This article outlines a survey that was undertaken in the community to find out how often patients with venous disease who are wearing compression hosiery have their ankle brachial pressure index (ABPI) monitored. It also asked clinical nurse specialists (CNSs) their opinion on the desired frequency of ABPI follow-up, and which patient groups they considered to be most at-risk. The survey findings highlight the lack of consensus and consistency in follow-up care. The majority of CNSs identified potential high-risk patient groups, the majority of which have their ABPI monitored every three months. However, there were inconsistencies in time interval for follow-up in patients with similar risk factors.
Winnie Furlong, Lead Clinical Nurse Specialist, Princess Alexandra Hospital and West Essex Leg Ulcer Service
Literature has shown that patients with leg ulcers can have a significantly poorer quality of life compared to those without leg ulcers. In addition, research has identified problematic relationships between patients with leg ulcers and practitioners, such as community nurses. The author contends that this mismatch needs to be addressed in order to improve patient quality of life through leg ulcer bandaging. He makes several recommendations for practice and highlights that community practitioners need to use innovative practice to help improve the quality of leg ulcer bandaging care they deliver. The overall aim of this article is to establish the extent of community practitioners’ understanding of the impact of leg ulcer bandaging on patient quality of life.
Edwin Tapiwa Chamanga, Tissue Viability Service Lead, Ipswich Hospital NHS Trust
An advanced wound care dressing that uses a natural resource in its ability to absorb and retain moisture as well as to provide antimicrobial properties, offers a new multi-functional, biointeractive protease modulator to the wound dressing arena. Several factors indicate the need for such a dressing, namely: an ageing population inevitably increases the prevalence of wounds managed across acute and community settings, the prevention and management of infection remains a priority and the use of natural resources is becoming more important. This article considers the literature supporting this product and, using care study examples, demonstrates its potential impact on patient outcomes.
Jackie Stephen-Haynes, Professor and Consultant Nurse, Practice Development Unit, Birmingham City University and Worcestershire Health and Care Trust
Elaine Gibson, Tissue Viability Nurse Specialist, East Kent University Hospitals, NHS Foundation Trust, Clinical Manager, Aspen
Medical Europe Ltd
Michelle Greenwood, Consultant Nurse Tissue Viability, Walsall Healthcare NHS Trust and Associate Lecturer, Practice Development Unit, Birmingham City University
Exit sites are commonly encountered in the community setting as a result of a shift in clinical practice that means more patients with complex conditions are being managed at home. The management of exit sites varies according to indication, but there are principles of practice that are common to all sites, and these are outlined in this article. Kendall™ AMD Antimicrobial Foam Dressing with PHMB has been used to successfully prevent and manage infection of exit sites, and to manage overgranulation, a common complication of these wounds.
Julie Evans, Tissue Viability Nurse, Abertawe BroMorgannwg University Health Board, Swansea
Pressure ulcer prevention is a challenge both in acute care and in community care, although prevalence is hard to determine due to differing ways of assessing and reporting both ulcers and risk of ulceration. Those who are acutely ill or have compromised mobility, or are older, or who have multiple co-morbidities are at greater risk of pressure ulcer development.
Acknowledgements:
All District Nursing Staff, Greater Glasgow & Clyde
Lynne Watret, MN, PGCertTLHE, MA, RGN, CNS Tissue Viability
Fiona Middler, BA, Master in Primary Care, Clinical Effectiveness Coordinator, Primary Care, Greater Glasgow & Clyde
Article accepted for publication: August 2012
Wound debridement plays an essential role in preparing the wound to heal and can be achieved in several ways. Most wound debridement requires the skills of specialist practitioners which can be both time consuming and expensive. This observational study looks at a new mechanical debridement system with a monofilament fibre pad that can be used in any healthcare setting with minimal training. In twenty patients with wounds and/or skin that required debridement, the new system was found to be a fast and effective method of debridement causing minimal pain to the patients. This new approach to wound debridement could potentially have far reaching benefits to the patient, the nurse and the organisation.
Susan Johnson, RN, MA, ANP, NMP. Lead Nurse Wound Care, Doncaster Royal Infirmary,
Agnes Collarte, BSN, RN. Tissue Viability Nurse, Central London Community Healthcare NHS
Loty Lara, BSN, RN. Tissue Viability Nurse, Central London Community Healthcare NHS
Andreia Alberto, MSc. Tissue Viability Nurse, Central London Community Healthcare NHS
Article accepted for publication: July 2012
The cost of diabetic foot ulcer management is estimated at around £300 million a year, but the true prevalence of diabetic foot disease is unknown, making the potential economic and personal burden of diabetes treatment and complications inestimable. This article will explore diabetic foot aetiology, risk factors for diabetic foot disease, prevention strategies and briefly discuss the management of people with diabetic foot disease
Maureen Benbow MSc, BA, RGN, HERC, Senior Lecturer, University of Chester
Article accepted for publication: May 2012
People with leg ulceration are predominantly treated in a community setting either in their own home, a clinic or a general practice surgery. Access to high quality, effective care is vital for timely healing. This article will consider aspects of the National Health Service quality agenda and how these align to leg ulcer care using national venous leg ulcer guidelines as a framework. The purpose of this is to prompt both practitioners and managers to consider the current provision of leg ulcer care and how this might stand up to scrutiny from a quality perspective.
Irene Anderson reader in Learning and Teaching in Healthcare Practice, and Programme Tutor, Tissue Viability, University of Hertfordshire.
Article accepted for publication: May 2012
In a short reflective exercise, the introduction of disposable Negative Pressure Wound Therapy (NPWT) was shown to improve the patient experience of being managed in the community with a complex wound. District nurses and treatment room staff found the system easy to use and in their view, it extended the interval required between dressing changes and time taken to carry out wound care. This article considers the benefits of NPWT, illustrating these with patient reflections and comments.
Lynne Watret RGN, MA, MN, PGCert TLHE CNS Tissue Viability, Primary Care, Greater Glasgow & Clyde Health Board.
Article accepted for publication: January 2012
Complex and chronic wounds present many challenges to the community nurse, not least identifying the most appropriate dressing from the plethora available. Coupled with the imperative that care is delivered in the most cost and clinically-effective manner, a carefully considered and evaluated formulary can help guide dressing choice and facilitate monitoring of usage and costs.
In this article, a runner-up in the JCN Writing Awards, Caroline Swayne reflects on the impact of a formulary in her organisation.
Caroline Swayne ENG, RGN, DN, Bsc, Non Medical Prescriber, District Nurse/Team Leader in the Isle of Man
