Excerpt

Prevention of pressure ulcers usually involves an assessment to identify people most at risk of pressure ulcers, such as elderly, immobile people or those with spinal cord injury. Assessments are most commonly carried out using specific pressure area risk scores (for example, the Braden or Waterlow scales for predicting pressure sore risk or the, Glamorgan scale for paediatric pressure ulcers).

Pressure ulcers are assessed, and potential treatment options include wound dressings, debridement, physical therapy, antibiotics and antimicrobials. Mobilising, positioning and repositioning interventions, and support surfaces are used in combination with other wound management strategies. Nutritional assessment is usually carried out so that nutritional deficiencies can be addressed.

Surgical interventions for debridement or to obtain coverage with skin flaps may be performed in some patients. If poor circulation is a contributory factor, vascular surgical intervention may be used. Infection may also be treated if it is a contributory factor to the persistence of the ulcer or is causing systematic illness or cellulitis.

There is variation in the consistency of approach to pressure ulcer prevention, and to treatment and care of established pressure ulcers across the NHS in both secondary and primary care. There is a need for guidance to rationalise the approaches used for prevention, treatment and care of pressure ulcers, and to ensure practice is based on the best available evidence.

Contents

• Guideline Development Group members
• Acknowledgements
• Pressure ulcer prevention
  • 1. Introduction
  • 2. Development of the guideline
    • 2.1. Remit
    • 2.2. Who developed this guideline?
    • 2.3. What this guideline covers
    • 2.4. What this guideline does not cover
    • 2.5. Relationships between the guideline and other NICE guidance
  • 3. Methods
    • 3.1. Developing the review questions and outcomes
    • 3.2. Searching for evidence
    • 3.3. Evidence of effectiveness
    • 3.4. Evidence of cost effectiveness
    • 3.5. Developing recommendations
  • 4. Delphi consensus methods
    • 4.1. Modified Delphi consensus methodology
    • 4.2. Round 1
    • 4.3. Round 2
  • 5. Guideline summary
    • 5.1. Algorithms
    • 5.2. Key priorities for implementation
    • 5.3. Full list of recommendations
    • 5.4. Key research recommendations
  • 6. Pressure ulcer prevention
    • 6.1. Introduction
  • 7. Risk assessment
    • 7.1. Introduction
    • 7.2. Recommendations and link to evidence
  • 8. Skin assessment
    • 8.1. Introduction
    • 8.2. Review question: What is the clinical and cost effectiveness of skin assessment methods in the prevention of pressure ulcers?
    • 8.3. Review question: What is the predictive ability of skin assessment tools for pressure ulcer development?
    • 8.4. Part 2
    • 8.4.2. Economic evidence (adults)
    • 8.4.3. Clinical evidence (neonates, infants, children and young people)
    • 8.4.4. Economic evidence (neonates, infants, children and young people)
    • 8.4.5. Evidence statements
    • 8.5. Recommendations and link to evidence
  • 9. Repositioning
    • 9.1. Introduction
    • 9.2. Review question: How and at what frequency should repositioning be undertaken for the prevention of pressure ulcers?
    • 9.3. Recommendations and link to evidence
  • 10. Skin massage
    • 10.1. Introduction
    • 10.2. Review question: What is the clinical and cost effectiveness of skin massage and rubbing in the prevention of pressure ulcers?
    • 10.3. Recommendations and link to evidence
  • 11. Nutritional supplements and hydration strategies
    • 11.1. Introduction
    • 11.2. Review question: What are the most clinically and cost-effective nutritional interventions for the prevention of pressure ulcers?
    • 11.3. Recommendations and link to evidence
  • 12. Pressure redistributing devices
    • 12.1. Review question: What are the most clinically and cost-effective pressure re-distributing devices for the prevention of pressure ulcers?
    • 12.2. Recommendations and link to evidence
  • 13. Pressure redistributing devices for the prevention of heel pressure ulcers
    • 13.1. Introduction
    • 13.2. Review question: What is the clinical and cost effectiveness of pressure redistributing devices for the prevention of heel pressure ulcers?
    • 13.3. Recommendations and link to evidence
  • 14. Barrier creams
