The current state of evidence-based protocols in wound care

Clinical practice guidelines have blossomed in the last 10 years in medicine as well as wound care. The physician practicing wound care and attempting to use published clinical practice guidelines may, however, have difficulty judging the quality of these guidelines given legitimate concerns that many aspects of clinical practice guidelines are not being properly addressed.

Guidelines were located using the National Guideline Clearinghouse Web site, PubMed, and the Cochrane database for reviews on diabetic foot ulcers, venous ulcers, and pressure ulcers. The Appraisal of Guidelines for Research and Evaluation instrument was used to evaluate guidelines.

Search engines returned many irrelevant guidelines. Many guidelines would be difficult to evaluate by clinicians not versed in guideline evaluation and were cumbersome in format or were presented more as reference works. Too little attention is focused on such issues as clarity of presentation, consideration of multidisciplinary panels, stakeholder involvement, validity, testing, settings, resources required, cost impact, methods of addressing guideline implementation, and a means of tracking important criteria for feedback once the guideline is in the field. The venous and diabetic ulcer guidelines that were formally evaluated scored poorly in many of these areas despite using relatively sound methods for gathering and evaluating the evidence. Only the developers of one guideline made a commitment for regular update.

Although progress has been made in regard to wound care clinical practice guidelines, much more work will be required before such guidelines are highly accepted by wound care clinicians.