This short report describes the development process and key recommendations of the new international pressure ulcer guidelines for prevention and treatment developed by EPUAP and NPUAP. Further key research and practical implications for pressure ulcer prevention and treatment are discussed.

Key innovations

• Development of joint international pressure ulcer guidelines by EPUAP and NPUAP
• Recognition of future goal to translate guideline recommendations into steps that can be implemented in each country or healthcare system.
• Development of a new and elegant model that may help to explain vulnerability to pressure ulcer development while seated, according to the body mass index (BMI).
• New research to illustrate the costs associated with pressure ulcers in the presence of malnutrition.

A MAJOR NEW INITIAITIVE

New international pressure ulcer prevention and treatment guidelines have been published recently by the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Ulcer Advisory Panel (NPUAP) in the US (link to press release). These guidelines, together with brief summaries (Fig 1), are available on the EPUAP website, with a summary of the prevention guideline recently disseminated through the EPUAP Review (available to EPUAP members) [1]. 

Fig 1: Quick reference guides are available from the EPUAP website. The full guidelines will be available from the NPUAP website

This major initiative has taken almost four-and-a-half years from the initial discussions regarding the value of standardised prevention and treatment guidelines between the US and Europe, to their release. With more than 1000 individuals participating directly in the guideline development, this has been the largest project attempted by both organisations to date.

The development process

The basis for the guidelines has been a detailed review of all pressure ulcer-related publications since the beginning of 1998, with earlier robust guidelines used to cover any literature published over 10 years ago. Each relevant publication has been reviewed by two EPUAP or NPUAP members and an evidence table created to summarise the content and conclusions of the paper. From these tables, draft guideline recommendations were developed by teams of working groups. More than 80 scientists and clinicians freely gave their time to review and build the guideline recommendations.

Guideline topics

The working groups covered a wide range of topics. In the prevention guideline these included:

• Pressure ulcer aetiology
• Risk assessment
• Skin assessment
• Nutrition
• Patient repositioning
• Use of support surfaces
• Special consideration of patients within operating theatres.

The treatment guideline covered a wider range of topics: pressure ulcer classification; assessment and monitoring of healing; nutrition in healing; pain assessment and management; support surfaces; wound cleansing; debridement; wound dressings; assessment and treatment of infection; biophysical agents; growth factors and biological dressings; surgical repair; and palliative care. The final treatment topic covered a scientific explanation of the principles of wound bed preparation and biofilms.