Journal of Community Nursing

6 / 20

6 JCN supplement 2018,Vol 32, No 2
BURDEN OF WOUND CARE
patients with non-healing wounds is
substantial (Guest et al, 2015), with
many of these costs being avoidable
if appropriate care is provided at the
right time (NHS England, 2017).
Therefore, investment in tissue
viability services can help reduce
overall costs by ensuring patients are
managed on the most appropriate
clinical pathway. In addition, use of
more expensive advanced dressings
may be beneficial in reducing time
to healing, and thus, in turn, have
a positive impact on costs. There
also needs to be a focus on waste
reduction. Guest et al (2017) found
evidence that the choice of dressings
and bandages was inconsistent, and
that the types used were continually
being switched at dressing changes,
leading to confusion and conflict
within the treatment plan and
ultimately waste.
Training
It is essential that healthcare
professionals understand the link
between the underlying disease
pathology and the complexities of
wound healing.They need to be
competent and confident in wound
assessment, dressing selection, ABPI
measurement and compression therapy
to optimise healing. Access to training
is increasingly difficult due to workforce
pressures, availability of opportunity
and funding. However, healthcare
organisations need to realise the
importance in investing in education
to improve patient outcomes (King’s
Fund, 2016b).
CONCLUSION
The burden of wound studies not
only evidenced the cost to the NHS
of managing patients with wounds,
but also highlighted a number of
shortcomings in the assessment
and management of patients.These
shortcomings can result in harm to
the patient by denying them evidence-
based care, resulting in avoidable
delayed healing.
Thus, it is important to ensure,
wherever possible, that wounds
are prevented and that healthcare
professionals have the ability to
accurately assess wounds, reach an
appropriate diagnosis, and formulate
individual patient-focused treatment
plans which are aligned with best
practice. Healthcare systems need
to aim to reduce the inconsistency
within wound care, ensuring that all
patients receive the‘right care at the
right time’and are not harmed by poor
management. By optimising patient
outcomes, there is a real potential to
reduce the financial and service burden,
leading to clinical and economic benefits
both for the patient and NHS.
REFERENCES
Ashby RL, Gabe R, Ali S, Adderley U
(2014) Clinical and cost-effectiveness of
compression hosiery versus compression
bandages in treatment of venous leg ulcers
(Venous leg Ulcer Study IV,VenUS IV): A
randomised controlled trial. Lancet 383: 871–9
Atkin L,Tickle J (2016) A new pathway for
lower limb ulceration. Wounds UK 12(2):32–6
Charles H (2004) Does leg ulcer treatment
improve patients quality of life? J Wound Care
13: 209–13
Franks P, McCullagh L, Moffatt C (2003)
Assessing quality of life in patients with
chronic leg ulceration using the Medical
Outcomes Short Form-36 questionnaire.
OstomyWound Manage 49(2): 26–37
Franks P, Moody M, Moffatt C (2004)
Randomized trial of cohesive short-
stretch versus four-layer bandaging in the
management of venous ulceration. Wound
Repair Regen 12: 157–6
Frykberg RG, Banks J (2015) Challenges in the
treatment of chronic wounds. AdvWound
Care 4(9): 560–82
GoodwinT, Atkin L (2018) The impact of
living with a chronic leg ulcer from young
adulthood. Wounds UK 14(1): 40–5
Green J, Jester R, McKinley R, Pooler A (2014)
The impact of chronic venous leg ulcers: a
systematic review. J Wound Care 23: 601–12
Guest JF, Ayoub N, McIlwraithT, Uchegbu I,
Gerrish A,Weidlich D,Vowden K,Vowden P
(2015) Health economic burden that wounds
impose on the National Health Service in
the UK. BMJ Open 5(12):e009283. Available
online:
Guest JF, Ayoub N, McIlwraithT, Uchegbu I,
Gerrish A,Weidlich D,Vowden K,Vowden P
(2017) Health economic burden that different
wound types impose on the UK’s National
Health Service. Int Wound J 14: 322–30
Guest JF, Fuller GW,Vowden P (2018) Diabetic
foot ulcer management in clinical practice
in the UK: costs and outcomes. Int Wound J
15(1): 43–52
JCN
Harding K (2016) Challenging passivity in
venous leg ulcer care — the ABC model of
management. Int Wound J 13(6): 1378–84
Jones J, Barr W, Robinson J, Carlisle C (2006)
Depression in patients with chronic venous
ulceration. Br J Nurs 15: S17–S23
King’s Fund (2016a)Understanding pressures
in general practice. Available online: www.
kingsfund.org.uk/sites/default/files/field/
field_publication_file/Understanding-GP-
pressures-Kings-Fund-May-2016.pdf
King’s Fund (2016b) Improving quality in the
English NHS. A strategy for action. Available
online:
files/field/field_publication_file/Improving-
quality-Kings-Fund-February-2016.pdf
Meaume S, Dompmartin A, Lok C, et al (2017)
Quality of life in patients with leg ulcers:
results from CHALLENGE, a double-blind
randomised controlled trial. J Wound Care
26: 368–79
Moffatt C, McCullagh L, O’Connor T (2003)
Randomized trial of four-layer and two-
layer bandage systems in the management
of chronic venous ulceration. Wound Repair
Regen 11: 166–71
NHS England (2017) NHS RightCare scenario:
The variation between sub-optimal and
optimal pathways. Betty’s story: leg ulcer
wound care. Available online: .
nhs.uk/rightcare/wp-content/uploads/
sites/40/2017/01/nhs-rightcare-bettys-story-
narrative-full.pdf
Persoon A, Heinen MM,Van DerVleuten CJM
(2004) Leg ulcers: a review of their impact on
daily life. J Clin Nurs 13: 341–54
Scottish Intercollegiate Guidelines Network
(2010) Management of ChronicVenous Leg
Ulcers: A National Clinical Guideline. SIGN,
Edinburgh
Vowden P (2011) Hard-to-heal wounds Made
Easy. Wounds Int 2(4). Available online: www.
woundsinternational.com/media/issues/514/
files/content_10140.pdf
Werdin F,Tennenhaus M, SchallerH-E,
Rennekampff H-O (2009) Evidence-based
management strategies for treatment of
chronic wounds. Eplasty 9: e19
White RA, Smerdon G, Bishop A,Witts S,
Reeves J, Ashford C (2017) Letters: Comment
on Guest et al.‘The health economic burden
that acute and chronic wounds impose on an
average clinical commissioning group/health
board in the UK. J Wound Care 26: 353–5
Wounds UK (2016) Best Practice Statement:
Holistic management of venous leg ulceration.
Wounds UK, London. Available online: www.
wounds-uk.com/pdf/content_12022.pdf