This article reports on the monitoring of healing rates of fullthickness pressure ulcers at one care provider in the Midlands. This was an agreed measure that was part of the Commissioning for Quality and Innovation (CQUIN) incentive scheme for the CCG. It was an attempt to provide data to support the anecdotal reports that pressure ulcer healing rates had improved after the implementation of a pressure ulcer reduction scheme called the Midlands and East Pressure Ulcer Ambition in 2012. The healing times for full-thickness pressure ulcers were recorded at 40 and 80 days after being reported by the community care provider (a community interest company [CIC], providing NHS funded services). There were 138 patients included in the data collected over a one-year period in 2015. A total of 34% of the patients were healed or healing at 40 days. A total of 55% of patients were healed or healing at 80 days. Of the 138 patients who had a full-thickness pressure ulcer, 56 died (41%), 15% had deteriorating or static wounds at 40 days and 9% at 80 days. This demonstrates that the majority of full-thickness pressure ulcers progress to healing unless the patient is at the end of life. There should be a continued emphasis on preventing as many pressure ulcers as possible to reduce avoidable harm to patients.
Chronic leg ulceration is an increasing burden in the UK, both financially to the health service and on a human level. This first article in a four-part series, which looks at leg ulcer management and understanding compression therapy, explores the cardiovascular system, the underlying causes of lower limb problems, and the risk factors for leg ulceration. An overview of how compression therapy works and an introduction to the options available for patients and clinicians in this field of practice is also given. Subsequent articles in the series will look at holistic assessment and clinical decision-making in leg ulcer management, understanding compression hosiery and adjustable wraps, as well as compression bandaging and skin care
Lower limb cellulitis is a common acute medical condition that results in a large number of hospital admissions (Clinical Resource Efficiency Support Team [CREST], 2005). It is a growing and costly problem. The NHS spends between £172–£254 million a year on inpatient treatment of people with lower leg cellulitis (Curtis, 2011). The clinical presentation of cellulitis is similar to other conditions and diagnostic errors are common and may prolong hospital stay (Nazarko, 2012). Community nurses are involved in caring for people at risk of cellulitis and are often responsible for referring on suspected cases and then continuing treatment upon discharge. It is essential that community nurses are aware of the evidence base for diagnosis, differential diagnosis, treatment and management, as well as the long-term prevention of cellulitis. This paper discusses the evidence base for treatment and prevention of cellulitis and presents a case study.
The publication of Guest et al’s study on the economic burden that acute and chronic wounds have on the NHS has provided a national picture and a better understanding of the true cost of wound care (Guest et al, 2015).
One thousand patients’ notes held within the Health Improvement Network (THIN) database were retrospectively examined and cost differences between having a wound or not were analysed. Indeed, from assessing wound care service delivery and costs for the year 2012/13, based on 2013/14 prices, the study estimated that the cost amounted to £5.3 billion, which is on a par with obesity treatment costs. The study also identified that the majority of wound care takes place in a community setting and is nurse-led. Guest et al (2015) has been cited in several recent studies and has even been raised in a debate in the house of Lords. The study also suggested that a ‘high proportion of wounds were unclassified’, highlighting shortcomings in undertaking wound assessment and accurate documentation.
Managing moisture to achieve the optimum ‘moist’ wound healing environment is key to facilitating wound healing. Wounds which are dry or have a low volume of exudate need moisture added for hydration. Wounds that are wet with a high volume of exudate need fluid to be removed effectively by dressings with high absorbency. Moisture imbalance can have negative consequences for patients — physically, psychologically and socially.
Pressure ulcers were the largest proportion of patient safety incidents in 2011–2012, accounting for 19% of all reports (National Institute for Health and Care Excellence [NICE], 2014). Developing strategies and incentives to help reduce pressure ulcer incidence by stressing the importance of improving nurses’ knowledge in areas of skin care and encouraging carers/relatives, together with patients, to take an active role has been shown to improve outcomes in reducing the development of pressure ulcers (NHS Commissioning Board, 2013). With guidance focusing on prevention as well as treatment, it is important that community services understand both the risks and how to stage pressure ulcers appropriately to provide timely and cost-effective treatment.
This article examines the differences in presentation, assessment and management of wounds in children compared with adults. In particular, it looks at pressure ulcers, their prevalence in children aged 0–18 years, location and how they present. The structure and function of the skin is also discussed, with consideration of risk factors associated with formation of pressure ulcers in children. The results of an online survey into healthcare professionals’ confidence and competence of wound and pressure ulcer assessment and management in this patient population within a large NHS trust is also explored, as this identified the need to provide more education and training to enhance tissue viability services for children.
Pilonidal sinuses are a common condition, and are often found in young males. Treatment is mainly by surgery and caring for these wounds is generally undertaken by primary care practitioners. Fistulas are also challenging wounds to care for. This article offers practical advice on the management of these, often problematic, wounds. Issues, such as cleansing, selecting appropriate wound care dressings, measuring and monitoring progression to healing will be discussed; together with advice on when to refer for specialist input.
Leg ulcer management presents a significant challenge to primary care, as not only is it costly in terms of resources, but is closely linked to social isolation and low mood. Research has also demonstrated that lonely people are more likely to visit their GP, have higher use of medication, higher incidence of falls and increased risk factors for long-term care (Cohen et al, 2006), thus a greater impact on healthcare services.
Thanks to everyone who entered the JCN/GPN Outstanding Practice in Wound Care Award 2017. We received a huge number of entries that demonstrated all the excellent wound care being delivered in the community around the UK. We asked for entries that showed evidence of making a real difference in wound care, according to the entry criteria, and are pleased to announce that the winner did just that.
