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## Complete Summary

#### GUIDELINE TITLE

SOLUTIONS® wound care algorithm.

#### BIBLIOGRAPHIC SOURCE(S)

ConvaTec. SOLUTIONS wound care algorithm. Princeton (NJ): ConvaTec;
2005. 8 p.

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Acute and chronic wounds including arterial, diabetic, pressure, venous,
or mixed arterial-venous ulcers

#### GUIDELINE CATEGORY

Evaluation\
Management\
Risk Assessment\
Treatment

#### CLINICAL SPECIALTY

Dermatology\
Family Practice\
Geriatrics\
Internal Medicine\
Physical Medicine and Rehabilitation\
Plastic Surgery\
Podiatry

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Health Care Providers\
Nurses\
Physical Therapists\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To facilitate health care professionals\' decision making by providing
stepwise management and evaluation strategies for wound care

#### TARGET POPULATION

Patients with acute and chronic wounds

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Assessment for signs and symptoms of infection

2.  Evaluation of depth, surrounding skin, and wound edges

3.  Cleansing and debridement of wound (autolytic, enzymatic, or
    surgical debridement)

4.  Wound dressing (moisture retentive dressing, wound hydration,
    exudate management)

5.  Reduction of risk factors for developing chronic ulcers and delayed
    healing

6.  Patient education and support

7.  Treatment of infections, as needed

8.  Assessment and management of wound pain and odor

9.  Re-evaluation

#### MAJOR OUTCOMES CONSIDERED

Wound healing

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The development of the initial algorithms, and their subsequent content
validation in 2001, is based on evidence obtained from Medline and
CINHAL literature searches for the time period between 1992 and 2001.
The Medline search was updated again in 2005, covering the period
2001-2005. No further changes to the algorithm were required as a result
of that search.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review\
Review of Published Meta-Analyses

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Other

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Two validated wound assessments were used as the basis for wound care
decisions (e.g., (1) Maintain a moist wound environment. (2) Absorb
excess exudate. (3) Hydrate a dry wound). Wound assessments guiding
treatment choices included the validated Pressure Sore Status Tool
(PSST) and an adaptation of that tool, the Bates-Jensen Wound Assessment
Tool (BWAT).

Two cross-sectional quantitative content validation surveys (see the
\"Availability of Companion Documents\" field) assessed and analyzed the
content validity of wound care decisions based on PSST and BWAT
assessments respectively. They both used a 4-point Likert scale to rate
clinical relevance of each item in the algorithm: 1=not relevant,
2=unable to assess relevance without further information; 3 = relevant
but needs minor attention (specified in comments section); 4=very
relevant and succinct.

The survey results were used to formulate the recommendations.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

Published cost analyses were reviewed from the literature. Kerstein et
al (2001) was identified as an appropriate model for conducting the
economic analysis. Telemedicine costs (the most costly format for
Solutions® algorithms in the cohort study) were added to 12-week healing
costs reported in the model. Using the most common wound dressing
applied during the prospective cohort study, (i.e., the hydrocolloid
dressing DuoDERM) would save U.S. \$969 for every pressure ulcer healed
during 12 weeks or \$766 for every venous ulcer healed, as compared to
gauze.

#### METHOD OF GUIDELINE VALIDATION

Clinical Validation-Trial Implementation Period

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Each step in the Solutions® algorithms was formally content validated by
wound care professionals (44 wound care nurses in 1998--1999). The final
version was again content validated by a multidisciplinary group of 21
invited global opinion leaders in wound care, including physicians of
varying specialties, nurses, and other wound care specialists. This
process also measured clinical healing outcomes during real-world use of
the algorithms.

See the \"Availability of Companion Documents\" field.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

The recommendations for wound care are presented in the form of 8
algorithms. Each algorithm corresponds to one of the following observed
wound assessments:

-   [Dry wound, minimal moisture: \>25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_1.html)

-   [Dry wound, minimal moisture: \<25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_2.html)

-   [Moist-lightly exuding: \>25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_3.html)

-   [Moist-lightly exuding: \<25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_4.html)

-   [Moist-moderately exuding: \>25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_5.html)

-   [Moist-moderately exuding: \<25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_6.html)

-   [Wet-heavily exuding: \>25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_7.html)

-   [Wet-heavily exuding: \<25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_8.html)

#### CLINICAL ALGORITHM(S)

Eight (8) detailed clinical algorithms are provided in the original
guideline document for:

-   [Dry wound, minimal moisture: \>25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_1.html)

-   [Dry wound, minimal moisture: \<25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_2.html)

-   [Moist-lightly exuding: \>25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_3.html)

-   [Moist-lightly exuding: \<25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_4.html)

-   [Moist-moderately exuding: \>25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_5.html)

-   [Moist-moderately exuding: \<25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_6.html)

-   [Wet-heavily exuding: \>25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_7.html)

-   [Wet-heavily exuding: \<25% necrotic tissue/fibrin
    slough](http://www.guideline.gov/algorithm/4749/NGC-4749_8.html)

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Appropriate wound management and evaluation strategies

-   Appropriate implementation of chronic wound risk factor assessment
    and risk reduction programs and interventions

-   Prevention of wound complications

-   Improved rates of wound healing

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   The cohort study did not include exclusion criteria, so the
    algorithms were used on all wounds deemed clinically appropriate
    including pressure, venous, diabetic and arterial ulcers as well as
    non- or slowly-healing surgical or other acute wounds.

-   The cohort study used mainly ConvaTec hydrocolloid, alginate or
    Hydrofiber® primary wound dressings with use of less than 5% gauze
    dressings. Less acceptable outcomes may result from substituting
    other products or gauze as the primary wound dressing.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Clinical Algorithm

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

ConvaTec. SOLUTIONS wound care algorithm. Princeton (NJ): ConvaTec;
2005. 8 p.

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1994 (revised 2004; reviewed 2005)

#### GUIDELINE DEVELOPER(S)

ConvaTec - Public For Profit Organization

#### SOURCE(S) OF FUNDING

Funding for development of this guideline was provided through
educational grants from ConvaTec, a Bristol-Myers Squibb Company and
through National Institutes of Health (NIH) funding (NIH Grants
1R43NR003474-01 and 1R43NR007717-01).

#### GUIDELINE COMMITTEE

Not stated

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Lia van Rijswijk, MSN, CWCN, Adjunct Associate Professor of Nursing;
Janice Beitz, PhD, RN, CS, CNOR, CWOCN, Associate Professor of Nursing;
Laura Bolton, PhD, Adjunct Assoc Professor, Surgery; Patrick McNees,
PhD, Professor; Barbara Bates-Jensen, PhD, Professor; Barbara Braden,
PhD, Professor and Dean

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Not available at this time.

Print copies: Available from the ConvaTec Information Center:
1-800-422-8811.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Beitz JM, van Rijswijk L. Using wound care algorithms: a content
    validation study. J Wound Ostomy Continence Nurs. 1999
    Sep;26(5):238-9, 241-9.

-   Bolton L, McNees P, van Rijswijk L, de Leon J, Lyder C, Kobza L,
    Edman K, Scheurich A, Shannon R, Toth M; Wound Outcomes Study Group.
    Wound-healing outcomes using standardized assessment and care in
    clinical practice. J Wound Ostomy Continence Nurs. 2004
    Mar-Apr;31(2):65-71.

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on July 27, 2006. The information
was verified by the guideline developer on August 24, 2006.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/10/2008