Does anyone remember “The Purple Book”? Those of us who have been in the wound care world for a while know it as the first pressure ulcer prevention guideline, a compendium of clinical practice recommendations published by the federal government. Released in 1992, it was the main “go-to” resource on this topic and was used by clinicians for many years.

What Was in the Purple Book?

In the 1990s, awareness of pressure injuries in hospitals and nursing homes was just beginning. The Agency for Health Care Policy and Research (AHCPR) commissioned a multidisciplinary panel of experts to develop the guideline, which was intended for clinicians who examine and treat persons at risk of developing pressure ulcers. It contained detailed recommendations for assessment and prevention, a decision-making algorithm, a glossary of terms, and a comprehensive list of references. Distributed free by the US Government, this book was a “must have” for anyone and everyone in the nascent field of wound care.

Rediscovering My Copy

I found my Purple Book in the bottom of a drawer when doing some cleaning. Although well used, it was in good shape, and brought back memories of my early career. The book was published just as I was beginning my first job as attending physician and director of research in a large nursing home in the Bronx. During my geriatric fellowship at Mount Sinai Medical Center I became interested in chronic wounds because many patients suffered with them but there was little information available on prevention and treatment. For those of us wanting to know more, this book was a huge gift.

Why the First Pressure Ulcer Prevention Guideline Still Matters

It’s amazing to reflect how the years have gone by so quickly, and how large and complex the wound care world has become. But the same challenges exist as three decades ago. As patients become older with complex medical needs, prevention of pressure injuries is of paramount importance. This involves knowledge of assessment of risk, the importance of nutrition, and the armamentarium of preventive devices.

Much has changed since 1992. In 2016, the National Pressure Injury Advisory Panel replaced the term “pressure ulcer” with “pressure injury,” and the organization itself became the National Pressure Injury Advisory Panel (NPIAP). The single federal guideline has given way to an International Guideline developed jointly by NPIAP, the European Pressure Ulcer Advisory Panel, and the Pan Pacific Pressure Injury Alliance, drawing on decades of research. Yet anyone who opens the Purple Book today will recognize its core principles in current practice.

Where to Find the Purple Book Today

The complete citation is Pressure Ulcers in Adults: Prediction and Prevention, Clinical Practice Guideline No. 3, published by the AHCPR (now the Agency for Healthcare Research and Quality) in the US Department of Health and Human Services, 1992. If you can’t find a printed copy for your library, this historic pressure ulcer prevention guideline is available free online from the National Library of Medicine.

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