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

This is the current release of the guideline.

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

Evaluation
Management
Risk Assessment
Treatment

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

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

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

Patients with acute and chronic wounds

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

Wound healing

Searches of Electronic Databases

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.

Not stated

Not stated

Not applicable

Review
Review of Published Meta-Analyses

Not stated

Other

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.

Not applicable

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.

Clinical Validation-Trial Implementation Period

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.

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

• 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

Not stated

• 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.

An implementation strategy was not provided.

Getting Better

Effectiveness

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

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

1994 (revised 2004; reviewed 2005)

ConvaTec - Public For Profit Organization

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).

Not stated

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

Not stated

This is the current release of the guideline.

Electronic copies: Not available at this time.

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

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.

None available

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

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