Guidelines for the prevention of pressure ulcers

Abstract

The Wound Healing Society is a professional organization of physicians, nurses, physical therapists, basic scientists, clinical researchers, and industrial researchers dedicated to assuring that every patient receives optimal wound care. Its mission is to advance the science and practice of wound healing. To that end, the following comprehensive, evidence- and consensus-based guidelines were developed to address the Prevention of Pressure Ulcers. The guidelines are presented in generic terms; the details of specific tests, therapies, and procedures are the discretion of an interdisciplinary team of health care professionals who establish, implement, and evaluate policies and procedures directed at the prevention of pressure ulcers. PubMed, EMBASE, and CINAHL and the Cochrane Database of Systematic Reviews were searched and reviewed for evidence on pressure ulcer prevention. In addition, a search of health care databases for current evidence-based guidelines addressing the prevention of pressure ulcers was conducted using electronic and online resources. The panel classified studies based on whether the intervention being evaluated addressed pressure ulcer risk screening (PURS) and assessment (PURA), pressure ulcer prevention plans of care (PUPCP) (including interdisciplinary approaches), selection of support surfaces, friction and shear prevention, management of moisture and incontinence, nutrition, and patient and caregiver education. Evidence references for each standard are listed and coded. The code abbreviations for the evidence citations were as follows: The strength of evidence supporting a guideline is listed as Level I, Level II, or Level III using the following definitions: Level I: Meta-analysis of multiple RCTs or at least two RCTs supporting the intervention in the guideline or multiple laboratory or animal experiments with at least two clinical series supporting the laboratory results. Level II: Less evidence than Level I, but at least one RCT and at least two significant clinical series or expert opinion papers with literature reviews supporting the intervention. Experimental evidence that is quite convincing but without support by adequate human experience. Level III: Suggestive data of proof-of-principle, but lacking sufficient data such as meta-analysis, RCT, or multiple clinical series. 1. Pressure Ulcer Risk Screening (PURS) Preamble: Pressure ulcer prevention is an important issue in every health care setting. Pressure ulcers are areas of localized tissue destruction caused by unrelieved pressure, shear, and friction to the skin. Contributing risk factors increase the person's susceptibility to a complex etiology that causes pressure ulcers. Common risk factors have been identified: immobility, friction and shear, moisture, incontinence, poor nutrition, perfusion, age, skin condition, and altered level of consciousness. Individuals at high risk should be screened and assessed and efforts can be focused with interdisciplinary plans of care for preventing pressure ulcers in these patients. Patients who are at risk should be identified by PURS shortly after admission to a health care setting. 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