2Development of the guideline

2.1. Remit

NICE received the remit for this guideline from the Department of Health as part of the guideline review cycle. They commissioned the NCGC to produce the guideline. It was commissioned as an update of; ‘Pressure ulcers’, NICE clinical guideline 29 (2005), ‘Pressure ulcer prevention’, and NICE clinical guideline 7 (2003), available from www.nice.org.uk/guidance/CG29 and www.nice.org.uk/guidance/CG7.

The updated documents have been amalgamated into 1 guideline which will replace CG29 and CG7.

2.2. Who developed this guideline?

A multidisciplinary Guideline Development Group (GDG) comprising professional group members and consumer representatives of the main stakeholders developed this guideline (see section on Guideline Development Group Membership and acknowledgements).

The National Institute for Health and Clinical Excellence (NICE) funds the National Clinical Guideline Centre (NCGC) and thus supported the development of this guideline. The GDG was convened by the NCGC and chaired by Professor Gerard Stansby in accordance with guidance from the NICE.

The group met every 4-6 weeks during the development of the guideline. At the start of the guideline development process all GDG members declared interests including consultancies, fee-paid work, share-holdings, fellowships and support from the healthcare industry. At all subsequent GDG meetings, members declared arising conflicts of interest, which were also recorded (Appendix B).

Members were either required to withdraw completely or for part of the discussion if their declared interest made it appropriate. The details of declared interests and the actions taken are shown in Appendix B.

Staff from the NCGC provided methodological support and guidance for the development process. The team working on the guideline included a project manager, systematic reviewers, health economists and information scientists. They undertook systematic searches of the literature, appraised the evidence, conducted meta analysis and cost effectiveness analysis where appropriate and drafted the guideline in collaboration with the GDG.

2.3. What this guideline covers

This guideline covers the following populations:

• People of all ages, including all adults and children. Guideline developers paid specific attention to the needs of different subgroups, including different age groups.

This guideline covers the following healthcare settings:

• Primary care settings, including general practices, healthcare centres and polyclinics, community care settings where NHS care is provided or commissioned, including the persons' home and secondary care settings where NHS care is provided or commissioned.

The guideline developers noted that, although the guideline is commissioned for the NHS, people providing care in other settings, such as private settings, may find the recommendations relevant.

This guideline covers the following clinical issues:

• Risk assessment, including the use of risk assessment tools and scales and scales.
• Skin assessment.
• Prevention of pressure ulcers, including the use of barrier creams, the use of pressure relieving devices, skin massage and rubbing, positioning and repositioning, nutritional interventions and hydration strategies.
• Assessment and grading of pressure ulcers.
• Management of pressure ulcers, including debridement, the use of pressure relieving devices, nutritional interventions and hydration strategies, antimicrobials and antibiotics, dressings, management of heel pressure ulcers and other therapies, such as electrotherapy, negative pressure wound therapy and hyperbaric oxygen therapy.
• Patient/carer education and education and training for healthcare professionals.

For further details please refer to the scope in Appendix A and review questions in Chapter 3.1

2.4. What this guideline does not cover

This guideline does not cover:

• Prevention and management of ulceration caused by ischemia or neuropathy.
• Prevention and management of venous leg ulcers.
• Prevention and management of pressure ulcers caused by devices.
• Prevention and management of Kennedy terminal ulcers.

2.5. Relationships between the guideline and other NICE guidance

This guideline will update and replace:

• Pressure ulcers. NICE clinical guideline 29 (2005). Available from www.nice.org.uk/guidance/CG29
• Pressure ulcer prevention. NICE clinical guideline 7 (2003). Available from http://www.nice.org.uk/guidance/CG7
• Multiple sclerosis. NICE clinical guideline 8 (2003). Available from www.nice.org.uk/guidance/CG8 (recommendations on pressure ulcers only)