Do Systematic Reviews Connect with Daily Practice in Wound Care?

Wednesday, 1 August 2012

Anne M. Eskes, MSc, RN1
Marja N. Storm-Versloot, MSc2
Hester Vermeulen, RN, PhD3
Dirk T. Ubbink, MD, PhD3
(1)Department of Quality Improvement and Process Innovation, Academic Medical Center, University of Amsterdam and Amsterdam School of Health Professions, Amsterdam, Netherlands
(2)Department of Surgery, G3-151, Academic Medical Center, Amsterdam, Netherlands
(3)Department of Quality Assurance & Process Innovation, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands

Learning Objective 1: The learner will understand that many patients receive care that contradicts available convincing evidence, while another group of patients receive care that is contra-indicated.

Learning Objective 2: The learner will be able to explain that awareness and use of scientific evidence is essential for effective treatment choices in wound care.

BACKGROUND    The evidence-based practice paradigm promotes evidence-based decision-making for and with patients in clinical practice. Nowadays, (Cochrane) systematic reviews offer an overview of best available evidence. However, reality shows that many patients receive care that is not in accordance with available compelling research evidence, while other patients may even receive care that is contraindicated. The aim of this study was to determine if care providers make evidence-based decisions in wound care.

METHODS   This national survey in the Netherlands included doctors (e.g. (plastic) surgeons, dermatologists, and general practitioners), nurses, and specialized wound care nurses involved in wound care.  We determined general awareness and use of evidence, based on (Cochrane) systematic reviews, for wound care products in open wounds and burns.

RESULTS   We included 231 care providers. Doctors (n=88) preferred conventional antiseptics (e.g. iodine), while nurses favoured modern products (e.g. silver). Most groups (except plastic surgeons and specialized nurses) considered silver as an evidence-based antiseptic. Notably, silver-containing products were mostly used by specialized nurses (n=57) (47/57;82%), although only few of them (9/55;16%) thought using silver is evidence-based. For burns, silver-sulfadiazine, paraffin gauze, and hydrofibre were most popular among all groups. The majority of groups considered using silver-sulfadiazine to be evidence-based, although this contradicts scientific results. Awareness and use of the Cochrane Library was lower among nurses (n=86) than among doctors (p<0.001). Awareness was higher (p=0.001) among specialized nurses than among (home care) nurses.

CONCLUSIONS   Present-day reality is that producing and disseminating systematic reviews with evidence-based recommendations for clinical practice do not result in more awareness and use of this evidence.  The finding that wound care products are being used despite contradicting evidence endorses this statement. The present availability of compelling evidence and the generally positive attitude toward evidence-based practice should make evidence-based decision-making in wound care possible.