Clinical Practice Guidelines for Intervention and Care of People with Pressure Ulcers or Risk of Suffering

Purpose: Elaborate a clinical practice guideline based on scientific evidence to guide decision making health team, in terms of prevention, intervention, treatment, recovery and rehabilitation of people with pressure ulcers or present the risk of suffering.

Methods:  Review of the scientific literature in the years 2009-2014 in the bibliographic resources MEDLINE, EMBASE, Scielo, Science Direct, Scopus and CUIDEN, with descriptors: pressure ulcer, nursing care, prevention and control, diagnosis, treatment. Additionally, Snow Ball methodology was used to extend and complement the search. For the elaboration of recommendations made a process of critical analysis of scientific literature found, taking into account the recommendations of the board Agency for Healthcare Research and Quality of the US Department of Health & Human Services.

Results: 152 research articles were considered for the development of the guideline, which were grouped into different chapters: 34 articles in the introduction, 7 items approach the definition of pressure ulcers, 30 articles about prevention, 11 articles related with the patient assessment, 26 articles of diagnosis and assessment of pressure ulcer, 34 articles on the treatment and 10 articles related to nursing process in person with pressure ulcer.

As for the practices related to prevention, found that the risk assessment is through the use of scales for assessing the risk of pressure ulcers also essential to be taken into account such important aspects as the assessment and skin care, especially with the use of hyper-oxygenated fatty acids, among other technologies for the prevention of skin lesions; the assessment and nutritional care; control of excess moisture; effective management of pressure through physical mobility and position changes, protection of bony prominences and the use of special surfaces for pressure management. It is important to implement educational programs in preventing pressure ulcers, including both the patient, family and health care team to lessen their impact on the quality of life of people with this type of injury.

In relation to patient assessment, was found to is important evaluate the intrinsic and extrinsic factors of the person who has or is at risk of pressure ulcer and to evaluate their health related quality of life and the pain impact.

For the diagnosis and assessment of pressure ulcers was found that is necessary doing a good identification of the stage of the ulcer and to assess the characteristics of the wound through different mechanisms with the aim of establishing actions for prevention or treatment.

Among the interventions for the treatment of pressure ulcers, tools were found to guide the preparation of the wound bed as the TIME instrument (Tissue, Infection, Moisture, Edges). For the control of non-viable tissue there are different types of debridement as: autolytic, enzymatic, biological (larval) and surgical for which must take into account the patient's health conditions and characteristics of the wound. Wound infection can be controlled through the use of various dressings containing honey, silver ions and antiseptics such as polyhexanide. As for the stimulation of the ulcers healing, there are a variety of technologies such as the use of dressings, pulsatile lavage, electrostimulation, polarized light therapy, treatment with natural substances and negative pressure therapy. It is important to consider nutritional support with formulas that provide the nutrients needed to promote the healing process.

Regarding the nursing process was found to be an important methodology for planning integral care for people with pressure ulcers, taking into account the use of nursing taxonomies which give security as efficiency and cost-effectiveness of nursing practice. The most frequent nursing diagnoses found in people with this type of injury are associated with activity and repose (impaired physical mobility and self-care deficit) and safety and protection (impaired skin integrity, tissue and risk for infection).

Conclusion:  The elaboration of clinical practice guideline is of great importance for the development of nursing as a profession and standardizes interventions both in prevention, treatment and rehabilitation of people with pressure ulcers. The implementation of this guideline is essential to guide and provide effective, efficient and quality care for people with pressure ulcers or at risk of suffering from a comprehensive and holistic approach in order to improve their quality of life related to health. Is expected to Clinical Practice Guideline can be used by all health professionals in Colombia, after their respective review and publication.