Treatment of pressure ulcers: results of a study comparing evidence and practice

Pressure ulcers remain prevalent in hospitals and nursing homes despite the availability of evidence-based guidelines for prevention and care. To evaluate the level of evidence-based literature and its application in pressure ulcer treatment, a search was conducted of relevant English and German articles published between 1994 and 2002 using the key terms decubitus ulcer and its synonyms in different combinations with therapy, wound management, and specific wound treatment terms. Results were compared to wound dressing use data obtained from two pressure ulcer prevalence surveys conducted in 51 hospitals and 15 nursing homes in Germany in 2001 and 2002 (N = 11,584). Dressing usage evidence levels were reviewed and reported usage was classified as consistent or not consistent with existing guidelines or as evidence base unknown. Pressure ulcer prevalence rates ranged from 10.6% to 13.2% and the majority of pressure ulcers (60%) were Grade 1. In nursing homes, dressing selection was consistent with current evidence in 6.8% of Grade 1 and 27.8% of Grade 2 ulcers. In acute care facilities, dressing selection in 2001 and 2002 was consistent with current evidence in 21.6% and 38.5%, respectively, of Grade 1 ulcers and in 40.2% and 51.5%, respectively, of Grade 2 ulcers. Although strong evidence exists to support the use of dressings that facilitate moist wound healing, barely half of the grade 3 and grade 4 ulcers in all care settings received this treatment. While dressing classification limitations restricted the ability to analyze all treatment methods used, findings suggest that clinician knowledge deficits regarding evidence-based treatments remain. The literature review results also indicate the level of evidence for many practice recommendations remains low. Studies to increase evidence levels of pressure ulcer prevention and treatment as well as programs to improve awareness and implementation of current evidence-based guidelines are needed.