Journal of Community Nursing

JCN supplement

2015 Vol 29 No 5

COMMUNITY WOUND CARE

being taken up by patients requiring

some form of wound management.

Therefore, it makes financial sense

for community practitioners to treat

patients who require complex wound

care in community hospitals rather

than more expensive

acute settings.

By managing these patients

effectively, clinicians in community

hospitals have the chance to be at the

forefront of proactive nursing care.

Similarly, by adopting newer wound-

healing strategies, they can reduce

costs and improve patient experience.

What is the role of the wound

care formulary?

A wound care formulary is a list

of products and treatment options

that have been endorsed by the

local trust or health board to assist

practitioners in choosing products

for their patients’wounds. For

clinicians to provide the best healing

environment, they need different

products at different stages of the

wound-healing trajectory.

However, dressings are only

part of the jigsaw of strategies that

are available to promote wound

healing (

Figure 1

), and the choice

of wound care product must follow

comprehensive holistic wound

assessment that involves examining

the patients themselves as well as

their wounds (see below) (Ousey and

Cook, 2011). Where practitioners are

unsure of best treatment, referral to a

specialist tissue viability nurse should

be made.

Wound assessment

Wound assessment must review all

aspects of the wound (Ousey and

Cook, 2012), whether it is a linear

surgical wound, a dehisced open

cavity, leg ulcer or pressure ulcer.

Debridement

Tissue type present should be

identified and any devitalised tissue

removed. Debridement is essential to

move the wound along the healing

continuum (Young, 2014). Within a

community hospital setting, this can

be undertaken in a number of ways:

Using wound dressings that

support autolysis (the removal of

devitalised tissue by the body’s

own enzymes)

Mechanically using a

monofilament soft pad (i.e.

Debrisoft

; Activa Healthcare).

Using larval therapy.

Sharp debridement is another

technique for removing necrotic

material, but this should only be

undertaken by trained clinicians.

Infection

Before a wound can successfully

be healed, any infection must be

identified. Cutting and White (2005)

list the signs and symptoms to assist

nurses in this (

Tables 1

and

Wound infection can be treated by

using topical antimicrobial dressings

(according to the local formulary as

suggested above). However, if the

patient is systemically unwell with

pyrexia (fever) and tachycardia

(heart rate that exceeds the normal

resting rate), oral antibiotics can

be prescribed.

Exudate

Although exudate is one of the

body’s natural responses to a

wound, being produced during the

inflammation phase and creating

a moist environment for autolytic

debridement (Griffin, 2014), in

chronic wounds the high level of

matrix metalloproteinases (MMPs)

in the wound fluid can cause tissue

breakdown in the periwound area.

Vowden andVowden (2003) explain

that poorly managed exudate can

increase the risk of infection and lead

to the potential ‘knock-on’ effect of

delayed wound healing.

Managing excess wound exudate

with an alginate/fibre-type dressing

will protect the periwound skin and

help to prevent any breakdown of

this tissue. Conversely, epithelial

migration can be slowed and

healing delayed if a wound is too

dry, illustrating the importance of

balance in providing a moist wound-

healing environment.

The patient’s role in

wound assessment

The role of patients in wound

assessment is important — no one

will understand a wound better than

the patient themselves and in many

cases patients can provide an in-

depth history.

Practice point

Wound assessment must review

all aspects of the wound, including

whether it is a linear surgical

wound, a dehisced open cavity, leg

ulcer or pressure ulcer.

Table 1:

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Cellulitus

Discharge

Delayed Healing

Discolouration

Unexpected pain/ tenderness

Bridging of epithelium or soft tissue

Malodour

Wound breakdown

Table 2:

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Abscess

Heat

Swelling/ oedema

Redness/erythema

Cellulitus

Inflammation

Discharge

Delayed healing

Friable tissue (easily bleeds)

Pain

Bridging of epithelium or soft tissue

Pocketing at the base of the wound

Malodour

Increase in wound size

Figure 1.

Different elements that must

be considered when attempting to heal

a wound.

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