It has long been recognised that pressure causes varying degrees of damage to the skin and underlying tissue. As such, experts have attempted to create tools that help to distinguish between these varying levels of damage. Since the National Institute for Health and Clinical Excellence (NICE) (2005) recommended the EPUAP/NPUAP system, it has been widely adopted in the UK.

The recent safety thermometer activity (Department of Health [DH], 2012a) recommends the most recent EPUAP (2009) version of grading (DH, 2012b). Having one national tool makes sense, as it makes data collection, comparisons between healthcare settings and measuring within research more meaningful.