[Treatment of pressure sores: rarely based on guidelines]

The prevention and treatment of pressure sores is regulated by a variety of evidence-based standards and guidelines, however there appears to be a lag between the theoretical knowledge and the actual practice. During our retrospective follow-up study "Connection between cause and appearance of pressure sore", including 127 deceased patients with pressure sore (degree 2 or higher), we evaluated the pressure sore treatment on the basis of nursing documentation and patient records. Although only cases of high-grade pressure sore were taken into account, 7% of the cases had no records of therapeutic measures at all. In 9% of the cases there was evidence of obsolete methods of wound treatment. Modern bandage material was used in partial combination with granulation-inhibiting substances or dry pads, so that in 46% of the cases there was no granulation-supporting treatment of the wound. In 38% of the cases treatment was oriented to the phase of wound healing and met the requirements of the guidelines. In parallel to these analyses, nursing personnel (n = 256) and physicians (n = 245) were interviewed on the issue of pressure sore. Improvement measures were seen in further education (physicians 24.2%, nurses 36.3%), improving instrumental aids like mattresses or cushions (physicians 28.8%, nurses 28.9%), improving nursing care quality (physicians 33.3%, nurses 27.4%), and more staff (physicians 34.2%, nurses 6.7%). Vocational training for physicians and nurses, and also a better interdisciplinary cooperation, are necessary for a better implementation of pressure sore guidelines.