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Wound care forms a major part of any community nurse’s workload and with more acute patients being discharged earlier from hospital, as well as an ever-growing case-load of long-term conditions, it is more important than ever that nurses are confident in assessing and care-planning effective wound care. As ever, accurate assessment of the patient and the wound is the starting point and will help nurses choose the most effective treatment, resulting in improved patient outcomes and reduced costs. Poor wound care can lead to delayed healing, increased infection and inappropriate use of wound dressings, all of which impact on patients’ quality of life. In this article, the author outlines five main steps to consider in providing evidence-based, effective wound care.
Leg ulcers present a common clinical problem for community nurses. The need for assessment and maintenance can take up a lot of nursing time and issues such as pain, exudate and compression bandaging have a significant effect on the quality of life of patients. This article describes an evaluation of two new compression devices, one for people with venous insufficiency resulting in leg ulcers who need compression therapy (Juxta CURES; medi UK); another for those with leg ulcers, venous insufficiency and lymphoedema (Juxta-Fit; medi UK). This evaluation involved 16 patients and demonstrated the impact of quality of life and the potential for savings in a community nursing team, both financially and in terms of reduced nursing time.
The use of compression bandaging in venous leg ulcers has been acknowledged as ‘best practice’ for some time now, but these wounds remain a serious management problem in many patients with pain, excess exudate, limb swelling and poor mobility all affecting their quality of life. Wound care in general, and leg ulcer management specifically, are two of the most common reasons for referral to community nursing services and recent government policy aimed at managing more patients in primary care and in their own homes has also meant that nurses are now seeing more patients than ever before. All of this means that they need compression systems that are easy to apply and can deliver safe and consistent pressures to minimise risk and safeguard patients. This article presents the findings of a 40-patient multi-centre evaluation of a new inelastic compression bandage system (HERO H-2®; H&R Healthcare) designed to provide optimal compression levels, reduce odour and moisturise the skin. The evaluation demonstrated that the bandage system had a positive effect on a number of parameters including wound size, healing rates, patient comfort and mobility.
Amputation surgery can be traumatic and life-changing for patients and many struggle to come to terms with the loss of a limb. Wounds that fail to heal following surgery can have an impact on each individual’s rehabilitation process. It is important to provide the correct management for these wounds to facilitate healing and enable the patient to work towards mobilisation. Equipping community nurses with the knowledge and skills to assist patients in managing their residual limbs can improve the time from amputation to ambulation. Similarly, overcoming problems with patients' skin; achieving properly filling prosthesis; and managing the ‘wear and tear’ of prosthetic limbs are all challenging aspects in the management of this patient group.
Choosing the correct dressing is often key to moving a wound along the healing trajectory, with its ability to deal with problems such as pain, excess exudate production and inflammation being crucial to the healing outcome. Infection is also a serious problem in many wounds and this article looks at the basics of wound infection as well as some of the main treatments, such as topical antimicrobials. However, clinicians are faced with a huge range of wound care products, many of which have antimicrobial properties. This article considers the use of one gelling fibrous silver dressing (Durafiber® Ag; Smith and Nephew), which is specifically designed to deal with many of the problems mentioned above, particularly excess exudate production and infection. The authors also presents the results of a small, prospective multicentre case series that was carried out to assess the efficacy of Durafiber Ag in a variety of wounds.
Due to concerns over pressure ulcer incidence data, a collaborative project was undertaken with the aim of improving quality of care within residential homes, specifically in relation to pressure ulcer prevention. The project comprised a residential home staff education programme based on the SSKIN bundle. The objective was to enhance staff awareness of pressure ulcer risk and their knowledge of pressure ulcer prevention approaches, such as the appropriate use of skin care products (ProshieldTM; H&R Healthcare) and the targeted use of local pressure-relieving methods such as dermal pads (AdermaTM; Smith & Nephew). To support residential home staff in putting pressure ulcer prevention theory into practice, skin care products and dermal pads were made more easy for staff to access, thereby facilitating the desired change in practice. Implementation of the project was supervised by the local tissue viability team. Tissue viability nurses — with the support of Smith & Nephew — delivered an educational package to the staff in each residential home including the SSKIN bundle and the appropriate use of local pressure-relieving techniques. A ‘stock-box’ containing supplies of dermal pads and skin care products was provided for each residential home immediately after the training — this meant that the staff could begin using these as soon as a risk assessment identified a patient who needed off-loading. Pressure ulcer incidence data routinely captured before the project began was compared with data from a similar time period following the project — this helped the authors assess and reflect upon the impact of the project.
If left untreated, leg ulcers can descend into a cycle of tissue breakdown and healing, resulting in chronic venous leg ulcers, which are associated with considerable morbidity and impaired quality of life. Compression therapy is widely held up as the ‘gold standard’ for management of venous leg ulcers, and the provision of safe and effective compression is one of the vital skills of the community nurse. However, to provide this level of treatment it is essential that the bandage system used provides the correct amount of sub-bandage pressure, as too little will be ineffective; whereas too great a pressure may cause constriction and patient discomfort (Moffatt, 2005; Milic et al, 2010). This article highlights a study that investigated the efficacy of a two-layer bandaging system (HERO H-2®, H&R Healthcare), which was tested by a group of clinicians for its ability to provide optimum compression alongside ease of application and patient comfort.
Community nurses often have very busy caseloads and need a wide variety of knowledge to deal with the many different clinical scenarios that they face. This is particularly true of wound care, which can present a unique set of challenges, including infection, how to control exudate and making sure that any dressing they have chosen does not actually further harm the patient by, for example, damaging the skin when it is removed. This article outlines some of the most important areas that community nurses need to understand when it comes to wound care before going on to look at the solutions provided by one particular dressing (Actilite Protect®; Advancis Medical), which is designed for use on the full range of wounds, including acute skin tears, post-surgical wounds, chronic leg ulcers, pressure ulcers, diabetic ulcers and infected wounds. As well as presenting an overview of the dressing, this article also presents a series of case studies that illustrate the benefits of the dressing in practice.
Venous leg ulcers make up a large part of a district nurse’s caseload, with the application of compression bandaging requiring competent and skilled practitioners. At Central and North West London Foundation Trust (CNWL) Camden Integrated Primary Care (IPC) Service recruiting and retaining community nurses is a challenge, a situation which is shared across all London boroughs. In particular, it is difficult to maintain consistent standards for wound cleansing and compression bandaging, resulting in the responsibility for a large caseload falling to a small number of practitioners. Following a review of innovative products on show at the European Wound Management Association (EWMA) conference in May 2014, an alternative to traditional compression bandaging was identified as a possible solution to this problem; namely, UCS™ for effective debridement and Juxta CURES™ as an alternative to compression bandaging (both medi UK Ltd, Hereford). A total of 26 patients evaluated the products, which were found to be more clinically effective than previous regimens and also resulted in substantial cost savings.
This article highlights the normal and abnormal physiology of fluid circulation in the lower limb with particular reference to venous and lymphatic flow. Consideration is given to the assessment and diagnosis of disease and its severity, particularly the impact on the patient including chronic oedema, ulceration, cellulitis and loss of mobility. Options for disease management and prevention such as compression bandaging and hosiery are also discussed, and the gaps between theory and practice are highlighted to provide community nurses with the most up-to-date information and practical solutions.