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T here is a great wealth of information to
guide clinical practice in areas such as
pressure ulceration (National Institute
for Health and Care Excellence [NICE], 2014a),
however, the same can’t be said for leg ulcer
management. The most recent national guidance
in the UK was published by the Scottish
Intercollegiate Guidelines Network (SIGN) in
2010. However, if clinicians follow this guidance
are they in danger of missing out on innovations in products and
practice that have emerged since then?
Management of hyperkeratosis that often accompanies venous leg
ulcers is steeped in tradition with dry plaques often being removed
with forceps (Crook et al, 2013). In the NHS today, one could question
if this is an effective use of resources. The NICE Medical Technology
Guidance has recognised that new innovations that support improved
wound care practice should be evaluated and integrated into clinical
care as soon as possible. In this vein, NICE recommended that
Debrisoft®, a monofilament debridement pad, should be routinely used
in debridement and the removal of hyperkeratosis, wound assessment
and wound bed preparation, owing to its rapid action and cost benefits
(NICE, 2014b). These two developments, which are already having an
impact on community practice, are the subject of this supplement.
Following the work of Moffatt et al (1992), compression therapy
became a life-changing development for patients and nurses alike
and this traditional therapy is still considered to be the‘gold standard’
for healing venous leg ulcers because of its effects on healing rates.
However, the bulk of four-layer component bandaging, its weight and
heat often have a negative effect on patient concordance with therapy.
Consequently, clinicians and patients will welcome the results of the
recently publishedVenUS IV randomised controlled trial (RCT), which
demonstrated that two-layer component hosiery systems (e.g. leg
ulcer hosiery kits) are as effective as four-layer component bandaging
systems for the healing of venous leg ulcers, and are more cost-
effective, have lower recurrence rates and improve self-management
(Ashby et al, 2014).
As clinicians delivering wound care it is our responsibility to
advance both our individual practice and, collectively, the care
delivered to patients with venous leg ulcers. We must make evidence-
based decisions using a variety of sources of appropriate information.
Evidence-based practice can bring demonstrable clinical benefits
and drive down the costs of wound care for the benefit of patients,
clinicians and healthcare organisations alike — a goal we will achieve
if we continue to challenge practice.
TrudieYoung, Director of Education and Training, Welsh Wound Innovation Centre
Ashby R, et al (2014) Lancet 383: 871–9
Crook H, et al (2013) EWMA Conference, Copenhagen, May 2013
Moffatt C, et al (1992) BMJ 305(6866): 1389–92
NICE (2014a) Clinical guideline 179
NICE (2014b) Medical Technology Guidance 17
SIGN (2010) A National Clinical guideline: 120
Managing director
Ed Rusling
Director
Nicola Rusling
Publisher
Binkie Mais
Editor
Jason Beckford-Ball
Business manager
Alec O’Dare
; 07535 282827
Operations manager
Stephen Mell
Editorial and advertising support
Joanna Issa
Office manager
Angela Brookes
Challenge your practice in
venous leg ulcer management
©Wound Care People Limited 2014
Finials House, The Square,
Stow-on-the-Wold, Gloucestershire GL54 1AF
ISSN 0263 4465
Journal of Community Nursing is indexed with
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› Contents
JCN supplement 2014,Vol 28, No 6 3
Journal of Community Nursing
EDITORIAL