Excerpt

NICE commissioned the NCC-NSC to develop a guideline on the use of pressure-relieving devices – specifically beds, mattresses and overlays – for the prevention of pressure ulcers for use in the NHS in England and Wales, to supplement the NICE inherited guideline on risk assessment and prevention, published in 2001. This followed referral of the topic by the Department of Health and the Welsh Assembly Government. This document describes the methods used to develop the guideline and presents the resulting recommendations. It is the source document for the NICE (abbreviated version for health professionals) and information for the public – patient –versions of the guideline, which are published by NICE. The guideline was produced by a multidisciplinary guideline development group and the development process was undertaken by the NCC-NSC.

The main objective of the guideline was to establish the most clinically and cost effective beds, mattresses or overlays for preventing pressure ulcers. Additional areas examined included: the evidence for linking risk assessment to allocation of pressure-relieving devices; differences between the various devices in terms of comfort and acceptability ratings, ease of use and adverse events; quality of life implications associated with the use of different pressure-relieving devices; the groups that are at particularly high risk of developing pressure ulcers; the costs of preventing pressure ulcers for both the health services and patients/carers and the costs to patients and carers of pressure-relieving devices.

Contents

• Guideline development group membership and acknowledgements
• Stakeholder involvement
• Terminology
• Abbreviations
• Glossary
• 1. Executive summary
• 2. Principles of practice and summary of guideline recommendations
  • 2.1 Principles of practice
  • 2.2 Summary of guideline recommendations
• 3. Background to the current guideline
  • 3.1 Clinical need for the guideline
  • 3.2 What are pressure ulcers?
  • 3.3 Groups at risk
  • 3.4 What are pressure-relieving devices?
• 4. Aims of the guideline
  • 4.1 Who the guideline is for
  • 4.2 Groups covered by the guideline
  • 4.3 Groups not covered by the guideline
  • 4.4 Health care setting
  • 4.5 Interventions covered
  • 4.6 Interventions not covered
  • 4.7 Guideline development group
• 5. Methods used to develop the guideline
  • 5.1 Summary of the development process
  • 5.2 Clinical effectiveness review methods
  • 5.3 Cost effectiveness review methods
  • 5.4 Submission of evidence process
  • 5.5 Evidence synthesis and grading
  • 5.6 Results of clinical effectiveness evidence retrieval and appraisal
  • 5.7 Results of cost effectiveness evidence retrieval and appraisal
  • 5.8 Results of quality of life evidence retrieval and appraisal
  • 5.9 Results of epidemiology evidence retrieval and appraisal
  • 5.10 Formulating and grading recommendations
• 6. Guideline recommendations, with supporting evidence
  • 6.1 Patient factors to consider in selecting a pressure-relieving device
  • 6.2 Minimum provision for all individuals vulnerable to pressure ulcers
  • 6.3 Patients at elevated risk of developing pressure ulcers
  • 6.4 Individuals undergoing surgery
  • 6.5 Repositioning and 24-hour approach to provision of pressure-relieving devices
  • 6.6 Using a co-ordinated, time-specified approach
  • 6.7 Education and information-giving
• 7. Recommendations for research
• 8. Audit criteria
  • 8.1 Objectives of an audit
  • 8.2 Individuals to be included in an audit
  • 8.3 Data sources and documentation of audit
• 9. Dissemination of the guideline
• 10. Validation
• 11. Scheduled review of the guideline
• 12 References
• Clinical Practice Algorithm
• Appendices
  • Appendix 1 Glossary of support surface equipment (Fiona Stephens, Project Co-ordinator, RCN pressure ulcer audit)
  • Appendix 2 General search strategies and databases searched
  • Appendix 3 Clinical effectiveness evidence table
  • Appendix 4 Quality checklists/Data extraction forms
  • Appendix 5 Quality assessment of trials included in clinical effectiveness review
  • Appendix 6 Characteristics of excluded studies (clinical effectiveness review)
  • Appendix 7 Cost/economic evidence table
  • Appendix 8 Quality of life evidence table
  • Appendix 9 Epidemiology evidence table (updates existing review of UK epidemiological data by Kaltenthaler et al. 2001)
  • Appendix 10 Meta-analysis figures

Guidelines commissioned by the National Institute for Clinical Excellence

Reprinted December 2004

Background: This work was undertaken by the National Collaborating Centre for Nursing & Supportive Care (NCC-NSC) and the guideline development group (GDG), which was formed to develop this guideline. Funding was received from the National Institute for Clinical Excellence (NICE). The NCC-NSC consists of a partnership between the Centre for Evidence-Based Nursing; the Centre for Statistics in Medicine; the Clinical Effectiveness Forum for Allied Health Professionals; Health Care Libraries (University of Oxford); College of Health; the Health Economics Research Centre; Royal College of Nursing; and the UK Cochrane Centre.

Disclaimer: As with any clinical guideline, recommendations may not be appropriate for use in all circumstances. One limitation of a guideline is that it simplifies clinical decision-making (Shiffman 1997). Decisions to adopt any particular recommendations must be made by practitioners in the light of: available resources, local services, policies and protocols, the patient’s circumstances and wishes, available personnel and devices, clinical experience of the practitioner, knowledge of more recent research findings.