A collaborative project to enhance efficiency through dressing change practice.

OBJECTIVE: A collaborative project between Hull CHCP and Smith and Nephew wound management, which sought to enhance practice efficiency, specifically in relation to the optimisation of dressing change frequency. The project involved the use of a new foam dressing (Allevyn Life, Smith & Nephew, Hull) designed to manage wound exudate more effectively, be more acceptable to patients by masking staining of the dressing surface, and to provide both the patient and clinical staff with an indicator for dressing change. METHOD: The project comprised a targeted programme of training and education to promote appropriate use of the new product and encourage practice change in dressing change frequency. The frequency of nursing visits, dressing changes and, where applicable, the reasons for a dressing change were documented pre- and post-implementation to determine the effect of this approach. RESULTS: Switching to the new dressing was accompanied by a reduction in dressing change visit frequency in 97.3% (36/37) of patients. The mean reduction in dressing change frequency was 1.8 visits per week, representing a 50.0% reduction. Post-implementation the mean number of dressings used per patient per dressing change had fallen from 2.1 at baseline to 1.1 (a 47.6% reduction). Furthermore, at baseline an average of 9.8 dressings were used per week per patient. This fell to an average of 2.0 dressings per week per patient following implementation, a reduction in dressings per patient of 79.6%. CONCLUSION: The results illustrate that a much less complex approach to the use of dressing products can be achieved. Furthermore, they demonstrate that with the adoption of advanced practice-enhancing products, coupled with appropriate training, education and effective promotion of practice change, valuable nursing time can be released. DECLARATION OF INTEREST: Alistair Bielby is a contractor for Smith & Nephew. Richard Searle is an employee of Smith & Nephew. This project was supported by an unrestricted grant from Smith & Nephew.

Reconciling increasing wound care demands with available resources.

Demographic and epidemiological data suggest that health-care demand will increase considerably in the future as a result of an ageing population and a rise in the prevalence of chronic diseases such as diabetes. This phenomenon has come to be referred to as the 'health care time bomb' in the popular press and political discourse. The authors seek to look beyond the headlines and political rhetoric to clarify the extent to which they reflect the likely future reality with a specific focus on wound management. The present-day burden that wounds and current wound management practices place upon the health-care system are detailed and clarified, and the potential future implications of increasing wound prevalence on the current picture are explored. Possible opportunities to enhance current wound management practice as identified in the analysis are discussed.

Living with wound-associated pain: impact on the patient and what clinicians really think.

OBJECTIVE: To gain an insight into current practice and practitioner opinions on the recognition and management of wound-associated pain as compared with that previously presented in the literature. METHOD: Delegates who attended Wound Expo 2009 and participated in the interactive learning workshops held in the wound pain educational zone were surveyed. This was therefore a convenience sample. All participants signed a consent form prior to the interactive voting session to allow their anonymous responses to be used. The survey consisted of questions that had been devised to generate a clearer insight into current practice and opinion on wound-associated pain. Questions were posed during the workshop (displayed in a PowerPoint presentation) and attendees were given 10 seconds per question to select their preferred responses, each using an individual electronic interactive voting panel. All responses were recorded electronically and the data were subsequently analysed. RESULTS: The survey identified a number of positive approaches used by the delegates in their assessment of wound-associated pain. These include a high level of continuous assessment, an awareness of the wide range of pain assessment tools available and an acknowledgement of the need for a multiprofessional approach to pain management. CONCLUSION: The findings highlight the issues clinicians face in the recognition, assessment and management of wound-associated pain during their everyday practice. Although many of these issues are difficult to resolve entirely, a fundamental element is that the patient's experiences must be assessed and documented in a consistent and informed manner, and then appropriate management actions taken.

A dynamic care pathway to coordinate the use of advanced therapy in diabetic foot ulceration.

The non-coordinated use of advanced therapies is not clinically or cost effective. A care pathway for the sequential use of these interventions on complex wounds provides a more restructured approach, and helped improve patient outcomes.

Use of ultrasound to characterise the fluid-handling characteristics of four foam dressings.

OBJECTIVE: To observe and measure the process of hydration and dehydration in four commonly used adhesive foam dressings using high frequency ultrasound. METHOD: High frequency ultrasound (20MHz) with an axial resolution of 60 microm was used to image the inside of the wound dressings under investigation and thereby assess their level of hydration. This allowed the uptake of a bolus of fluid into the dressing via absorption and the subsequent loss of fluid via evaporation to be both observed and measured. Four dressings were assessed:ActivHeal Foam Island (10 x 10cm), Allevyn Adhesive (10 x 10 cm), Biatain Adhesive (12 x 12cm), and Mepilex Border (10 x 10 cm). RESULTS: Part I showed that Allevyn hydrated most rapidly followed byActivHeal, Biatain and Mepilex. Part 2 indicated that Allevyn dehydrated most rapidly followed by Mepilex,ActivHeal and Biatain. CONCLUSION: High frequency ultrasound proved to be an effective tool in assessing the fluid handling properties of wound dressings. Of the dressings tested Allevyn demonstrated the best fluid handling properties in terms of how rapidly it could hydrate and dehydrate.

Integrating nursing research and practice: Part I--A journey into the unknown.

We must all face the challenge of weaving together the art and science of nursing, of integrating nursing research and practice. In a two part article Northland nurses tell about their experiences with research and the study they carried out. Part one describes their beginning experiences with integrating research and practice.