The NHS spends the majority of its budget on labour costs and it could be argued that frontline staff such as community nurses are the organisation’s most valuable resource. However, optimal wound care is dependent upon effective patient engagement, the application of clinical expertise and access to wound management products. The tension between increasing demands for services and the number of nurses is already causing problems in care provision as staff cuts and excessive workload inevitably endanger patient care. Enhancing efficiency through the use of innovative products will become essential in the future if nurses are to continue to provide expert care against a backdrop of cost-savings. This article details the appraisal process undertaken within Worcestershire Health and Care NHS Trust to investigate the in-practice clinical performance of a silicone foam dressing (Allevyn™ Life Smith & Nephew, Hull).
Declaration of interest: Richard Searle and Alistair Bielby are employees of Smith & Nephew. This project was supported by an unrestricted grant from Smith & Nephew.
Jackie Stephen-Haynes, Professor and Nurse Consultant, Practice Development Unit, Birmingham City University and Worcestershire, Health and Care Trust
Alistair Bielby, Clinical Team Manager, Smith & Nephew Healthcare Ltd
Richard Searle, Health Economics Manager, Smith & Nephew Medical Ltd
This article outlines a survey that was undertaken in the community to find out how often patients with venous disease who are wearing compression hosiery have their ankle brachial pressure index (ABPI) monitored. It also asked clinical nurse specialists (CNSs) their opinion on the desired frequency of ABPI follow-up, and which patient groups they considered to be most at-risk. The survey findings highlight the lack of consensus and consistency in follow-up care. The majority of CNSs identified potential high-risk patient groups, the majority of which have their ABPI monitored every three months. However, there were inconsistencies in time interval for follow-up in patients with similar risk factors.
Winnie Furlong, Lead Clinical Nurse Specialist, Princess Alexandra Hospital and West Essex Leg Ulcer Service
Literature has shown that patients with leg ulcers can have a significantly poorer quality of life compared to those without leg ulcers. In addition, research has identified problematic relationships between patients with leg ulcers and practitioners, such as community nurses. The author contends that this mismatch needs to be addressed in order to improve patient quality of life through leg ulcer bandaging. He makes several recommendations for practice and highlights that community practitioners need to use innovative practice to help improve the quality of leg ulcer bandaging care they deliver. The overall aim of this article is to establish the extent of community practitioners’ understanding of the impact of leg ulcer bandaging on patient quality of life.
Edwin Tapiwa Chamanga, Tissue Viability Service Lead, Ipswich Hospital NHS Trust
An advanced wound care dressing that uses a natural resource in its ability to absorb and retain moisture as well as to provide antimicrobial properties, offers a new multi-functional, biointeractive protease modulator to the wound dressing arena. Several factors indicate the need for such a dressing, namely: an ageing population inevitably increases the prevalence of wounds managed across acute and community settings, the prevention and management of infection remains a priority and the use of natural resources is becoming more important. This article considers the literature supporting this product and, using care study examples, demonstrates its potential impact on patient outcomes.
Jackie Stephen-Haynes, Professor and Consultant Nurse, Practice Development Unit, Birmingham City University and Worcestershire Health and Care Trust
Elaine Gibson, Tissue Viability Nurse Specialist, East Kent University Hospitals, NHS Foundation Trust, Clinical Manager, Aspen
Medical Europe Ltd
Michelle Greenwood, Consultant Nurse Tissue Viability, Walsall Healthcare NHS Trust and Associate Lecturer, Practice Development Unit, Birmingham City University
Exit sites are commonly encountered in the community setting as a result of a shift in clinical practice that means more patients with complex conditions are being managed at home. The management of exit sites varies according to indication, but there are principles of practice that are common to all sites, and these are outlined in this article. Kendall™ AMD Antimicrobial Foam Dressing with PHMB has been used to successfully prevent and manage infection of exit sites, and to manage overgranulation, a common complication of these wounds.
Julie Evans, Tissue Viability Nurse, Abertawe BroMorgannwg University Health Board, Swansea
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
