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.
This two-part article aims to help healthcare professionals understand constipation; the possible causes, and the anatomical and functional problems. In the first part, the author explained anatomy and physiology of the lower gastrointestinal tract, what are normal bowel motions, frequency and variation, which includes the Bristol Stool Chart to view the types of bowel motions sufferers may often experience. Here, the focus is on conservative treatment interventions for constipation, exploring the four ‘Fs’ acronym (Rex, 2013): fibre (in diet); fluids (those best for health reasons); fitness (‘if you do not move, it will not move’); and finally feet, which relates to the best sitting position to help achieve bowel evacuation successfully.
This article discusses the considerations and actions taken to facilitate the discharge of a ventilated end-of-life patient called Michael, whose name has been changed for confidentiality, from a critical care unit (CCU) to his expressed preferred place of care. It focuses on how the district nurse (DN) and the single point of access (SPA) for end-of-life care teams by working between primary and secondary care services and across organisational service units were able to facilitate this discharge and achieve the wishes of Michael to die peacefully at home. For all services involved, this proved to be a complex discharge and following completion of the care episode a root cause analysis was undertaken to capture the lessons learnt and advise the CCU at a services debreif how discharges to the community from the CCU could be improved.
Financial fraud, or scamming, is a growing problem (Financial Fraud Action UK, 2014), specifically for those who may be more at risk due to vulnerabilities, such as loneliness and mental capacity. The internet is increasing opportunities for scammers to reach a broader pool of potential victims. It is an area of growing concern for professionals involved in supporting and safeguarding vulnerable people. An estimated £5–10 billion is lost to scams annually (National Trading Standards Scams Team, 2015), and this has serious implications for victims, their families, and the wider UK economy through lost commerce and consumer confidence. A cycle of crime is created by criminal networks using proceeds from scams to fund further exploitation.
