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Unavoidable Pressure Injury: State of the Science and Consensus Outcomes

Edsberg, Laura E.; Langemo, Diane; Baharestani, Mona Mylene; Posthauer, Mary Ellen; Goldberg, Margaret

Journal of Wound, Ostomy and Continence Nursing: July/August 2014 - Volume 41 - Issue 4 - p 313–334
doi: 10.1097/WON.0000000000000050

In the vast majority of cases, appropriate identification and mitigation of risk factors can prevent or minimize pressure ulcer (PU) formation. However, some PUs are unavoidable. Based on the importance of this topic and the lack of literature focused on PU unavoidability, the National Pressure Ulcer Advisory Panel hosted a multidisciplinary conference in 2014 to explore the issue of PU unavoidability within an organ system framework, which considered the complexities of nonmodifiable intrinsic and extrinsic risk factors. Prior to the conference, an extensive literature review was conducted to analyze and summarize the state of the science in the area of unavoidable PU development and items were developed. An interactive process was used to gain consensus based on these items among stakeholders of various organizations and audience members. Consensus was reached when 80% agreement was obtained. The group reached consensus that unavoidable PUs do occur. Consensus was also obtained in areas related to cardiopulmonary status, hemodynamic stability, impact of head-of-bed elevation, septic shock, body edema, burns, immobility, medical devices, spinal cord injury, terminal illness, and nutrition.

Laura E. Edsberg, PhD, Director, Center for Wound Healing Research, Natural & Health Sciences Research Center, Associate Professor Natural Sciences Department, Daemen College, Amherst, New York.

Diane Langemo, PhD, RN, FAAN, Adjunct Faculty, University of North Dakota College of Nursing, Grand Forks.

Mona Mylene Baharestani, PhD, APN, CWON, FACCWS, Associate Chief, Wound Care & Research Programs, James H. Quillen Veterans Affairs Medical Center, Johnson City (Mountain Home), Tennessee, and Clinical Associate Professor, Quillen College of Medicine, Department of Surgery, Johnson City, Tennessee.

Mary Ellen Posthauer, BS, RDN, President, MEP Healthcare Dietary Services, Inc, Evansville, Indiana.

Margaret Goldberg, MSN, RN, CWOCN Wound Care Consultant, Delray Wound Treatment Ctr, Delray Beach, Florida.

Correspondence: Laura E. Edsberg, PhD, Center for Wound Healing Research, Daemen College, 4380 Main St, Amherst, NY 14226 (

The authors declare no conflict of interest.

© 2014 by the Wound, Ostomy and Continence Nurses Society.