Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System

Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised definitions were the focus of a multidisciplinary consensus conference held in April 2016. As a result of stakeholder and public input, along with the consensus conference, important changes were made and incorporated into the new staging definitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised definition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised definition of a Stage 2 pressure injury seeks to clarify the difference between moisture-associated skin damage and injury caused by pressure and/or shear. The term suspected has been removed from the Deep Tissue Pressure Injury diagnostic label. Each definition now describes the extent of tissue loss present and the anatomical features that may or may not be present in the stage of injury. These important revisions reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development

Commentaries on Venous Leg Ulcers Diagnostic and Treatment Draft Guideline

A guideline on venous leg ulcer diagnosis and treatment was developed by a research team from the University of Pennsylvania School of Medicine, Philadelphia, Pa., in collaboration with an interdisciplinary panel of wound care clinicians. Working from a consensus statement based on a literature review, the authors developed preliminary algorithms, which were reviewed by a national advisory panel. The draft guideline was prepared, and the authors now seek national peer review to address whether it is clinically relevant, useful, and represents current practice. The entire diagnostic draft guideline was published in the April issue of Ostomy/Wound Management; the entire treatment draft guideline in the May issue. After peer review and pilot testing, the guideline will be modified and validated in prospective clinical trials. Published here are a summary of the draft guideline (prepared by Diane K. Langemo, PhD, RN, Professor of Nursing at the University of North Dakota College of Nursing, Grand Forks, N.D.), the draft algorithms, and commentaries from five reviewers contacted by Advances in Wound Care