Assessing the Need for Developing a Comprehensive Content-Validated Pressure Ulcer Guideline
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Supporting evidence for PU care: construct validity. In addition to content validation, each AAWCGS member will search the MEDLINE, CINAHL, and EMBASE databases to identify and summarize three or more studies providing the best available evidence supporting each aspect of PU patient and wound management. Standardized strength of evidence ratings (see Table 3) adapted from prior AHRQ guidelines for PU care20,21will be utilized along with diagnostic and prediction criteria adapted from the American Society of Plastic Surgeons (ASPS) Scales for Rating Levels of Evidence and Grading Practice Recommendations. 22
When complete, all PUCI recommendations that meet the standardized content validity and/or strength of evidence criteria will be made available for free public use on the AAWC website, www.aawconline.org and, if accepted, on the NGC website, www.guideline.gov. Other content-validated algorithms have been published for venous ulcers41 and general wound care. 29 In addition, the need for professional education to prevent PUs has been validated. 42 The sole wound care guideline identified in this literature search with outcomes of its use validated as a standard in two prospective controlled clinical trials addressed venous ulcers. 43
Although still far from becoming a standard, the PUCI can grow and improve in content validity with input and review of the Ostomy Wound Management readership — people who qualify as having the interest and knowledge to rate the clinical relevance of these steps of PU care. Ostomy Wound Management readers, therefore, are encouraged to assist in PUCI development and content validation by rating clinical relevance of guideline items. This task should take less than 1 hour and may be done in intervals at the reader’s convenience by downloading the virus-free file. Evaluating the clinical relevance of PUCI items will serve as preparation for the final construct validation step of the process — ie, determining the level of best available evidence supporting each item. Participants also are invited to share Level A evidence with the authors for any aspect of PU care. The final validated guideline will be updated regularly to incorporate new evidence, offering a benchmark for professional PU care and reimbursement.
Guideline quality is characterized by clear, precise, unambiguous language with logical easy-to-follow recommendations annotated with the best available evidence. 12 In addition to previously published differences in existing PU guidelines, 11 the authors review of 11 published guidelines, including 10 on the NGC website and two draft guidelines, showed important variations in definitions, procedures, content, professional focus, evidence basis, and degree or methods of validation. By crafting and content-validating one unified guideline for all steps to PU care (the PUCI), the authors hope to increase clarity and clinical relevance of all PU steps of care. Finally, by summarizing the best available evidence supporting each step, construct validity that supports the efficacy of each step of PU management will be forged and will clarify which components of care or recommendations need further research.
The resulting PUCI guideline will be neither a consensus-based document nor a comprehensive systematic review of all literature supporting each aspect of care. As a compendium of objectively rated, best currently available evidence supporting all recognized aspects of PU care, the guideline will reduce confusion.