Evidence-based guidelines for the prevention of pressure ulcers using pressure-relieving support surface for bedbound elderly

Abstract

Background Pressure ulcer prevention has been an important and a common health care problem in every health care setting. Pressure ulcers are the clinical situation that can be avoided. To prevent pressure ulcer, the main strategy is to reduce either the pressure contact time, or magnitude of pressure, between a patient and his or her support surface. Pressure-relieving support surfaces are shown to be effective in preventing the development of pressure ulcer with strong evidence support.

In Hong Kong, the low compliance of the ward staff to apply pressure-relieving support surfaces for at risk patients is compared with other countries. Therefore, a feasible evidence-based guideline of using pressure-relieving support surfaces to prevent pressure ulcers stands out from the multi-interventions pressure ulcer prevention guideline to maximize its effectiveness in this clinical issue.

Purpose Reviewing the needs in modifying the current clinical practice and guidelines in local setting, the aim of the dissertation is to develop evidence-based guidelines for prevention of pressure ulcers using pressure‐relieving support surface for bedbound elderly. The findings are used to develop recommendations for nursing guideline to prevent pressure ulcers through the utilization of pressure‐relieving support surface in Hong Kong public hospital setting.

Methods Four electronic databases published from 1937 to 2012 were searched. All the studies extracted were randomised controlled trials while focusing on using pressure-relieving support surfaces to prevent pressure ulcers of adult patients. The quality of each study was assessed by a methodology checklist, the Scottish Intercollegiate Guideline Network in order to justify the level of evidence of the studies’ internal validity.

Conclusion From the evidence, the clearest conclusion that can be drawn is that a range of pressure‐relieving mattresses and overlays in the prevention of pressure ulcers can outperform the standard hospital mattress. It can be applied to any health care settings. The reviewed studies have shown that pressure‐relieving mattresses are effective on at risk patients, especially they are in advanced age with low mobility. Therefore, this evidence-based guidelines will serve in the medical rehabilitation wards to reduce the number of elderly from developing pressure ulcer after using the pressure‐relieving supporting surfaces.