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2/23/2015
1
2015 National Pressure Ulcer Advisory Panel | www.npuap.org
The History
of Pressure Ulcer
Guidelines
Janet Cuddigan, PhD, RN, CWCN, FAAN
Faculty Disclosures
Member of the International Guideline
Development Group.
No financial conflicts of interest.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org2
2/23/2015
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. Filled with interesting characters
2015 National Pressure Ulcer Advisory Panel | www.npuap.org3
..with many chapters
2015 National Pressure Ulcer Advisory Panel | www.npuap.org4
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and more chapters
1996, 2008, 2013 American Medical Directors Association
1998 European Pressure Ulcer Advisory Panel
2000 Consortium for Spinal Cord Medicine and Paralyzed Veterans of America
2001, 2014 Royal College of Nursing (National Institute for Clinical Excellence)
2001 Singapore Ministry of Health
2001 Australian Wound Management Association
2002, 2005, 2011 Registered Nurses of Ontario
2002 University of Iowa Gerontological Nursing Intervention Research Center
2015 National Pressure Ulcer Advisory Panel | www.npuap.org5
..and more chapters
2003, 2010 Wound Ostomy and Continence Nurses Society
2003, 2012 John A. Hartford Foundation Institute for Geriatric Nursing
2003 Danish Guideline
2008 Wound Healing Society
2010 Association for Advancement of Wound Care
2011 Trans Tasman Dietetic Wound Care Group
2012 Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury
www.guideline.gov2015 National Pressure Ulcer Advisory Panel | www.npuap.org6
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.developed over time
2015 National Pressure Ulcer Advisory Panel | www.npuap.org7
.influenced by Research, Education and Public Policy
2015 National Pressure Ulcer Advisory Panel | www.npuap.org8
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Agency for Health Care Policy and Research Pressure Ulcer Guidelines
2015 National Pressure Ulcer Advisory Panel | www.npuap.org9
19921995
Do you remember 92?
2015 National Pressure Ulcer Advisory Panel | www.npuap.org10
Top Song: Black or White Top Quote: You cant handle the truth!
$1.31
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How about 1995?
2015 National Pressure Ulcer Advisory Panel | www.npuap.org11
NCAA Football Champs: NebraskaBest Quote: Houston, we have a problem.
Top TV: ER, Seinfeld and Friends
$1.15
Established: December 19, 1989 by the Omnibus Reconciliation Act.
Goal: To enhance the quality, appropriateness and effectiveness of
health care services.
Criteria for Guideline Development
High volume
High cost
High variability in care practices
Sufficient evidence to inform guidelines2015 National Pressure Ulcer Advisory Panel | www.npuap.org12
Agency for Health Care Policy and Research
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Agency for Health Care Policy and Research Contributions
Cultivated the science of guideline development.
Planted the seeds for future guidelines.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org13
A Uniquely American Initiative
2015 National Pressure Ulcer Advisory Panel | www.npuap.org14
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1992 & 1995 AHCPR Guideline Panel
Nancy Bergstrom (Chair)
Richard Allman
Carolyn E. Carlson
William Eaglstein
Rita Frantz
Susan L. Garber
Davina Gosnell
Bettie S. Jackson
Mildred G. Kemp
Thomas A. Krouskop
Elena Marvel
George T. Rodeheaver
George C. Xakellis
Oscar Alvarez
M. Alisan Bennett
Mitchell V. Kaminski
Victor L. Lewis, Jr
JoAnn Maklebust
David J. Margolis
Steven Reger
Richard Salcido
Gary M. Yarkony
Janet Cuddigan, Panel
Manager & Research Analyst
2015 National Pressure Ulcer Advisory Panel | www.npuap.org15
Pressure Ulcers in Adults: Prediction and Prevention
1. Risk Assessment
Tools and Risk
Factors
2. Skin Care and
Early Treatment
3. Mechanical
Loading and
Support Surfaces
4. Education
2015 National Pressure Ulcer Advisory Panel | www.npuap.org16
1992
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Treatment of Pressure Ulcers
1. Assessment
2. Managing Tissue Loads
3. Ulcer Care
4. Managing Bacterial Colonization and
Infection
5. Operative Repair
6. Education
7. Quality Improvement
2015 National Pressure Ulcer Advisory Panel | www.npuap.org171995
Whats Special About the AHCPR Guidelines?
Government-sponsored initiative
Cultivated the science of guideline development.
Interdisciplinary Panel
Public forums
Review and critique at NPUAP meetings
Multi-user perspective
User-friendly implementation guides
In the public domain
Simple, but elegant.2015 National Pressure Ulcer Advisory Panel | www.npuap.org18
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Do you remember 2009?
2015 National Pressure Ulcer Advisory Panel | www.npuap.org19
World Series Champions: New York YankeesSuper Bowl: Pittsburgh SteelersNo. 1 Movie: AvatarTV Shows: NCIS, Football, Dancing with the Stars
$2.41
2009 NPUAP-EPUAP International Guideline
2015 National Pressure Ulcer Advisory Panel | www.npuap.org20
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.more interesting characters.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org21
2009 Guideline Development Group
Carol Dealey, EPUAP Chair
Michael Clark
Tom Defloor
Lisette Schoonhoven
Katrien Vanderwee
Anne Witherow
Janet Cuddigan, NPUAP Co-Chair &
Editor-in-chief
Diane K. Langemo, NPUAP Co-Chair
Mona Baharestani
Joyce Black
Evan Call
Mary Ellen Posthauer
2015 National Pressure Ulcer Advisory Panel | www.npuap.org22
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2009: First International Guideline
2015 National Pressure Ulcer Advisory Panel | www.npuap.org
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2009 EPUAP-NPUAP Guideline Translated Into.
