DRAFT FOR CONSULTATION
Treatments for pressure ulcers
The paragraphs in the draft are numbered for the purposes of consultation. The final version will not contain numbered paragraphs.
Understanding NICE guidance – information for the public
Information for the public – pressure ulcers
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DRAFT FOR CONSULTATION
Contents About this information ......................................................................................3 Clinical guidelines.........................................................................................3 What the recommendations cover................................................................3 How guidelines are used in the NHS............................................................4 Pressure ulcers ................................................................................................4 What are pressure ulcers? ...........................................................................4 Your role in treatment ......................................................................................5 What you can expect from treatment in general...............................................5 Assessing your pressure ulcer .........................................................................6 Care and treatments ........................................................................................7 Changing position.........................................................................................7 Relieving pressure........................................................................................8 Using dressings............................................................................................8 Removing tissue from the sore.....................................................................9 Surgery.........................................................................................................9 Eating well ....................................................................................................9 Other treatments ........................................................................................10 Where you can find more information ............................................................10 If you want to read the other versions of this guideline...............................10 If you want more information about pressure ulcers...................................11 If you want to know more about NICE ........................................................11
Information for the public – pressure ulcers
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Information for the public – draft for consultation
About this information 1. This information describes the guidance that the National Institute for Clinical Excellence (called NICE for short) has issued to the NHS on pressure ulcers. It is based on ‘Pressure ulcers: the management of pressure ulcers in primary and secondary care’ (NICE Clinical Guideline No. [XX]), which is a clinical guideline produced by NICE for doctors, nurses and others working in the NHS in England and Wales. Although this information has been written for people with pressure ulcers, it may also be useful for family members, those who care for people with pressure ulcers and anyone interested in healthcare in general.
Clinical guidelines 2. Clinical guidelines are recommendations for good practice. The recommendations in NICE guidelines are prepared by groups of healthcare professionals, people representing the views of those who have or care for someone with the condition, and scientists. The groups look at the evidence available on the best way of treating or managing the condition and make recommendations based on this evidence. 3. There is more about NICE and the way that the NICE guidelines are developed on the NICE website (www.nice.org.uk). You can download the booklet ‘The guideline development process – an overview for stakeholders, the public and the NHS’ from the website, or you can order a copy by phoning the NHS Response Line on 0870 1555 455 (quote reference number N0472).
What the recommendations cover 4. NICE clinical guidelines can look at different areas of diagnosis, treatment, care, self-help or a combination of these. The areas that a guideline covers depend on the topic. They are laid out in a document called the scope at the start of guideline development.
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Information for the public – draft for consultation 5. The recommendations in ‘Pressure ulcers: the management of pressure ulcers in primary and secondary care’, which are described here, cover the diagnosis and treatment of pressure ulcers in adults, young people and children who are seen by a GP or in hospital. 6. The information that follows tells you about the NICE guideline on pressure ulcers. This booklet doesn’t attempt to explain pressure ulcers or the treatments in detail. NHS Direct is a starting point to find out more. Phone NHS Direct on 0845 46 47 or visit the website (www.nhsdirect.nhs.uk or www.nhsdirect.wales.nhs.uk). 7. If you have questions about the specific treatments and options covered, talk to a healthcare professional.involved in your care.
How guidelines are used in the NHS 8. In general, healthcare professionals in the NHS are expected to follow NICE’s clinical guidelines. But there will be times when the recommendations won’t be suitable for someone because of his or her specific medical condition, general health, wishes or a combination of these. If you think that the treatment or care you receive does not match the treatment or care described on the pages that follow, you should talk to a healthcare professional involved in your treatment. 9. You have the right to be fully informed and to share in making decisions about your healthcare, and the care you receive should take account of your individual needs.
Pressure ulcers What are pressure ulcers? 10. People who are most at risk of getting pressure ulcers are the elderly, people who are seriously ill and confined to bed, and people who have injuries to their spinal cord.
