EPUAP Review 5/2 RIP - European Pressure Ulcer Advisory Panel

64
epuap News
EUROPEAN PRESSURE ULCER ADVISORY PANEL
from the Netherlands
A NEW EVIDENCE-BASED PRACTICE GUIDELINE
ON PRESSURE ULCER PREVENTION AND MANAGEMENT
IN 2002 new guidelines on pressure ulcer prevention
and management were released in the Netherlands.
These evidence-based guidelines built upon the literature
review conducted during the development of the
United States Agency for Health Care Policy and Research
(AHCPR) pressure ulcer guidelines issued in the early 1990s.
As such the new Dutch guidelines offer new insights into
the management of pressure ulcer prevention and management
given their foundation upon new research studies
and an awareness of literature published in languages other
than English. The European Pressure Ulcer Advisory Panel
would like to acknowledge CBO, Dutch Institute for Quality
in Health Care (Kwaliteitsinstituut voor de Gezondheidszorg)
CBO, PO Box 20064, 3502 LB Utrecht, the Netherlands
for their kind permission to present an edited version
of these new guidelines within the EPUAP Review. In
this issue we cover the methodological issues related to the
development of the new guidelines.
Why was the new guideline developed?
Recent years have seen greater focus upon the problem of
pressure ulcers in the Netherlands at a political and economic
level. For example political initiatives have included
a report on pressure ulceration to the Secretary of Health
and the Health Council. 1 This report was followed by a written
reply to the report’s conclusions submitted by the Health
Minister to the Dutch House of Commons. In parallel with
these political issues there has been a growth in the availability
of national epidemiological data 2 along with a
stronger awareness of the economic impact of pressure ulcers.
3–18 In the Netherlands approximately 13% of all patients
in teaching hospitals have pressure ulcers, the prevalence
then rises in home care (17%), general hospitals
(23%) and to about 30% in nursing homes 2 while the annual
spend on pressure ulcer care is about 600 million Euros
with a total population of 16 million. 16–17 These developments
have not occurred in a vacuum; Dutch demography
has changed over the past ten years with greater numbers
of elderly people, while the scientific basis for pressure ulcer
prevention and management has also advanced. Taken
together there was perceived to be a need to revise earlier
consensus texts developed in the Netherlands during the
mid 1980s, and to update the US AHCPR guidelines that
date from 1992. This update of the guideline was commissioned
by the CBO (Dutch quality organization for health
care) with all relevant interest groups represented in the
working group established to direct the guideline update.
What is the purpose of the new guideline?
Essentially the guideline must be appropriate for use in daily
medical, nursing and paramedical practice giving sound recommendations
and practical advice. All patient groups and
care settings are to be covered by the guideline’s recommendations
– both those with an elevated risk of developing
pressure ulcers and those with established pressure ulcers.
One important consideration was that the guideline
should seek to facilitate the co-ordination of care both within
and between institutions.
Definition of pressure ulceration used
throughout the guideline
In this guideline, ‘pressure ulcer’ should be considered to
refer to any tissue damage caused by mechanical loading
(pressure, shear and friction alone or in combination).
Developing the guideline
In 2000 a Working Group was formed to lead the development
of the new guideline (See Appendix 1 for composition
of the group) formed of society representatives and
active researchers. In particular this latter group comprised
of post-doctoral fellows drawn from the Netherlands and
Belgium and collectively known as the European Pressure
Ulcer Research Interest Group (EPURIG).
The working group first met on 11 May 2000 and separated
the guideline development into two phases – development
of the recommendations, and commentary from
appropriate stake-holders. The EPURIG members were
tasked to identify the relevant literature, review it and form
draft recommendations. The primary role of the scientific
society representatives was to provide comment upon these
draft recommendations. Studies to be included in the review
were to have been published since the AHCPR pressure
ulcer prevention guideline issued in 1992. Initially it
was anticipated that the latest date of publication to be covered
by the review was Summer 2000 but this process extended
to include new publications for a further twelve
months (Summer 2001). Throughout the review process
close co-operation was sought with relevant Dutch steering
committees and European and North American pressure
ulcer organizations (EPUAP and NPUAP).
During the initial meeting, the chair of the working
group proposed the guideline be divided into five sections
covering:
Volume 5, Number 2, 2003