Wound Care Resources

In each issue we investigate a hot topic currently affecting you and your community practice.

The JCN clinical skills series looks at different aspects of wound management in the community, with useful tips on patient care and improving practice. The fourth and final part focuses on dressing selection.

The last part of our clinical skills series looks at dressing selection. Wound dressings should create an environment that supports the wound healing process. However, with an ever-increasing array of dressings available, selecting the correct product can seem daunting. Holistic patient assessment, including assessment of the wound environment, needs to be undertaken before choosing a dressing and will help in the decision-making process. This article explores the principles of appropriate dressing selection and how they can be applied in clinical practice.

Recently, the national wound care agenda has centred around the cost of wounds to the NHS, inadequate holistic wound assessment, reducing unnecessary variations in care and increasing supported shared care. This article demonstrates how one organisation, by transforming the delivery of wound care services into one, addressed those factors while also freeing up valuable community nurse time. It also describes how working in partnership with industry can not only assist in improving the care journey for patients, but also liberate and empower clinical staff.

It is estimated that 1.5% of the adult population in the UK is currently living with a leg ulcer (Guest et al, 2015). There is substantial evidence to suggest that venous leg ulcers are being poorly managed with delays in assessment, poor primary dressing choice and suboptimal levels of compression contributing to the delay in wound healing (Gray et al, 2018). The bulk of leg ulcer care takes place within primary care (Guest, 2015). Despite there being considerable evidence to support the use of compression therapy and undertaking accurate leg ulcer assessment, this does not appear to always happen in practice. This paper looks at how one clinic improved healing outcomes and patient quality of life through holistic assessment, patient education, supported self-care and introducing compression wraps into the treatment regimen.

Historically, wounds have been treated within the medical model with a paternalistic approach where healthcare professionals assess the aetiology and condition of the wound bed, identify any modifiable patient risk factors which may impact on healing, and then implement evidence-based treatments to promote healing (Lusher, 2020). This article discusses the challenges in implementing both shared decision-making and self-care and reviews some of the innovative initiatives which have been developed to encourage patient self-care for wounds. The theories underpinning self-care and the advantages and disadvantages of self-care and shared decisionmaking are also discussed from both healthcare professionals and patients/carers’ perspectives.

Now more than ever, the NHS is searching for ways to reduce wastage and achieve efficiency savings, while at the same time improving patient outcomes. One area which can sometimes be overlooked when it comes to innovation and new ways of working is wound care.

Chronic wounds create poor health (e.g. infection and immobility) and personal issues for patients (e.g. malodour, pain and sleepless nights), as well as substantial costs to healthcare systems (Guest et al, 2017; Atkin et al, 2019). They present many clinical challenges, but two key areas are wound bed preparation and exudate management (Atkin et al, 2019), which are intrinsically linked. A chronic or cavity wound bed which has not been prepared for healing through cleansing and debridement (Mahoney, 2020), containing slough, necrotic tissue or wound biofilm, usually produces a high volume of exudate (World Union of Wound Healing Societies [WUWHS], 2019).

To effectively deal with complex wounds, the importance of oedema and that all oedemas are on a lymphoedema continuum needs to be understood. The efficiency of lymphatic drainage is paramount to oedema management and wound healing. Therefore, interventions to help prevent damage to lymphatic capillaries, and techniques to facilitate lymphatic drainage and lymphangiogenesis should be considered as part of wound management. This article highlights the importance of the lymphatic system in the treatment of leg ulceration and the emergence of a new ‘hybrid nurse’, who combines the specialisms of tissue viability and lymphoedema to improve patient outcomes, reduce waiting times, and improve efficiency within the NHS with the provision of a one-stop service.

With pressure ulcers remaining a challenge to the healthcare system across all care settings, this 12-week pilot study aimed to evaluate implementation of the SEM Scanner as an adjunct to standard of care (SoC) in pressure ulcer (PU) prevention. Two district nursing bases enrolled 17 palliative care patients, who received SoC and preventive interventions. Patients with Waterlow scores 10–19 who were able to be scanned for three consecutive days were included. Broken skin was not scanned, and visual skin checks were documented after SEM scans. Patients with SEM delta ≥0.6 were considered at high risk and preventive interventions were escalated using a clinical decision matrix aligning with SoC. The study found that implementing the SEM Scanner in an existing PU prevention pathway resulted in a reduction in community-acquired PU (CAPU) incidence by 26.7% from 16.1% to 11.8%; 88% (n=15) of patients remained PU free. Furthermore, clinical judgement informed by SEM deltas resulted in 82% (n=14/17) of nurses reporting that the SEM delta had changed their clinical decision-making.