Journal of Community Nursing

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BURDEN OF WOUND CARE
Management of patients with
wounds, such as leg ulcers, pressure
ulcers or diabetic foot ulcers, provides
challenges for many healthcare
professionals (Werdin et al, 2009;
Frykberg and Banks, 2015). It is
widely recognised that such wounds
negatively impact patients’quality
of life and that the cost related
to managing patients with these
wounds is substantial (Vowden,
2011; Guest et al, 2015). In 2015, the
true economic burden that wounds
impose on the National Health
Service (NHS) within the United
Kingdom (UK) was documented
by Guest et al (2015). This paper
acted as a catalyst for change and
is becoming a seminal publication.
Following this initial research, a
number of additional papers have
been published, highlighting not just
the economic burden, but also:
` Inconstancies in management
` Lack of evidence-based care
` Poor healing rates
` Service impact of non-healing
ulceration (Guest et al, 2015;
2017; 2018).
THE BURDEN
The original burden of wound care
study was a retrospective cohort
analysis of records contained within
‘The Health Improvement Network’
(THIN) database (Guest et al, 2015).
The THIN database contains over
11 million patient records from 562
general practices across the UK.
These records have been shown to be
representative of the UK population
in terms of demographics and disease
distribution (Guest et al, 2015). Data
was systematically extracted from the
anonymised electronic patient records
from a randomly selected cohort of
1,000 patients who had a wound in
2012/2013, and this was compared
to a control group of 1,000 matched
patients.The information gained from
this analysis was used to provide
estimations of UK prevalence of
wounds and associated treatment costs.
Key findings from the study were:
` The NHS treats more than 2.2
million wounds annually, equating
to 4.5% of the adult population
` The total cost of managing
these wounds and associated
comorbidities is calculated to be
£5.3 billion annually
` Wound care products accounted
for only 14% of the overall cost of
managing wounds
` Non-healing or delayed
healing was a major factor in
increasing costs
` Healing rates were much lower
than expected, with only 47%
of patients with venous leg
ulceration healing within the
one-year study period
` Lack of evidence-based care,
treatment deviating from
approved guidelines
` Change in healthcare providers:
with an increasing number of
patients being managed by
general practice nurses (GPNs),
rather than community nurses.
In terms of optimising patient
outcomes, one of the most concerning
elements of this publication was the
lack of diagnosis of the cause of the
wound — 12% of all wounds were
labelled as unspecified, and 18% were
leg ulcers but of an unspecified nature.
Without a clear diagnosis, there is
a very real risk of an effective care
pathway, such as compression therapy,
not being implemented (Atkin and
Tickle, 2016).
Over the last decade, the focus for
many tissue viability services appears to
have been fixed on the area of pressure
ulcers, due to the requirement of many
organisations to report their incidence
and prevalence through the NHS
Safety Thermometer .
digital.nhs.uk/thermometer). However,
Leanne Atkin, lecturer practitioner/vascular nurse
consultant, School of Human and Health Sciences,
University of Huddersfield and MidYorkshire
NHS Trust
Burden of wounds: are we causing
harm to our patients?
IN BRIEF
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KEYWORDS:
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ulcers, pressure ulcers
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Leanne Atkin
4 JCN supplement 2018,Vol 32, No 2