Wound assessment Resources

Keeping clear and accurate patient records is key to safe and effective practice (Nursing and Midwifery Council [NMC], 2018). In wound management, systematic and timely wound assessment can lead to correct diagnosis, the implementation of clinically effective treatments and subsequent improvement in patient and wound-related outcomes (Atkin and Critchley, 2017). Updating records at every subsequent reassessment can ensure continuity of care between healthcare professionals. This article examines the importance, requirements and barriers to documentation in wound care, how ongoing comprehensive holistic assessment contributes to keeping records up to date and relevant, and looks at the increased use of digital photography in a virtual setting.

One of the key components of comprehensive holistic wound assessment, particularly of venous leg ulcers, is measuring a patient’s ankle brachial pressure index (ABPI), as this will help to rule out the presence of arterial disease and guide treatment decisions, i.e. the introduction of compression therapy. However, it has been identified that performing ABPI assessment is an area that needs improvement (Guest et al, 2015) to ensure that all patients get a timely diagnosis. Indeed, such meaurements should not only be taken at initial presentation, but regularly to ensure that there has been no deterioriation in a patient’s arterial status (National Institute for Health and Care Excellence [NICE], 2013; Wounds UK, 2016). This article outlines the impact on one GP surgery of implementing a standardised lower limb pathway, in addition to introducing new technology to calculate ABPI, which resulted in improved patient outcomes and effective use of nursing time and resources.

Venous leg ulcers (VLUs) present a huge burden, not just in terms of healthcare costs (Guest et al, 2017), but also in their negative impact on patient quality of life (Marczak et al, 2019). A holistic, multifaceted approach to assessment is needed to ensure that all factors contributing to their development are considered to allow optimal healing to take place. The European Wound Management Association (EWMA, 2016) however, has highlighted a disparity in care between community and specialist settings, with some nurses lacking the necessary skills needed to undertake effective assessment. Since wound assessment is a core component of wound management, impacting directly on therapeutic choices and thus healing (Lázaro-Martínez et al, 2018), it is imperative that general practice nurses (GPNs) are supported in being able to assess wounds accurately. This article discusses and reflects on the value of effectively assessing wounds in primary care using the Triangle of Wound Assessment framework, which focuses not just on the wound bed, but also the periwound skin.

The ability to recognise the need for debridement is a vital skill for general practice nurses (GPNs), since it is an important part of preparing the wound for healing. Debridement removes dead tissue within the wound that can otherwise provide a physical barrier to healing, while also providing an ideal environment for micro-organisms, increasing the risk of infection. In order for healing to progress, it is important to debride the wound promptly. Failure to do so can result in wound chronicity and an associated impact on resources and patient quality of life. While there are different methods of debridement available, this article focuses on autolytic and mechanical, explaining how they work and their benefits and limitations.

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This article highlights the role of general practice nurses (GPNs) in the care of a variety of wounds that are becoming 
increasingly commonplace in primary care. GPNs have a unique opportunity to develop their skills in this field,  articularly as there is a plethora of wound care products available to them on prescription. However, it is also the GPN’s professional duty to ensure that they have the understanding and knowledge necessary to use these products in a way that benefits patients clinically as well as providing cost-effective care.