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Information for the public – draft for consultation 11. Pressure ulcers can be very serious. Without treatment pressure ulcers can damage not only the skin, but also the deeper layers of tissue under the skin. Pressure ulcers may cause pain, or having them may mean a longer stay in hospital. Severe pressure ulcers can destroy the muscle or bone underneath the skin, so they can take a very long time to heal. In extreme cases, pressure ulcers can become life-threatening, as they can become infected, sometimes causing blood poisoning or bone infections. 12. There are other names for pressure ulcers. For example, your doctor may say that you have pressure damage, a pressure injury or a decubitus ulcer.
Your role in treatment 13. NICE recommends that healthcare professionals work together with patients so that patients can play an active part in making decisions about their care, and that the treatment offered to them should take into account each patient’s individual needs. 14. This means you should be given information that you can understand so you can talk about your choices for treatment with your healthcare team. If you wish, your carers should also be involved in helping you make decisions about your treatment, if you want them to be.
What you can expect from treatment in general 15. If you have a pressure ulcer your healthcare team will use a range of treatments and approaches to try to keep your pressure ulcers from getting worse and to heal them. There are many different healthcare professionals involved in the treatment of pressure ulcers, including GPs and nurses. Their approach to your care may include many different treatment options, which should be discussed with you fully prior to treatment decisions being made. As part of this strategy, your healthcare team should look at, draw or photograph your pressure
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Information for the public – draft for consultation ulcer, try and understand why you got it and then write this down in your plan for treatment. 16. Your treatment may include the use of mattresses or cushions and other equipment that relieve the pressure on the area where you have your pressure ulcer. Any other illnesses you have may also be treated so that they do not stop your sore from healing and new ulcers from developing.
Assessing your pressure ulcer 17. Your pressure ulcer should be assessed as soon as possible after it appears and then again at regular intervals. A trained healthcare professional should check on your pressure ulcer at least once a week, but sometimes this will happen more often. 18. There are different ways to assess how severe a pressure ulcer is. NICE recommends that your healthcare team grade the seriousness of a pressure ulcer using a scale developed by the European Pressure Ulcer Advisory Panel. Scores on this scale range from 1 to 4, where 1 is the least severe and 4 is the most severe. 19. If your pressure ulcer is at stage 1, you may have a reddened area of skin that does not go away and the skin may feel warm. At stage 4, you will have an open ulcer, and the damage to the tissue will also affect the muscle or bone under the skin. 20. In addition to using this grading scheme, your healthcare team will also keep a written record of whether the sore is getting smaller or larger and how deep it is. 21. Your healthcare team should also look at other factors that may affect your recovery. The healthcare team will call these ‘holistic’ factors. These are: •
how healthy you are generally
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Information for the public – draft for consultation •
how well you are able to move around
•
how your posture affects your pressure ulcer
•
whether you have had pressure ulcer before
•
whether you are in pain
•
whether you have an infection that needs to be treated
•
your ability to look after yourself and your need for support
•
whether you have sight or hearing problems
•
whether your home is set up in a way that will prevent you from getting pressure ulcers or help the ones you have to heal.
Care and treatments Changing position 22. If you have a pressure ulcer, one of the most important steps in treating it is to change your position regularly. This applies to people sitting in chairs or wheelchairs, as well as to those in bed. It is also important to stay as active as possible. If you are in hospital or a nursing home and are unable to change your position or move about on your own then someone should help you. If you are at home, then your carer may need to help. 23. How often you need to change position or move about will depend on how severe your pressure ulcer is and where it is on your body.You should never be in a position where you are lying or sitting directly on your pressure ulcer. You should also never be in a position where most of your weight is on a part of the body where bones are close to the skin, such as your hips or shoulder blades. If you are being cared for in hospital, your healthcare team should record of how often someone helps you change position or move around.
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Information for the public – draft for consultation
Relieving pressure 24. There are other ways to relieve the pressure on your pressure ulcer. For example, using mattresses or cushions that have been specially designed for people with pressure ulcers may help you. A healthcare professional who has been trained to treat patients with pressure ulcers should work with you to decide which types of support are best for you. 25. This decision about which type of support to use should be based on a number of factors including: •
how severe your pressure ulcer is
•
where the pressure ulcer is on your body
•
your general health
•
how comfortable the support is for you
•
whether you can change position on your own or whether there is someone who can help you change position.
