Preventing and Treating Pressure Ulcers
Pressure ulcers are one of the major healthcare burdens (Demarre, et al., 2015; Behrendt, et al., 2014). The treatment of this disease calls for high-quality health care practices, which results in additional costs and resources as well as an increased workload to the health providers (Palfreyman & Stone, 2015). Most of the treatment attempts of this disease are directed in promoting wound healing. Therefore, it is important to evaluate the viable practices that can prevent and treat pressure ulcers across the globe and reduce the high expenditures associated with this disease. As such, the aim of this paper is to provide a Clinical Practice Guideline (CPG) for the treatment and prevention of the pressure ulcers.
Scope and Purpose
The drive of this CPG is to deliver evidence-based recommendations for treating and preventing pressure ulcers that apply to all health care providers across the globe. Moreover, the CPG also aims at providing an evidence-based guidance on the efficient approaches of promoting the healing of pressure ulcers. In the attempt of achieving these goals, the guideline used the following research questions. What are the prevention and treatment measures that can be taken for the patients with pressure cancer? Which practices promote the healing of pressure ulcers? In this case, the guideline targets the individuals with pressure ulcers. The beneficiaries of the guideline are the nurses, hospitals, advanced practice nurses, health care provider, physicians, and patients.
Stakeholder Involvement
Any health care profession who facilitate the process of preventing and treatment of the pressure ulcers was a key stakeholder of this guideline. The involvement of these stakeholders was facilitated by availing the development process of the guideline in the guideline website. The stakeholders were notified of any new updates through emails where they were required to read and comment on the new update as well as providing new recommendations used to revise the guideline before approving the final recommendations.
Rigor of Development
The Guideline Development Group (GDP) used various clinical questions used to direct the literature search. The scientific literature on the prevention and treatment of pressure ulcers was searched in various electronic databases such as MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, PubMed, AMED, and CINAHL databases. The search criteria included the search dates from January 1st, 2008 to July 1st, 2013. The methodologist screened the search results to determine the relevant and irrelevant pieces of literature by determining the inclusion and exclusion criteria. The major inclusion criteria of the identified literature were availability of an abstract, peer-reviewed journal, and the article must have been addressing prevention or treatment of the pressure ulcers in human subjects. The exclusion criteria involved conducting a study with less than 10 participants, paper with insufficient details such as lack of an abstract, duplicating other research, and carrying research on non-human subjects.
The strength of the evidence obtained through these searches is that it identified clear-cut results with systematic literature review meeting the Cochrane methodology. In addition, the evidence in these forms of literature was supported by standard references and blinding. However, various limitations were evident in these studies where some of the sources did not offer consistent evidence with poor referencing standards; others had random trials with uncertain findings while other evidence from these sources did not specify the number of subjects used.
The potential benefit of the guidelines was that it identified the suitable treatment of the persons with pressure ulcers. However, during the development of this CPG, there were many side effects especially for those individuals who used systematic opioids as local irritation and itching were common. Besides, there was an increased risk during the CPG especially the iodine toxicity for the individuals with large wounds. This is because the risk of systemic absorption surges with a large use of iodine products.
The recommendation provided in the CPG is significantly supported by other studies that have focused on assessing the ways of treating and preventing pressure ulcers. The guideline discussed various wound care techniques such as cleansing pressure ulcers with potable water, or during the dress change as well as the use of the cleansing solutions with antimicrobials with debris or surfactants. Levine, Sinno, Levine, and Saadeh (2013) claimed that the use of wound cleansers is an effective strategy for treating and preventing pressure ulcers. This is important in removing foreign bodies from the wound as well as dead tissue (Sevine, et al., 2013). Moreover, the guideline has recommended for the debridement as a wound care. Palfreyman and Stone (2013) claimed that the wound debridement method used should be based on the clinical setting and the situation of an individual.
External experts reviewed the CPG before its publication. The process was facilitated where these experts provided a wide base of their opinion as they rated the strength of evidence. The small working groups (SWG) and guideline development group (GDG) members, as well as the other stakeholders, used these opinions before giving their opinion on each of the recommendation. The update process of this CPG was facilitated by presenting the new sections of the guidelines to the stakeholders who commented and made new recommendations on the possible changes to the guidelines before making a final update.
