A protocol from the National Guideline Clearing House regarding evidence-based practice for the treatment and prevention of pressure ulcers was compared to the findings of three separate research studies. The first of these studies was aimed at ascertaining the effects of repositioning and comfort measures upon bedridden children, the second centered on establishing which techniques are best to prevent pressure ulcers in individuals who suffer from wounds, and the third was aimed at determining whether overlays or mattresses are more effective for preventing patients in ventilated intensive care from developing pressure ulcers. The protocol was consistent with the findings of all three studies.
Throughout the course of this paper, a protocol from the National Guideline Clearing House regarding evidence-based practice for the treatment and prevention of pressure ulcers will be discussed. Attention will be paid to detailing why it is important and how it impacts upon patients and nurses. An examination of whether or not this protocol is supported by three different items of research will also be provided.
This protocol states that states that risk assessments should be carried out in both inpatient and outpatient settings in order to assess the likelihood of pressure sores developing. When patients are being treated in an inpatient setting, skin inspections should be conducted within six hours of them being admitted and then every eight to twenty-four hours depending upon the nature of the patient. A plan for preventing pressure ulcers should be drawn up that includes interventions aimed at minimizing or eliminating shear and friction, using offloading to minimize pressure, managing moisture, and maintaining adequate hydration and nutrition. Patients should be regularly repositioned if it is possible to do so.
The protocol also states that the treatment of pressure ulcers should include evaluation and patient assessment, and that all treatments, interventions, skin inspection findings and risk assessments should be documented. In addition to these points, it also warns that special care and attention should be taken when using compression stockings on account of the fact that they can result in the impairment of the arterial function of lower extremities. The medical practitioners should rule out arterial diseases of the lower extremities before applying compression. Stockings should be fitted based upon measurements of the patient’s lower leg, calf and ankle length. Skin surfaces should be supported and bony prominences should be placed on wedges or pillows.
Other instructions contained within the protocol state that group I or II prevention mattresses should be used, the microclimate should be managed to minimize the risk of pressure ulcers, and the nutrition and hydration of the patient should be maintained at all times. It says that patients and caregivers should be educated on the correct positioning, dietary needs, ulcer prevention and the factors that cause pressure ulcers. The patient’s psychosocial needs should also be catered to and further services related to this area should be provided when necessary (Institute for Clinical Systems Improvement, 2012).
This protocol is important, as it outlines in detail the best practices regarding the prevention of pressure ulcers so as to provide patients with the maximum possible chance of avoiding developing these painful afflictions. It provides provisions for treating them if they do develop. It provides nurses with a systematic approach to preventing patients from developing this condition and clears up any ambiguities that might exist.
Pressure ulcers are extremely common, with a prevalence of between three and fourteen percent amongst inpatients. If elderly patients suffer from these afflictions then the chance of mortality is five times higher than it would be if they did not contract them (Enoch, Grey & Harding, 2006). Pressure ulcers can cause fatal septic infections that lead to thousands of deaths per year (Lee, Redelings & Sorvilo, 2005). It is therefore essential for nurses to follow all of the appropriate steps to prevent these ulcers from developing, hence the importance of the protocol.
Devi, Kaur and Kaur (2013) conducted a study in which the effects of repositioning and comfort measures upon bedridden children were evaluated. Purposive sampling was used to select the participants. They were regularly repositioned and provided with comfort measures including pillows, hand rolls and blanket rolls. The Braden scale was utilized in order to measure the risk of the children developing pressure ulcers at various different intervals. It was revealed that their risk had reduced severely by day six and many of them were discharged, indicating that the intervention had a significant effect upon their likelihood of developing pressure ulcers. However, limitations of this study include the fact that no control group was included in the study and different comfort measures were used for different children (Devi, Kaur & Kaur, 2013).
Harmod, Lee, Lo and Tsao (2013) conducted a study using a quasi-experimental design in which convenience sampling was used to select ninety patients who suffered from wounds from an SICU. A third of them were given regular repositioning and skin examinations, a third received hydrocolloid dressings on their wounds, and a third had them dressed with foam dressings. The aim of the study was to see which of these techniques was best at preventing pressure ulcers. The EPUAP ulcer classification system was used to rate occurrence of ulcers. The result was that repositioning and regular skin examinations were the most effective technique. A limitation of this study is that it was carried out in a clinical setting, meaning that it is not clear whether the results apply to other settings. It also did not include a control group (Harmod, Lee, Lo & Tsao, 2013).
Aguilar et al (2013) carried out a quasi-experimental study that used purposive sampling to select participants. It was aimed at determining whether overlays or mattresses are more effective at preventing patients in ventilated intensive care from developing pressure ulcers. The incidence of ulcers was ascertained via visually scanning for them at regular intervals. The results were that significantly fewer participants who had pressure mattresses were observed to develop ulcers. The limitation of this study was that the group who used the overlays performed worse for multiple health assessments at baseline, which might have skewed the results (Aguilar et al, 2013).
The results of Devi, Kaur and Kaur’s (2013) study support the section of the protocol that indicates that bony prominences should be held up using wedges or pillows and that skin surfaces should be supported. Harmod, Lee, Lo and Tsao’s (2013) findings support the section of the protocol that states that regular skin inspections should be carried out and the part that says that patients should be regularly repositioned if it is possible to do so. Aguilar et al’s results support the part of the protocol that refers to prevention mattresses. The protocol appears to reflect best practices.