Guidelines for the prediction and prevention of pressure ulcers. The Agency for Health Care Policy and Research.

Abstract

Of the 26 recommendations made by the panel, only six (23 percent) have sufficient research data to warrant a level A or B strength of evidence rating. Thus expert opinion, while traditionally valuable for filling the gaps where research-based information is missing, is used more extensively than data to support the recommendations of this guideline. The literature on pressure ulcers is voluminous but of variable quality. After reviewing this literature, I am not surprised at the confusion and frustration that physicians feel when trying to prevent pressure ulcers. More research is needed to confirm or refute expert opinion on prevention of pressure ulcers. The guideline does, however, provide physicians five specific steps that can be used to prevent pressure ulcers in their patients: (1) perform a risk assessment on all bed- and chair-bound patients, (2) keep the pressure off the bony prominences of at-risk patients by using a turning schedule, (3) use a pressure-reducing mattress in the treatment of all at-risk patients, (4) avoid massage of bony prominences, and (5) encourage the development of institutional educational programs or skin care teams for the prevention and treatment of pressure ulcers. The remaining 20 recommendations are reasonable and can be applied selectively, but they are based on expert opinion and have not been shown to reduce the rate of pressure ulcers in well-designed research studies.