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Conclusions
The European Pressure Ulcer Advisory Panel (EPUAP) has successfully undertaken
a pilot study of the prevalence of pressure ulcers across a limited number
of hospitals in five European countries. Overall the prevalence of pressure
ulcers was 18.1% (1078 of 5749 surveyed patients). Although differences
were seen in the prevalence reported across different countries these
cannot, by themselves, be used to mark differences in the quality or effectiveness
of the care delivered. Clearly the differences in prevalence proportion
which ranged from 8.5% to 22.9% may have been influenced by differences
in the patient population and their vulnerability to developing pressure
ulcers. For these reasons this report should not be used to compare and
contrast the occurrence of pressure ulcers across the surveyed hospitals.
Rather the main value in this pilot study has been the large scale testing
of a methodology through which the prevalence of pressure ulcers could
be recorded; this methodology appears sufficiently robust for the EPUAP
to recommend its adoption in future prevalence studies.
Across the 5947 surveyed patients, 143 (2.5%) were reported to experience
the most severe form of pressure ulcer highlighting that effective prevention
and treatment of pressure ulcers remains a high priority in acute care
across Europe. This survey attempted to identify the appropriateness of
the preventive care reported to be delivered; surprisingly few patients
apparently received fully appropriate interventions - with the percentage
receiving such care ranging from 0% (Italy), to 0.5% (Portugal), 1.8%
(Sweden), 2% (Belgium) with the highest percentage allocated appropriate
preventive care found in the United Kingdom. However even in the UK it
was noted that fewer than 10% of the surveyed patients received fully
adequate preventive care. These low percentages would suggest that there
is much scope for the improvement of pressure ulcer preventive care across
Europe.
Over several years our understanding of the burden of pressure ulcers
upon European health care systems has been undermined by the confusion
that exists when the epidemiological measures of incidence and prevalence
are discussed. It would appear that generally these indicators of the
occurrence of patients with pressure ulcers are often treated as being
interchangeable with little reflection upon the correct interpretation
of the information generated through prevalence or incidence data. For
this reason the EPUAP have supplemented our pilot work upon collecting
pressure ulcer prevalence data with a draft position statement setting
out the EPUAP view on the interpretation of prevalence and incidence along
with several practical suggestions to guide members towards appropriate
data collection and reporting. The development of this draft statement
was led by Dr Tom Defloor (Belgium) in conjunction with Gerrie Bours and
Lisette Schoonhaven (both from the Netherlands). The draft EPUAP statement
on pressure ulcer prevalence and incidence data is reproduced in this
issue of the EPUAP Review with the aim of stimulating debate regarding
its content.
Appendices
1) Members of the EPUAP Pressure Ulcer Prevalence Project Steering
Group.
Chair: Ms Gerrie Bours, University of Maastricht, Department of Nursing
Science, the Netherlands.
Professor Gerry Bennett, East London Wound Healing Centre, Royal London
Hospital, United Kingdom.
Dr Michael Clark, Wound Healing Research Unit, University of Wales College
of Medicine, United Kingdom.
Mrs Carol Dealey, Nursing and Therapy Research Unit, University Hospital
Birmingham NHS Trust, Birmingham, United Kingdom.
Dr Tom Defloor, University of Gent, Department of Nursing Science, Belgium.
Mrs Jacqui Fletcher, University of Hertfordshire, United Kingdom.
Dr Ruud Halfens, University of Maastricht, Department of Nursing Science,
the Netherlands.
Dr Sylvie Meame, Groupe Hospitalier Charles Foix-jean Rostand, France.
2) Elements of the care allocated to patients considered
to mark fully appropriate pressure ulcer preventive care.
A patient was deemed to receive fully appropriate preventive care if they
were allocated one of the following combinations
- powered device in bed and powered device in chair
- powered device in bed and non-powered device in chair
and repositioning in chair every two or three hours
- powered device in bed and bedfast (activity Braden
scale)
- non-powered device in bed and repositioning in bed
every two, three or four hours and powered device in chair
- non-powered device in bed and repositioning in bed
every two, three or four hours and non-powered device in chair and repositioning
in chair every two or three hours
- non-powered device in bed and repositioning in bed
every two, three or four hours and bedfast (activity Braden scale)
- no device in bed and repositioning in bed every two
hours and powered device in chair
- no device in bed and repositioning in bed every two
hours and non-powered device in chair and repositioning in chair every
two or three hours
- no device in bed and repositioning in bed every two
hours and bedfast
3) EPUAP Pressure Ulcer Prevalence Data Collection
Instrument.
The EPUAP Minimum Data Set collection form is reproduced below.
4) The EPUAP Pressure Ulcer Classification System.
The full-colour visual guide to Pressure Ulcer Grading is reproduced at
the end of this issue.
© EUROPEAN PRESSURE ULCER ADVISORY PANEL, 2002.
Above: Appendix 3 The EPUAP Minimum
Data Set collection form
Above: Appendix 4 The EPUAP
Pressure Ulcer Classification System -
the full colour visual guide to Pressure Ulcer Grading used for the
Pressure Ulcer Prevalence Monitoring Project.
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