The Prevention and Management of Pressure Ulcers in Primary and Secondary Care

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
  • 3. Methods
  • 4. Delphi consensus methods
  • 5. Guideline summary
  • 6. Pressure ulcer prevention
  • 7. Risk assessment
  • 8. Skin assessment
  • 9. Repositioning
  • 10. Skin massage
  • 11. Nutritional supplements and hydration strategies
  • 12. Pressure redistributing devices
  • 13. Pressure redistributing devices for the prevention of heel pressure ulcers
  • 14. Barrier creams
  • 15. Information for patients and their carers
  • 16. Training and education of healthcare professionals
  • 17. Reference list
  • 18. Acronyms and abbreviations
  • 19. Glossary
• Pressure ulcer management
  • 1. Guideline summary
  • 2. Pressure ulcer treatment
  • 3. Pressure ulcer measurement
  • 4. Categorisation of pressure ulcers
  • 5. Nutrition and hydration
  • 6. Pressure redistributing devices
  • 7. Adjunctive therapies
  • 8. Debridement
  • 9. Systemic antibiotics
  • 10. Topical antimicrobials and antiseptics
  • 11. Dressings
  • 12. Management of heel pressure ulcers
  • 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.