Wound Care Resources

The recent Covid-19 pandemic has reinforced the need for health care to be delivered in a different way to enable the NHS to be fit for purpose and continue to provide high levels of health care at an affordable cost. One way of doing this is to utilise the benefits of shared care, a concept that is not new, but has not yet been fully embraced. This encourages sharing the responsibility of delivering care in a variety of ways. Wound care is one area that provides general practice nurses (GPNs) with a significant opportunity for patients to be involved in their own care. This can even include wounds producing a high volume of wound exudate, if an appropriate dressing is selected which gives the patient confidence that it will work, despite the unpredictable nature of chronic wounds. Patients need a package of information to reinforce the verbal education given to ensure that they know how to carry out their care, and what to do in the event of a problem or change in wound status. Virtual clinics, which have been especially useful during the recent pandemic, are also an option to replace some face-to-face contact.

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.