26. If you have pressure ulcers you should have 24-hour access to the types of equipment, such as mattresses and cushions, that work best for you. And you should be re-examined regularly to find out whether your needs have changed and another type of support would work better, for example if your sores are starting to heal. 27. Young children who have pressure ulcers will need to be assessed especially carefully to determine which types of support will help them. This is because most supports are designed for adults so these supports may be less comfortable for children or may not work as well for them.
Using dressings 28. Sometimes you may need other treatments, especially if your pressure ulcer is more severe.
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Information for the public – draft for consultation 29. Your pressure ulcer may need to be covered with a dressing to help it heal. There are many different types of dressings that can be used. A trained healthcare professional will decide which type is best for you in the treatment of your pressure ulcer. 30. The things that affect which type of dressing is used include: •
how severe your pressure ulcer is
•
whether you have had pressure ulcers before and whether a particular dressing seemed to work well for you
•
whether a dressing is comfortable for you.
Removing tissue from the sore 31. In some cases it may be necessary to remove dead tissue from the ulcer to encourage it to heal. This type of treatment is called debridement. It can be done with dressings or it may involve cutting away areas of dead tissue. This can be performed at the bedside, but it may require an operation in hospital.
Surgery 32. If your pressure ulcer does not heal you may need to have surgery to close the wound. Usually, you will not have surgery unless other treatments have been tried first.
Eating well 33. Someone on your healthcare team should assess whether you are eating well and getting all the nutrients that you need. You could talk to a dietician and he or she may suggest making changes to your diet in order to keep you as healthy as possible.
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Other treatments 34. In some cases, you may be offered other treatments in addition to standard care. One type of treatment uses electrical stimulation to encourage pressure ulcers to heal. Another type of treatment is known as negative pressure therapy which helps new tissue to grow.
Where you can find more information 35. If you need further information about any aspects of pressure ulcers or the care that you or a family member are receiving, please ask any member of the healthcare team providing that care. You can discuss the NICE guideline on pressure ulcers with them, especially if you aren’t sure about something in this booklet.
If you want to read the other versions of this guideline 36. [Note: the information in this paragraph and the next one will apply when the guideline is published] There are four versions of this guideline: •
this one
•
the full guideline, which contains all the details of the guideline recommendations and how they were developed, and information about the evidence on which they were based
•
a version called the NICE guideline, which lists all the recommendations on pressure ulcers
•
the quick reference guide, which is a summary of the main recommendations in the NICE guideline for healthcare professionals.
37. All versions of the guideline are available from the NICE website (www.nice.org.uk/CGXXX). This version and the quick reference guide are also available from the NHS Response Line – phone 0870 1555 455 and give the reference number(s) of the booklets you want (N0XXX for
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Information for the public – draft for consultation this version in English, N0XXX for this version in English and Welsh, and N0XXX for the quick reference guide).
If you want more information about pressure ulcers 38. NHS Direct may also be a good starting point for finding out about pressure ulcers. You can call NHS Direct on 0845 46 47 or visit the website (www.nhsdirect.nhs.uk or www.nhsdirect.wales.nhs.uk). 39. There may be support groups in your area for people with disabilities or long-term illnesses – people who may be at risk of developing pressure ulcers. Your healthcare team should be able to give you more details. Information about local groups may also be available from NHS Direct or your local library or Citizens Advice Bureau.
If you want to know more about NICE 40. For further information about the National Institute for Clinical Excellence (NICE), you can visit the NICE website (www.nice.org.uk). At the NICE website you can also find information for the public about other guidance that may be relevant for people with pressure ulcers or pressure ulcers: •
National Institute for Clinical Excellence (2003) Pressure ulcer prevention - Pressure ulcer risk assessment and prevention, including the use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care.
41. These can also be ordered from the NHS Response Line (phone 0870 1555 455). [Smart numbers to be added]
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