Wound Management Resources

Wound care in the UK has long been overlooked, often treated as a consequence of underlying health conditions rather than a distinct medical concern. However, as the prevalence of chronic wounds continues to rise, it is becoming increasingly evident that this perspective is unsustainable. Chronic wounds impact around 7% of the UK population, imposing a substantial burden on both patients and the healthcare system, with the NHS spending over £8.3 billion annually to manage the issue (Making wound care work: 9). Despite these alarming figures, wound care services remain understaffed and undervalued, straining to meet the rising demand for their expertise (Making wound care work: 4).

Here, Susan Brookes, clinical and deputy lead, Birmingham and Solihull Training Hub (BSolTH), explains how they set themselves a challenge — namely, how could they ensure that the future general practice workforce understood and appreciated the ever-evolving roles within it? Not only that, how could they show the symbiotic relationships of these roles, include learning opportunities and make it innovative, fun and enhance other skills required to promote confident and competent practitioners? The team then went about creating an escape room experience using the background of gamification as their guide. This first ‘room’ was created for nurses and linked to wound management. Although early days in terms of its use, the initial feedback was good and BSolTH look forward to developing more rooms across a wider range of healthcare professionals.

Appropriate and accurate assessment and management of lower limb wounds requires a timely, holistic assessment of the patient and their wound, including the recording of an ankle-brachial pressure index (ABPI) (Wounds UK, 2019a). A manual ABPI procedure requires advanced skills, using a handheld ABPI device, and is undertaken by a healthcare professional who is appropriately trained. In addition, the procedure is time consuming, taking a minimum of 40 minutes, and is subjective in its results, based on the technique and skill of the operator. This article describes an innovative service evaluation project that has seen the introduction of 20 automated ABPI machines into 19 general practices and a community vascular clinic in Staffordshire. The project has included the development of a care pathway, recruitment of wound champions, and training within each of the practices. Evaluation of the project is ongoing but tracks ABPI readings, assessment and wound management of patients, onward referrals and outcomes for patients, to ensure that the project’s potential to improve patient care is realised.

Exudate is produced as part of the inflammatory phase of wound healing and assists the healing process by providing essential nutrients to the wound, promoting moist wound healing and naturally debriding the wound bed. However, exudate can also be detrimental to the healing process and managing excessive exudate in clinical practice is often challenging. The key to managing exudate is accurate assessment and identifying the underlying cause of excessive production. Accurate diagnosis and assessment will assist general practice nurses (GPNs) in selecting appropriate treatment options and strategies that can help in managing exudate efficiently. This article discusses what exudate is and its function in wound healing. It also explores the causes of excessive exudate production and what GPNs can do to manage high volumes to prevent skin damage and improve patient quality of life.

Debridement is a key component of wound bed preparation, which should not be seen as a one-off procedure, but rather as something to be done on a regular basis and included in the patient care pathway. It plays a vital part in removing dead and contaminated tissue, which harbour bacteria posing a barrier to timely healing. Debridement can also remove the presence of biofilm. Wound cleansing is also an integral part of wound care practice. However, there is little evidence about the best method, frequency, or solution to use, which causes wound cleansing often to be seen as a controversial procedure. With developments in the wound care product market and smarter dressings and wound care therapies becoming available, little attention has been given to the use of cleansing solutions. Wound cleansing is technically defined as the use of fluids to remove loosely adherent debris and necrotic tissue from the wound bed to create an optimal wound healing environment.

Holistic patient assessment remains central to informing wound management plans, despite the nature and origin of the wound. As with any other type of wound, the management of surgical wounds is multifaceted, with both intrinsic and extrinsic factors needing to be addressed to achieve wound healing. In addition to the challenges these pose to the wound healing process, surgical wounds are at risk of dehiscing and overgranulation. Advances in research and technology have resulted in an increase in the use of disposable topical negative pressure devices in the community to manage surgical wounds (Khanbhai et al, 2012; Hudson et al, 2015), which has demonstrated positive patient outcomes in most studies (World Union of Wound Healing Societies [WUWHS], 2016).

The number of patients with venous leg ulcers is growing as the population ages. Recent estimates indicate that 730,000 people with venous leg ulcers were treated in 2012/13 (Guest et al, 2015); a number that is predicted to increase year on year. Venous leg ulcers can be difficult to manage in some patients despite best practice, particularly in those with multiple comorbidities. These patients can develop chronic ulceration that can be present for months or even years in some cases. The cost of managing these patients presents a significant burden to the NHS. An evaluation was carried out to determine the efficacy of LQD® wound spray, a unique spray-on wound dressing that contains Chitosan FH02™, in promoting wound healing in patients with longstanding venous leg ulcers. The results indicated that LQD wound spray contributed to putting the wounds onto a healing trajectory.