Wound Care Resources

Numerous studies have shown that pain during dressing change is a major issue for patients with both acute and chronic wounds. Despite this evidence, pain is often misunderstood by clinicians and can be poorly managed. Pain can result in patients abandoning dressing regimens and clinicians need to ensure that patients have their pain reduced as much as possible and do not have to face the trauma of repeated painful dressing changes. This article presents some of the causes of pain and outlines some strategies that clinicians can use to prevent or minimise their patients’ pain.

Jacky Edwards, Burns Nurse Consultant, Burn Centre, University Hospital of South Manchester and Lead Nurse, Northern Burn Care Network

In patients with venous and lymphovenous disease, skin changes to the lower limb(s) occur gradually, and become more serious over time if left untreated. The CHRonic Oedema Signs and Symptoms (CHROSS) Checker is a tool kit consisting of an assessment chart and key cards that have been developed to help clinicians easily identify the skin changes that occur as a result of underlying venous and lymphovenous disease, when carrying out holistic patient assessment. It also provides clear guidance on which compression products can be used to manage the disease type and severity of skin change. For clinicians unfamiliar with some or all of the signs and symptoms listed on the CHROSS Checker chart, the key cards contain further information in the form of a photograph, definition and cause of each sign and symptom listed. This article will describe the theory behind the development of the CHROSS Checker tools and explain how to use them in clinical practice.

Janice Bianchi, Independent Medical Education Specialist and Honorary Lecturer, Glasgow University

Ongoing changes to the NHS (Department of Health [DH] 2010a–c) mean that clinicians responsible for the delivery of wound care need to reduce expenditure while meeting the increasing demand for the provision of quality care (DH 2010a–c). The high impact action (HIA), Your SkinmMatters, identified ‘no avoidable pressure ulcers’ in NHS care settings as a vital improvement to the quality of patient experience and cost effectiveness (NHS Institute for Innovation and Improvement, 2010).

Aaron Knowles, Tissue Viability Podiatrist;
Richie Skinner, Senior Tissue Viability Podiatrist, both at Wound Healing Centres, Eastbourne
Steve Young,Managing Director, Cambridge Health Technology;
Sylvie Hampton, Tissue Viability Consultant,Wound Healing Centres, Eastbourne

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