WOUND CARE TODAY
2014,Vol 1, No 1
9
DISCUSSION
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terms of visits and time spent, staff are seldom allowed
to specialise in this area alone.
The aging population and care closer to home
have led to increasing demands on community
healthcare teams, causing an increased number of
daily calls per nurse as a result of financial constraints.
In addition, the skill mix in community teams has
changed and a greater number of junior staff are
taking up community roles. These staff can and do
offer excellent care to patients, however, the ability
to influence change in the teams can be difficult if
those in hierarchical positions are resistant. In turn,
the introduction of these junior roles has led to
experienced district nurses becoming office-based
coordinators of care, as opposed to seeing patients.
The number of daily visits often leads to a task
mentality to enable the nurse to survive the day so to
speak, as they have little or no time to reflect or plan
next steps of care. Time to stop and think is essential.
This is further reinforced by the target-driven litigious
healthcare system, with documentation being key.
However, the amount is ever-increasing and I would
question its correlation to improved care.
JM
WHAT ARE THE MAIN CARE AREAS THAT ARE MISSING
OUT (PRESSURE ULCERS, LEG ULCERS, ETC)
Leg ulcer care has been missing out for years, with
the government not acknowledging that it is a
chronic condition for many of its sufferers, affecting a
significant proportion of the population. Pressure ulcers
recently gained attention, being seen as ‘never events’
and indicators of the quality of care given. Straightaway
that shifted the focus from any other form of wound
care to pressure ulcers. With zero tolerance and CQUIN
targets on pressure ulcers from the commissioners, it is
only fair to assume that clinicians become much more
focused on treatment and avoidance of pressure ulcers
than any other wound types.
EC
Most wound care services are based on reactive as
opposed to proactive models of care. For example,
how many of us offer preventative leg ulcer screening
services? Much focus has been placed on surgical site
infection (SSI) reduction and preoperative screening,
and high risk patient identification and interventional
wound management to avoid complications, as
opposed to dealing with the consequences of care.
Lessons could be learnt from this approach in other
areas of wound care.
JM
WHAT IS THE MAIN DRIVER FOR ENSURING THAT
ADEQUATE WOUND CARE IS PROVIDED IN
THE COMMUNITY?
Highlighting that cancer wounds, leg ulcers, burns
and any other form of wounds can be as emotionally,
socially, financially expensive and debilitating as
pressure ulcers.
EC
We have conflicting drivers and therein lies the
problem. As suggested above, alongside an aging
population, we are reducing budgets in real terms
with an increasingly target-driven system and an
aging workforce. To address this, we need to look at
roles and responsibilities across the board. What is
the role of the tissue viability service, how does this
link with other services, what is the role of the nurse,
GP, and professionals allied to medicine (PAM). For
example, access to community physiotherapy, dietetics
and enablement teams for housebound patients is
a precious but limited resource, which is essential
to prevent pressure ulcers and ensure function. In
addition, engaging GPs and other stakeholders in the
adoption of a proactive as opposed to reactive service
that specialises in wound care. Patients should be
triaged into the right service at the right time.
We also need to explore what is reasonable in
respect to patient responsibility, with regard to self-
care and concordance, or conversely, if they refuse
treatment, what responsibility do the staff looking
after them have? When is it ok to withdraw services
and allow self-care of chronic long-term conditions
with minimal support.
JM
IN THE FUTURE, WHAT ONE THING DO YOU THINK
COULD BE DONE TO ENSURE THAT PATIENTS WITH
WOUNDS RECEIVE THE CARE THEY NEED
Lobby the government to consider the fact that all
wounds can be debilitating and impact on patients’
quality of life, irrespective of their nature and
origin.
EC
The key to success is consistency of messaging
to staff, patients and other key stakeholders. This
requires the use of clear, concise teaching, aide
memoires/reference guides, and patient information,
which are adopted regionally, nationally and
internationally that demystify wound management
and embrace technology and patients’ ability to
self-care and access information. While some would
criticise this ‘cook book’ approach to wound care,
it ensures a basic level of care from which to build.
In addition, it avoids clinicians reinventing the wheel,
and also helps build the body of evidence, as it enables
comparison of real life data, which can be used to monitor
patient outcomes in a meaningful way.
JM
REFERENCE
Department of Health (2010)
White Paper: Equity and Excellence:
Liberating the NHS
. DH, London
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