Spanish
Hebrew
Swedish
German
Polish
Dutch
Japanese
Italian
Portuguese
Finnish
Turkish
Norwegian
French
Chinese
Hungarian
Belgian
Danish
2015 National Pressure Ulcer Advisory Panel | www.npuap.org24
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Translation Information
2015 National Pressure Ulcer Advisory Panel | www.npuap.org25
2009 Prevention Guideline
Etiology
Risk Assessment
Skin Assessment
Nutrition
Repositioning
Support Surfaces
Special Population: Patients in the
Operating Room
2015 National Pressure Ulcer Advisory Panel | www.npuap.org26
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2009 Treatment Guideline
Classification
Assessment & Monitoring Healing
Nutrition for Healing
Pain Assessment & Management
Support Surfaces for Treatment
Wound Bed Preparation & Biofilms
Cleansing
Debridement
Dressings
2015 National Pressure Ulcer Advisory Panel | www.npuap.org27
2009 Treatment Guideline (continued)
Assessment and Treatment of Infection
Biophysical Agents
Biological Dressings
Growth Factors
Surgery for Pressure Ulcers
Special Population: Individuals Receiving Palliative Care
2015 National Pressure Ulcer Advisory Panel | www.npuap.org28
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Whats Special About the 2009 Guidelines?
First international guideline
Peer reviewed on (almost) every continent
Sharing of research and best practice
Sharing of languages and cultures
First international pressure ulcer classification system
Put politics aside for the greater good
2015 National Pressure Ulcer Advisory Panel | www.npuap.org29
2014 International Guideline
http://internationalguideline.com/
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2014 International Guideline
2015 National Pressure Ulcer Advisory Panel | www.npuap.org31
. And more interesting characters
2015 National Pressure Ulcer Advisory Panel | www.npuap.org32
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2014 Guideline Development Group
Lisette Schoonhoven, EPUAP Chair
Michael Clark
Jan Kottner
Cees Oomens
Keryln Carville, PPPIA Chair
Pamela Mitchell
Siu Ming Susan Law
Ai Choo Tay
Diane Langemo, NPUAP Chair
Janet Cuddigan
Laurie McNichol
Joyce Stechmiller
Takafumi Kadono, Japanese Observer
Emily Haesler, Methodologist & Editor-
in Chief2015 National Pressure Ulcer Advisory Panel | www.npuap.org33
2014 International GuidelineHow much is new?
575 recommendations in the
guideline
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Whats New in 2014?
Background
Prevalence and Incidence of Pressure Ulcers
New Conceptual Model for Etiology
Prevention of Pressure Ulcers
Skin and Tissue Assessment
Emerging Therapies for Prevention of Pressure Ulcers
Interventions for Prevention and Treatment of Pressure Ulcers
Repositioning and Early Mobilization
Medical Device Related Pressure Ulcers
Heel Ulcers
Special Populations
Bariatric
Critically Ill
Spinal Cord Injured
Operating Room
Palliative Care
Pediatrics
Older Adults
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Whats New in 2014? (continued)
Implementing the guideline (new sections)
Facilitators, Barriers & Implementation Strategies
Health Professional Education
Patient Consumers and Their Caregivers
Quality Indicators for this Guideline
Future Research Needs
2015 National Pressure Ulcer Advisory Panel | www.npuap.org37
Lessons from the past.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org38
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We killed a lot of trees.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org39
207
812
348409
63154 130
308
15 2662
136
0
100
200
300
400
500
600
700
800
900
1992 1995 2009 2014
Number of Pages Per ReportTechnical Report Clinical Practice Guideline Quick Reference Guide
Bedside Care
ResearchEvidence-based
Guidelines
Education & Public Policy
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International collaboration enriches us all.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org41
Where Are We?
2015 National Pressure Ulcer Advisory Panel | www.npuap.org42
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The Future.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org43
THE BEST
WAY TO
PREDICT
YOUR
FUTURE..
IS TO
CREATE IT.
The Future.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org44
THE FUTURE
DEPENDS ON
WHAT YOU DO
IN THE
PRESENT!
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The Future.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org45
THE FUTURE
AINT WHAT IT
USED TO BE.
A Guideline Broad Enough to Encompass the World..
2015 National Pressure Ulcer Advisory Panel | www.npuap.org46
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..Bring It To the Bedside.
2015 National Pressure Ulcer Advisory Panel | www.npuap.org47
Levels of Change
D
Policy, Payment, Regulation & Accreditation
C
Organizations that house & support microsystems (macro & meso systems)
B
Small units of care delivery (microsystems)
A Experience of patients
Adapted from Berwicks Levels of Change. Quality of actions at B, C, D should be defined as the effects on A.
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How can Big Data facilitate the process?
2015 National Pressure Ulcer Advisory Panel | www.npuap.org49
Our Challenge for Today
1. Whats new?
2. How do I
bring it to
the
bedside?
2015 National Pressure Ulcer Advisory Panel | www.npuap.org50