    • 14.1. Review question: What are the most clinically and cost-effective topical barrier preparations for the prevention of pressure ulcers and moisture lesions?
    • 14.2. Recommendations and link to evidence
  • 15. Information for patients and their carers
    • 15.1. Introduction
    • 15.2. Review question: What information is required for patients/carers to prevent the occurrence of pressure ulcers?
    • 15.3. Recommendations
  • 16. Training and education of healthcare professionals
    • 16.1. Introduction
    • 16.2. Review question: What training and education is required for healthcare professionals to prevent the occurrence of pressure ulcers?
    • 16.3. Recommendations and link to evidence
  • 17. Reference list
  • 18. Acronyms and abbreviations
  • 19. Glossary
• Pressure ulcer management
  • 1. Guideline summary
    • 1.1. Algorithms
    • 1.2. Key priorities for implementation
    • 1.3. Full list of recommendations
    • 1.4. Key research recommendations
  • 2. Pressure ulcer treatment
    • 2.1. Introduction
  • 3. Pressure ulcer measurement
    • 3.1. Introduction
    • 3.2. Review question: What are the most reliable techniques/tools to measure the dimensions of a pressure ulcer?
    • 3.3. Recommendations and link to evidence
  • 4. Categorisation of pressure ulcers
    • 4.1. Introduction
    • 4.2. Review question: What is the best method of categorising different types of pressure ulcers?
    • 4.3. Recommendations and link to evidence
  • 5. Nutrition and hydration
    • 5.1. Introduction
    • 5.2. Review question: What are the most clinically and cost-effective nutritional interventions for the treatment of pressure ulcers?
    • 5.3. Recommendations and link to evidence
  • 6. Pressure redistributing devices
    • 6.1. Introduction
    • 6.2. Review question: What are the most clinically and cost effective pressure redistributing devices for the management of pressure ulcers?
    • 6.3. Recommendations and link to evidence
  • 7. Adjunctive therapies
    • 7.1. Negative pressure wound therapy (NPWT) - introduction
    • 7.2. Review question: What is the clinical and cost effectiveness of negative pressure wound therapy for the treatment of pressure ulcers?
    • 7.3. Hyperbaric oxygen therapy
    • 7.4. Review question: What is the clinical and cost-effectiveness of hyperbaric oxygen therapy for the treatment of pressure ulcers?
    • 7.5. Electrotherapy
    • 7.6. Review question: What is the clinical and cost effectiveness of electrotherapy for the treatment of pressure ulcers?
    • 7.7. Recommendations and link to evidence
  • 8. Debridement
    • 8.1. Review question: What are the most clinically and cost effective methods of debridement of non-viable tissue for the treatment of pressure ulcers?
    • 8.2. Maggot (larval) therapy
    • 8.3. Review question: What are the most clinically and cost effective methods of maggot debridement of non-viable tissue for treatment of pressure ulcers?
    • 8.4. Recommendations and link to evidence
  • 9. Systemic antibiotics
    • 9.1. Review question: What are the most clinically and cost effective systemic agents for the treatment of pressure ulcers?
  • 10. Topical antimicrobials and antiseptics
    • 10.1. Review question: What are the most clinically and cost effective topical agents for the treatment of pressure ulcers?
    • 10.2. Recommendations and link to evidence
  • 11. Dressings
    • 11.1. Review question: What are the most clinically and cost effective dressings for the treatment of pressure ulcers?
  • 12. Management of heel pressure ulcers
    • 12.1. Review question: What is the most clinically and cost-effective method for management of pressure ulcers of the heel?
    • 12.2. Recommendations and link to evidence
  • 13. References
  • 14. Acronyms and abbreviations
  • 15. Glossary
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Review protocols
  • Appendix D. Clinical article selection
  • Appendix E. Economic article selection
  • Appendix F. Literature search strategies
  • Appendix G. Clinical evidence tables
  • Appendix H. Economic evidence tables
  • Appendix I. Forest plots
  • Appendix J. Excluded clinical studies
  • Appendix K. Excluded economic studies
  • Appendix L. Cost effectiveness analysis
  • Appendix M. Research recommendations
  • Appendix N. Delphi consensus results
  • Appendix O. Risk assessment and skin assessment
  • Appendix P. Dressings

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.