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The quality and clinical applicability of recommendations in pressure injury guidelines: A systematic review of clinical practice guidelines. 2021

Brigid M Gillespie, and Sharon Latimer, and Rachel M Walker, and Elizabeth McInnes, and Zena Moore, and Anne M Eskes, and Zhaoyu Li, and Lisette Schoonhoven, and Rhonda J Boorman, and Wendy Chaboyer
School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia. Electronic address: b.gillespie@griffith.edu.au.

BACKGROUND Pressure injuries are one of the most frequently occurring, yet preventable hospital-acquired adverse events. Given there are many clinical practice guidelines available on the prevention and treatment of pressure injuries, it is useful to understand the quality of these guidelines and the clinical application of their recommendations. OBJECTIVE To critically evaluate the quality and applicability of the recommendations in pressure injury prevention and treatment clinical practice guidelines. METHODS Systematic review, reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS We systematically searched the literature published from 2005 to 2020 using MEDLINE, EMBASE, CINAHL, the Cochrane Library, ProQuest and PubMed electronic databases, and nine guideline repositories. METHODS We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II (AGREE II) and AGREE Recommendation Excellence (AGREE-REX) tools. Overall % mean scores across AGREE II and AGREE-REX domains were calculated for each guideline. Clinical practice guidelines were then ranked in tertiles based on "high", "moderate" or "low" quality. The review protocol was registered in the International Prospective Register of Systematic Reviews. RESULTS Initial combined database and repository searches yielded 3247 documents. Of these,73 full text documents were reviewed. The final analysis included 12 complete guidelines and 14 related documents. Overall AGREE II scores ranged from 32% to 96% while AGREE-REX scores were generally lower ranging from 10% to 75%. Combined % mean scores across AGREE II and AGREE-REX criteria suggest that four guidelines were ranked as "high" (range 69% to 85%) and are recommended without modification. These included; the 2019 International Guideline, the 2016 Canadian Guideline, the 2014 NICE Guideline, and the 2013 Belgian Guideline. CONCLUSIONS There is disparity in the quality of the included guidelines, however four high quality guidelines are available. These guidelines could ideally be implemented in daily practice and adapted to local policies.

UI MeSH Term Description Entries
D002170 Canada The largest country in North America, comprising 10 provinces and three territories. Its capital is Ottawa.
D003668 Pressure Ulcer An ulceration caused by prolonged pressure on the SKIN and TISSUES when one stays in one position for a long period of time, such as lying in bed. The bony areas of the body are the most frequently affected sites which become ischemic (ISCHEMIA) under sustained and constant pressure. Bedsore,Decubitus Sore,Decubitus Ulcer,Pressure Injury,Pressure Sore,Bed Sores,Bed Sore,Bedsores,Decubitus Sores,Decubitus Ulcers,Injury, Pressure,Pressure Injuries,Pressure Sores,Pressure Ulcers,Sore, Bed,Sore, Decubitus,Sore, Pressure,Ulcer, Decubitus,Ulcer, Pressure
D016208 Databases, Factual Extensive collections, reputedly complete, of facts and data garnered from material of a specialized subject area and made available for analysis and application. The collection can be automated by various contemporary methods for retrieval. The concept should be differentiated from DATABASES, BIBLIOGRAPHIC which is restricted to collections of bibliographic references. Databanks, Factual,Data Banks, Factual,Data Bases, Factual,Data Bank, Factual,Data Base, Factual,Databank, Factual,Database, Factual,Factual Data Bank,Factual Data Banks,Factual Data Base,Factual Data Bases,Factual Databank,Factual Databanks,Factual Database,Factual Databases
D017410 Practice Guidelines as Topic Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. Clinical Guidelines as Topic,Best Practices,Best Practice

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