Protocol for development of the fourth edition of Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline using GRADE methods.

The National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel and the Pan Pacific Pressure Injury Alliance are commencing a new (fourth) edition of Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline . The aim is to outline the methodology. The fourth edition of the International PI Guideline will be developed using GRADE methods to ensure a rigorous process consistent with evolving international standards. Clinical questions will address prevention and treatment of PIs, identification of individuals at risk of PIs, assessment of skin and tissues, and PI assessment. Implementation considerations supporting application of the guidance in clinical practice will be developed. The guideline development process will be overseen by a Guideline Governance Group (GGG) and methodologist, and the Guideline Development Team (GDT) will include health professionals, educators, researchers, individuals with or at risk of PIs and informal carers. This paper presents the project structure and processes to be used to undertake a systematic literature search, appraise risk of bias of the evidence and to aggregate research findings. The method details how certainty of evidence will be evaluated; presentation of relative benefits, risks, feasibility, acceptability and resource requirements and how recommendations will be made and graded. The methods outline transparent processes of development that combine scientific research with best clinical practice. Strong involvement from health professionals, educators, individuals with PIs and informal carers will enhance the guideline's relevance and facilitate uptake. This update builds on previous editions to ensure consistency and comparability, with methodology changes improving the guideline quality and clarity.

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