We owe a great deal to the founder of modern nursing, Florence Nightingale, and as nurses we should always strive to further her work and that of other eminent practitioners. However, over the last few decades, approaches to nursing have moved away from the nurse doing 100% of the patient’s care, to patients being involved in their own treatment, and gaining increased independence and quality of life. By forging ahead in the development of modern techniques to improve patient care and working strategies of the nursing profession, we see improvements in terms of workload, staffing and budgets. This article looks back at the public’s perception of nurses, and how nursing roles have changed over time. It also considers wound care, a key component of the district nurse’s role, looking at how much progress has been made in the manufacture and use of compression therapy: from using multilayer bandaging to accurate, measurable and instantly adjustable compression wrap systems. By harnessing new therapies and techniques, healthcare professionals can both positively impact the lives of patients and improve their own working days.
Currently, within the NHS there is a need to improve efficiency to maximise quality of care, patient experience and outcomes, within the constraints of a limited budget. At the Royal Wolverhampton NHS Trust, the cost of wound care was increasing year on year, and in order to drive efficiency, procurement of dressings was switched from supply chain to ONPOS. Over a 12-month period, the use of ONPOS has resulted in 100% formulary compliance for adult community services. The number of brands of products used by the service has almost been halved, and the number of individual dressing units purchased has reduced by 36,000. Finally, cost savings are predicted for the adult community service in 19/20, after a five-year growth in costs year on year.
The total estimated cost of managing wounds in the UK is reported to be more than £5 billion per year, with a great deal of that cost coming from nursing time (Guest et al, 2015). Patients with lower leg wounds should receive an ankle brachial pressure index (ABPI) before compression therapy (Wounds UK, 2019). Measuring ABPI using the traditional Doppler probe, however, can be unreliable, time-consuming and can only be carried out by practitioners with specialist training and knowledge (Al-Qaisi et al, 2009). Waiting times for appointments can also delay treatment. Automated ABPI assessments are speedy, accurate and do not require specialist nurses, thus freeing up nursing time and lowering costs, as well as reducing waiting and assessment times (Boast et al, 2019). This article assesses the introduction of the MESI ABPI (medi UK) automated device at a Leg Club in North East Essex. The challenges faced by the Leg Club are discussed, along with the benefits seen over a two-month period after acquiring the automated ABPI device.
Chronic wounds are a growing problem in the UK, impacting on patients quality of life as well as vital healthcare resources. Preventing and managing biofilms is fast becoming a primary objective in wound care treatment. Poloxamer-based surfactants, which target biofilms, are emerging as an effective treatment of chronic wounds. Surfactants have been shown to play an active role in cleansing, desloughing, debridement, prevention, disruption and removal of biofilms. This article explores the role of biofilms in wound development — how to prevent, identify and treat them. It also looks at surfactants, such as poloxamer, which is showing promising results in the management of wound biofilm. One particular poloxamer-based surfactant, known for its anti-biofilm capabilities and contained within the UCS™ debridement cloth, is discussed in this article.
Caring for patients in a community setting continues to offer challenges to nurses and therapists because of the complexities of patients’ intricate and complicated conditions. The demand on district nursing is increasing as more patients are being cared for in their own homes with no additional resources to support nurses. Management of lower leg wounds dominates the workload. Compression bandaging has historically been the treatment of choice to reduce oedema and heal venous leg ulcers. However, there are safe and reliable alternatives to assist community nurses in their practice. Getting compression therapy right first time achieves many positive aspects: it improves patient quality of life, reduces costs, and enhances staff morale and job satisfaction. This article explores some of the challenges nurses face, and offers solutions with the use of the juxta range from medi UK.
Dehisced surgical wounds are a common occurrence and are seen both in primary and secondary care. The impact of a dehisced wound is far reaching. For the National Health Service, there are increased in-patient costs and additional resources in terms of an extended healing time, such as staffing and dressing materials and therapies. For the patient, a dehisced wound can impact significantly on their wellbeing and quality of life and for patients of working age, the economic impact of not being able to work can be enormous. This article discusses the incidence of wound dehiscence, outlines the types of wounds which are most likely to dehisce, and the most common reason for this, wound infection. Strategies for managing wound infection, including the use of antiseptic and antimicrobial products, together with a frequently used therapy, topical negative pressure therapy (TNPT), are also discussed.
