Development of pressure ulcers is generally considered an indicator for quality of care, but questions regarding avoidability remain. In 2007, the United States Centers for Medicaid and Medicare Services classified full-thickness pressure ulcers as “never events,” meaning ulcers should never occur or are reasonably preventable. This classification raised the issue of whether are not the development of pressure ulcers can always be avoided.

On February 25, 2010, the National Pressure Ulcer Advisory Panel hosted a multidisciplinary conference to establish consensus on whether there are individuals in whom pressure ulcer development is unavoidable. Twenty-four organizations from various disciplines attended the conference, and unanimous consensus was reached over the following matters:

  • Most, but not all, pressure ulcers are avoidable;
  • Certain situations render pressure ulcer development unavoidable, including inability to maintain nutrition and hydration status and the presence of an advanced directive prohibiting artificial nutrition or hydration. These conditions do not make pressure ulcers inevitable, however, and the duty to provide preventive care remains; and
  • Pressure redistribution surfaces cannot replace turning and repositioning.

The conference attendees did not reach consensus regarding the use of medical devices in relation to their potential to cause skin damage or the standard of turning patients every two hours. It was determined that further research is needed to examine these issues.