Pressure ulcers and incontinence-associated dermatitis: effectiveness of the Pressure Ulcer Classification education tool on classification by nurses

Qual Saf Health Care. 2010 Oct;19(5):e3. doi: 10.1136/qshc.2008.028415. Epub 2010 Jul 29.


Context: Previous studies report that pressure ulcer classification and differentiation from incontinence associated dermatitis are difficult. Incorrect classification and differentiation result in incorrect prevention and treatment. Education is important to spread evidence-based insights about this topic and to improve classification skills.

Aim: To assess the effectiveness of the Pressure Ulcer Classification (PUCLAS) education tool. PUCLAS was developed by the PUCLAS Workgroup of the European Pressure Ulcer Advisory Panel.

Design: Randomised controlled trial.

Setting and participants: A convenience sample of 1217 Belgian, Dutch, British and Portuguese nurses.

Outcome measure: Correct classification of pressure ulcer photographs and differentiation from photographs of incontinence-associated dermatitis.

Results: Baseline, 44.5% of the photographs were classified correctly. In the post-test, the results in the intervention group were significantly higher (63.2%) compared with the control group (53.1%; p<0.001). The percentage of correct assessments of incontinence associated dermatitis (IAD) was 70.7% in the intervention group and 35.6% in the control group (p<0.001). The skill to differentiate IAD from pressure ulcers was significantly associated with the experimental intervention (OR 4.07, 95% CI 3.21 to 5.15, p<0.001).

Conclusion: The PUCLAS tool improved pressure ulcer classification and IAD differentiation significantly.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Dermatitis / classification*
  • Dermatitis / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nursing Staff / education*
  • Pressure Ulcer / classification*
  • Urinary Incontinence / complications*
  • Young Adult