ACP develops practice guidelines for treatment/prevention of bedsores

The American College of Physicians has released two evidence-based guidelines for both the treatment and prevention of pressure ulcers that were published in Annals of Internal Medicine.

“Up to $11 billion is spent annually in the United States to treat bedsores and a growing industry has developed to market various products for pressure ulcer prevention. ACP’s evidence-based recommendations can help physicians provide quality care to patients while avoiding wasteful practices,” ACP President David Fleming, MD, MA, MACP, said in a press release.

David Fleming

Both sets of guidelines were based on systematic evidence reviews of existing literature (ie, Medline, Cinahl, etc.) through February 2014.

Risk factors and prevention

American College of Physicians (ACP) recommends physicians assess patients with the following risk factors for pressure ulcers: older age, black or Hispanic race, lower body weight, cognitive impairment, physical impairments, urinary or fecal incontinence, diabetes, edema, impaired microcirculation, hypoalbuminemia, malnutrition and other comorbid conditions which affect integrity and healing of soft tissue. Additionally, the use of the Braden, Cubbin and Jackson, Norton or Waterlow scales may help identify patients who are more likely to develop sores.

Patients at risk for pressure ulcers should receive advanced static mattresses or advanced static overlays instead of traditional hospital mattresses, as they have been shown to lower the risk for pressure ulcers, and are deemed more cost-effective. In contrast, the ACP advises against using alternating-air mattresses or alternating-air overlays, as there is no strong evidence that they prevents bedsores and are more expensive.

“More research is needed on the comparative efficacy of pressure ulcer risk assessment tools and their efficacy compared to clinical judgment,” Amir Qaseem, MD, PhD, MHA, FACP, director of the department of clinical policy at the American College of Physicians, and colleagues wrote.

Treatment Options

The ACP recommends the following for the treatment of bedsores:

use of hydrocolloid or foam dressings, rather than gauze dressings, to reduce wound size;
amino acid or protein supplements for the reduction of wound size; and
use of electrical stimulation, in addition to standard treatment, to accelerate wound healing.

The ACP noted that these recommendations should not override a clinician’s judgment and may not apply to every patient or situation.

In an accompanying editorial, Joyce Black, PhD, RN, CWCN, of the University of Nebraska Medical Center, Omaha, pointed out numerous weak spots in the ACP guidelines, including the absence of clinical evidence.

“Unlike the international guideline, the ACP guidelines contain only recommendations supported by evidence. This raises issues about the helpfulness of the recommendations at the bedside, where treatment decisions must sometimes be made in the absence of good evidence,” Black wrote. – by Casey Hower

References:

Qaseem A, et al. Ann Intern Med. 2015; doi:10.7326/M14-1567.

Qaseem A, et al. Ann Intern Med. 2015; doi:10.7326/M14-1568.

Black J. Ann Intern Med. 2015;doi:10.7326/M15-0190.

Disclosure: Qaseem reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.