Appraising and comparing pressure ulcer guidelines.
BACKGROUND
Whilst considerable activity has been related to guideline development for nurses regarding pressure ulcer prevention and management, no attempt has been made to comparatively evaluate these guidelines against some form of quality indicators.


OBJECTIVE
To compare and contrast four national pressure ulcer guidelines, and identify similarities and differences in their quality and content.


METHODS
An international comparative appraisal method, using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument, was undertaken to appraise four published pressure ulcer guidelines. Two further domains were added to the AGREE instrument to assess comparability of the guidelines and their perceived contribution to practice. An international group undertook the comparative appraisal.


RESULTS
The domain scores for each guideline show some but not total agreement among reviewers. One particular set of guidelines was identified as scoring highest in a majority of AGREE domains. Overall, evidence of variability exists between pressure ulcer guidelines and common areas of development to consider for all guidelines.


CONCLUSIONS
The results raise many questions concerning the "best" pressure ulcer guideline to use, particularly related to the AGREE scoring. Some notable shortcomings exist in all the pressure ulcer guidelines reviewed and these shortcomings need to be addressed from a quality perspective. However, other issues such as style of reporting and potential contribution to practice might more fully affect choice by practitioners as opposed to guideline developers.


CONCLUSIONS
Notable differences exist among the four guidelines that are possibly explained by different approaches to development and also because of different cultural factors and intentions for use. Whilst the AGREE tool identifies the quality of the guideline development process it still requires local engagement with practitioners to determine which guideline should be implemented.
Wimpenny
Peter
P
Joanna Briggs Collaborating Centre, The Robert Gordon University, Faculty of Health and Social Care, Gartdee Campus, Garthdee, Aberdeen, Scotland. p.wimpenny@rgu.ac.uk
van Zelm
Ruben
R
D019985:Benchmarking; D015400:Clinical Nursing Research; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000592:standards*; D015279:Organizational Culture; D017410:Practice Guidelines as Topic / Q000592:standards*; D003668:Pressure Ulcer / Q000451:nursing* / Q000517:prevention & control*