Wound Care Today

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despite, in many cases, being a largely
avoidable injury with the right care
and early detection.
Back in 2009 the Department of
Health (DH) labelled pressure ulcers
as being ‘never events’ and in 2013
NHS England identified pressure
ulcer prevention as a priority under
domain 5 of the NHS outcomes
framework for 2014/15 (DH, 2013).
So, given the complexity and
demand around grading pressure
damage, it is not surprising that the
EPUAP/NPUAP/PPPIA guidance was
adopted throughout the UK (Beldon,
2014), presumably to establish
uniformity and to help capture real
data on the scale of the problem.
Yet, while healthcare professionals
in primary care might still be ‘coming
to grips’with this guidance, some
amendments have now been made
to the system outside of the joint
guidance from EPUAP/NPUAP/
PPPIA (2014), with the term pressure
injury replacing pressure ulcer and
updates to the previous stages.
However, rather than being
universally applauded, this move has
led to open debate and criticism as
to the rationale behind the changes,
in that flaws from the original
guidelines (such as the notion that
skin damage takes a top-down
approach from the epidermis to the
bone, when it can occur from within
the muscle layer [Bryant, 2016]),
rather than being addressed were
being perpetuated (Bohn, 2016;
Bryant, 2016; Schank, 2016).
Whatever view you might take
on the new staging system, the
advantage of healthcare professionals
being educated and trained to
competently stage pressure ulcers/
injuries with consistency across
healthcare settings is a given if
prevalence is to be reduced and
patient outcomes improved.
WOUND CARE TODAY 2016,Vol 3, No 1 5
WCT
Changes and improvements in clinical practice are necessary to improve the level and quality of
care being delivered especially to untoward harms. However, the idea of changing terminology
without addressing the harm does not seem to improve the level of care being delivered. In relation
to pressure ulcer guidelines, this is not the first time that terminological changes have been
introduced — not so long ago the term grading in pressure ulcers was abolished to be replaced
with category/staging. Up to this very day in most clinical settings pressure ulcers are still recorded
and reported as grades. The whole idea of EPUAP, NPUAP and PPPIA is to create a universal
consensus on how to reduce pressure ulcers, but I am not sure if this will be achieved by having a
battle on terminology.
Edwin T Chamanga, Tissue viability service lead, Hounslow and Richmond Community Healthcare NHS Trust
WOUND WATCH i
There are two main changes here that deviate from
the joint international guidance last published in
2014. The first is about the use of the term injury.
It’s important to remember the healthcare context in
the USA and the way that services are reimbursed
by healthcare insurers. The term ‘injury’ very clearly
points towards a negative event, whereas ‘ulcer’ may
represent a symptom of an organic disease process.
The other change is the addition of mucosal membrane
pressure injuries and medical device-related pressure injuries, along with the
detail provided in their definitions. There is some disparity around the UK
about how these two groups of tissue damage are reported and investigated,
these changes may help if adopted in the next revisions of the EPUAP
ratified guidance.
Michael Ellis, clinical nurse specialist in tissue viability; lecturer in
healthcare practice, Royal Devon and Exeter NHS Trust
REFERENCES
Beldon P (2014) How to accurately
identify and record pressure ulceration.
J Community Nurs 28(5): 33–40
Bohn G (2016) Pressure injury replaces
pressure ulcer: provider thoughts on
changes to pressure ulcer staging.
Ostomy Wound Manage 62(5): 46–7
Bryant R (2016) The revised pressure
ulcer staging criteria: where are we
going and why? J Wound Care
25(7): 1–3
Department of Health (2009) NHS
2010–2015: from good to great.
Preventative, people-centred, productive.
DH, London. Available online at:
system/uploads/attachment_data/
file/228885/7775.pdf
Department of Health (2013) NHS
Outcomes Framework for 2014/15. DH,
London. Available online: .
uk/government/uploads/system/
uploads/attachment_data/file/256456/
NHS_outcomes.pdf
EPUAP/NPUAP/PPPIA (2014)
Prevention and Treatment of Pressure
Ulcers: Quick Reference Guide.
Available online: .
org/wp-content/uploads/2014/08/
Updated-10-16-14-Quick-Reference-
Guide-DIGITAL-NPUAP-EPUAP-
PPPIA-16Oct2014.pdf
Reid K, Morrison M (1994) Towards a
consensus: classification of pressure
sores. J Wound Care 3(3): 157–60
Schank J (2016) Changing pressure
ulcer terms: consensus or conspiracy.
Ostomy Wound Manage 62(6): 1–7
Torrance C (1983) Pressure Sores:
aetiology, treatment and prevention .
Croom Helm, London