Clarity and Presentation
The guideline has clearly presented the recommendations of preventing and treating pressure ulcers. The major recommendations presented in the paper are divided into comprehensive individual summaries that cover both interventions for treatment and prevention, prevention, and treatment. These recommendations are easily identifiable throughout the guideline with each of the recommendation having its section and respective sub-categories. For each of the recommendation raised in the guideline, the strength of recommendation and evidence used is presented for ease of identifying the relevance of the recommendation. The guideline also reveals the various ways of managing to assess and managing pain as an intervention measure. Each of the practice is clearly described in the section of management.
Applicability
The application of the CPG presented is facilitated by the presence of facilitators and barriers. The patient consumer and caregivers have an essential role in facilitating the prevention of the pressure ulcers. The guideline reveals the role of the patient consumer in acquiring information and collaborate with the health professionals in the treatment and prevention of pressure ulcers. Another facilitator factor is the use of quality indicators through monitoring practices. The quality indicators are the ones that show a successful implementation of the guideline in delivering quality pressure ulcer treatment and prevention practices. Besides, the guideline has provided the advice on proper use of the guideline in the healthcare setting by specifying on the limitations and appropriateness of the guideline. In this case, the guideline has offered substantial information on areas where the recommendations should be used and others that it should not. The use of any of the provided recommendation in the guideline should be made using the available resources as well as the circumstances of the individual patient. The key monitoring criteria for the assessment of healing of the pressure ulcers patients using the assessment scales is making clinical judgments, as well as use of serial photographs and baseline to track the healing of pressure ulcers over time (Sibbald, et al., 2012; Qaseem, et al., 2015).
Editorial Independence
The funding bodies were prevented from influencing the development of the guideline by making sure that the financial contributions were made after the guideline development stage. In addition, there were possible conflicts of interests during the development of the guideline where the GDG together with SWG were likely to compete. In this case, these members were required to disclose the nature of any form of competition of interests, as it was an effective way of recusing them from decisions related to such a competition. Moreover, the involvement of the SWG members in the evaluation of a study and using them as authors would possibly raise conflict of interests. As a result, they were required to undertake an appraisal to avoid such conflict.
Summary
The guideline has effectively achieved its objectives by addressing the effective ways of preventing and treating pressure ulcers. With the access to a wide range of articles and studies that address the treatment and prevention of pressure ulcers, the guideline has presented appropriate recommendations that have been assessed by various stakeholders and external experts before being approved. As an advanced nurse, this practice is important in assessing the various forms of pressure ulcers and using the appropriate intervention practice to counter each of the identified issues.
References
Behrendt, R., Ghaznavi, A. M., Mahan, M., Craft, S., & Siddiqui, A. (2014). Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit. American Journal of Critical Care, 23(2), 127-133. https://dx.doi.org/10.4037/ajcc2014192
Demarré, L., Van Lancker, A., Van Hecke, A., Verhaeghe, S., Grypdonck, M., & Lemey, J. et al. (2015). The cost of prevention and treatment of pressure ulcers: A systematic review. International Journal of Nursing Studies, 52(11), 1754-1774. http://dx.doi.org/10.1016/j.ijnurstu.2015.06.006
Levine, S., Sinno, S., Levine, J.P., & Saadeh, P.B., (2013). Current thoughts of the prevention and treatment of pressure ulcers: using the evidence to determine fact or fiction. Annals of Surgery, 257(4), 603-608. https://dx.doi.org/10.1097/SLA.0b013e318285516a
Palfreyman, S.J., & Stone, P.W., (2014). A systematic review of economic evaluations assessing interventions aimed at preventing or treating pressure ulcers. International Journal of Nursing Studies, 52(3), 769-788. https://dx.doi.org/10.1016/j.ijnurstu.2014.06.004
Qaseem, A., Humphrey, L. L., Forciea, M. A., Starkey, M., & Denberg, T. D. (2015). Treatment of pressure ulcers: A clinical practice guideline from the American College of Physicians. Annals of internal medicine, 162(5), 370-379. doi: 10.7326/M14-1568
Sibbald, R. G., Goodman, L., Norton, L., Krasner, D. L., & Ayello, E. A. (2012). Prevention and treatment of pressure ulcers. Skin Therapy Lett, 17(8), 4-7. https://www.ncbi.nlm.nih.gov/pubmed/22949132
