Wound care Resources

This article outlines the development of a community tissue viability service over the same five-year-period in which a number of national issues with wound care were identified through research. These included a lack of evidence-based practice, a changing community workforce and an unwarranted variation in care attributed to a lack of education and training among generalist practitioners. The author describes how a proactive approach was taken to local service development to address these issues, and how partnership working with both colleagues and industry enabled improved wound care education delivery and uptake among a generalist community workforce. These measures resulted in a reduced spend on wound care dressings year on year, despite a predicted trend for increasing costs nationally.

The problem of delayed wound healing has been highlighted in several publications which has stimulated debate on variance and the need for updated care pathways. This paper demonstrates how adjunctive therapy can be added to the ‘standard care’ model, described in the National Wound Care Strategy Programme’s recommendations for lower limb wounds, to enhance outcomes for patients with ‘hard-to-heal’ lower limb wounds (NWCSP, 2020). A decision-making pathway based on published literature is described,  which uses wound assessment and observed response to treatment to allow the effective and targeted introduction of adjunctive therapies for ‘hard-to-heal’ wounds. This approach will allow the cost-effective introduction of new and evolving therapies, such as WoundExpress™(Huntleigh Healthcare), which addresses the underlying problems associated with resistant lower limb oedema and compromised venous function. The pathway also indicates how other adjunctive or innovative topical wound-based treatments can be integrated to optimise outcomes while providing cost-effective care.

This article explores why we should adapt assessment of leg ulceration to be more mindful of the presence of lymphoedema. If clinicians can change the assessment process and begin to treat leg ulceration with a lymphatic component differently to venous oedema, this, in turn, can potentially reduce complications such as toe, foot and knee oedema. The introduction of simple changes in documentation and additional training can lead to improved outcomes for patients as well as potential cost savings for healthcare providers.  

How fortunate we are to have specialist teams and services that provide wound care across the UK. But, these teams and services are frequently overwhelmed. Even in pre-pandemic times, increasing referrals, rising caseloads, and the complexities of supporting people with multiple morbidities conspire to challenge service delivery (Guest et al, 2020). At the same time, an over reliance on these teams’ skills by the rest of the system gives rise to the de-skilling of some groups, while inhibiting fundamental wound care skills development in others.

If I were a stick of rock, you would find the word ‘NURSE’ right through me (or maybe ‘community tissue viability nurse’ if there was enough room for all those letters!) So, in 2018, when I came into post as director of the National Wound Care Strategy programme (NWCSP), I saw the issue primarily through a clinical lens. I was not so cloistered that I thought wound care was just a nursing issue, but I did think that it was primarily a clinical challenge. If we could just get the clinical pathways sorted and get everyone who saw people with wounds (GPs, paramedics, podiatrists, surgeons and so on) to work in a more collaborative and coordinated way, we would solve the problem.

This article explores wound assessment and management, specifically the management in a challenging group of patients who inject drugs. It describes the development of a service to meet their specific needs and how this service has flexed and adapted over time. A case study is presented to showcase the assessment and subsequent management of a chronic wound, which developed as a result of injecting drugs, with Biatain® Ag Non-Adhesive with 3DFit™ Technology.

It can be a bit daunting when you are faced with a complex, chronic wound that is failing to progress. What makes a chronic wound hardto- heal and where do you start with its management? It can also be challenging for patients because the wound may be affecting their quality of life, often causing a high volume of exudate, increased pain or discomfort and malodour (Atkins et al, 2019). This article describes what can make a wound become hard-to-heal and offers guidance on assessment and management and how the use of a collagen wound dressing, Cutimed® Epiona (Essity), can help promote wound healing.

A recent economic analysis has reported a £8.3 billion cost to the NHS for wound management. This overwhelming cost has meant alternate wound management strategies are needed. One example is a Hospital @ Home (H@H) negative pressure wound therapy (NPWT) service, whereby patients are discharged from hospital with an open wound and traditional NPWT (tNPWT) and/or single-use (sNPWT) is provided in their own home. The aim of the service evaluation presented here, which was conducted from the H@H nurse base within Brighton General Hospital, was to highlight the clinical outcomes of utilising NPWT in a homecare setting, to assess changes in patient quality of life through a validated instrument, and to understand the anticipated cost savings to the NHS. Thirty-one patients, all of whom had received surgical intervention resulting in an open wound requiring NPWT and were receiving H@H NPWT, were included in the evaluation. A statistically significant reduction in wound dimentions and improvement in patient reported general quality of life was found. Overall, the delivery of this H@H NPWT service enables patients to return home, with ongoing wound management which results in wound closure. The service evaluation also enabled a cost saving analysis to be reported, suggesting that this locally implemented H@H service can reduce costs of approximately £5,256 per patient by utilising H@H NPWT compared to hospital inpatient managed NPWT.