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EVIDENCE-BASED PRACTICE
Wounds result in significant costs,
not only to patients’ wellbeing,
but also to the health economy. In
a recent study, the annual cost to
the NHS of wound management
and associated comorbidities
was estimated at £5.3 billion per
year (Guest et al, 2017). Certain
types of wounds, such as leg
ulcers and diabetic foot ulcers,
often taken a long time to heal,
resulting in a cycle of pain, anxiety
and reduced quality of life for
the individual patient (Dowsett,
2015). Delayed wound healing and
wound complications incur further
healthcare costs and are associated
with longer and more intensive
treatment, extended hospital stays,
or readmission and specialist
intervention (Dowsett, 2015).
Wounds, such as leg ulcers,
pressure ulcers or diabetic foot
ulcers, which develop in the
community are more likely to
require hospital referral for
specialist assessment and, in some
cases, admission for treatment,
which further increases the cost of
care. Strategies that focus on early
recognition of those patients at risk
of developing a hard-to-heal wound
are essential to break the cycle
of delayed healing and hospital
admission as a result of wound
complications (Dowsett, 2017).
Accurate and timely assessment
is essential to select the correct
treatment and intervention for the
patient. Interventions need to be
based on the best available
evidence to ensure the optimal
outcome for the patient.
EVIDENCE-BASED PRACTICE
The advent of evidence-based
practice has been traced to the mid-
1800s when Florence Nightingale
was credited with evaluating and
making nursing decisions based on
observed outcomes (Mackey and
Bassendowski, 2016). Evidence-
based medicine was formally
introduced in a series of articles
published by Cochrane in 1992
(Evidence-Based Medicine Working
Group, 1992; Keller, 2012). These
Cochrane publications inspired
an ongoing trend of defining and
improving what is now known as
evidence-based practice.
Using evidence-based practice
allows nurses to provide the highest
quality and most cost-efficient
patient care possible. It involves
the use of current best evidence in
conjunction with clinical expertise
and patient values to guide
healthcare decisions, i.e. the patient
may have had a good experience
of wound care treatment and
bring that to the discussions about
their care plan. One definition of
evidence-based practice described
it as ‘the conscientious, explicit
and judicious use of current best
evidence in making decisions
about the care of the individual
patient. It means integrating
individual clinical expertise with
the best available external clinical
evidence from systematic research’
(Sackett et al, 1996).
Evidence-based practice
involves synthesising results from
research studies, i.e. looking at
the results of different studies and
collating the findings to formulate
a treatment plan for an individual
patient, applying clinical expertise
and considering individual patient
preferences (Sackett et al, 2000;
Melynk and Fineout-Overhold,
2015) (
Figure 1
).
The implementation of evidence-
based practice begins with an
understanding of the various
types of evidence, along with their
strengths and limitations. Deciding
when and how to implement
evidence can be challenging for
nurses and this can be compounded
by conflicts in expert opinion (Rice,
Caroline Dowsett, nurse consultant, wound care
Evidence-based practice in wound care
IN BRIEF
Utilising evidence-based practice helps us to provide the highest
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evidence as methodologically appropriate, rigorous and
clinically relevant.
KEYWORDS:
Evidence-based practice
Assessment
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Advanced wound
care products
Caroline Dowsett
JCN supplement
2018,Vol 32, No 2
7
‘Interventions need to be
based on the best available
evidence to ensure the
optimal outcome for
the patient.’