of risk?" Dan Berlowitz, MD, MPH, also discussed NPUAP's efforts regarding reverse staging and how to use the Pressure Ulcer Scale for Healing (PUSH) tool to monitor PrU healing. Dr Baharestani reminded clinicians that timely and accurate documentation has a legal imperative.
The importance of nutrition in PrU prevention and healing was the focus of presentations by Dr Langemo and Ms Posthauer. Participants were urged to visit the NPUAP's Web site, http://www.NPUAP.org, to review the NPUAP's newest statement on nutrition and PrUs, which is posted in the frequently asked questions section. The NPUAP's international support surface initiative served as a frame of reference for a discussion of support surfaces by David M. Brienza, PhD, and Mary Jo Geyer, PhD, PT, CWS. George Taler, MD, promoted the importance of a community-wide system of integrated PrU care, and Spencer Van B. Wilking, MD, MPH, FACP, AGSF, reminded clinicians about the ethics and dilemmas of palliative care. Current adjunctive therapies were covered by Pamela G. Unger, PT, CWS, and interactive case studies were presented by the NPUAP panel, including Drs Black and Taler, Ms Posthauer, and Catherine Ratliff, RN, PhD, CWOCN, CS.
New this year, and in keeping with the conference theme, participants had the opportunity to complete a preconference and postconference survey about their individual PrU practice, their institution's practice, and their perception of PrU practice in the United States. A preliminary report card was then given during the closing session, with a more extensive report to follow from the NPUAP.
No program would be complete without the opportunity to network with colleagues, learn about new wound care products directly from exhibitors, and read the many posters on display. The incoming president of the European Pressure Ulcer Advisory Panel (EPUAP), Dr Denis Colin, was also in attendance.
The next NPUAP conference will be held in February 2005 in Las Vegas, NV.
"Isn't it easier to say your care practices are adequate if you can show that you have treatment protocols that increase the intensity of intervention dependent upon the level of risk?" - -Barbara J. Braden, PhD, RN, FAAN