Wound Care Today

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Akey study by Guest et al
(2015) into the realities of
wound care service provision
in the UK identified inconsistencies
in the assessment and management
of wounds, and the opportunities to
improve both efficiency of working
and patient outcomes.
The records of 1000 patients with
wounds and 1000 patients without
were randomly selected fromThe
Health Improvement Network (THIN)
database. Information concerning
wound-related health outcomes
and healthcare resources used was
analysed and costed at 2013/14 prices.
The study revealed that in
2012/13, 2.2 million wounds
and associated comorbidities
were managed by the NHS at an
estimated cost of £5.3 billion — a
cost equal to the management of
obesity. These costs were attributed
to the management of wounds that
It’s TIME to get to grips with wound
assessment in the community
healed (£2.1 billion) and remained
opened (£3.2 billion) during the
study year, respectively.
Two-thirds of the total cost was
attributed to nurse-led, community-
based wound care, which included:
i 18.6 million practice nurse visits
i 10.9 million community
nurse visits
i 7.7 million GP visits
i 3.4 million hospital
outpatient visits
i 97.1 million drug prescriptions
i 262.2 million dressings
i 73.4 million bandages
i 9.0 million compression bandages
(Guest et al, 2015).
However, the findings also
revealed that of the 2.2 million
wounds managed during the study
year, 30% lacked a differential
diagnosis. For example, of the
wounds recorded as being a leg
ulcer, 19% did not have any further
characterisation; they were not
recorded as being venous, arterial
or mixed. It is easy to recognise
the negative impact that this lack
of information could have on
management and patient outcomes
and, in some cases, could result
in harm.
On this point, Guest et al (2015)
noted that existing best practice
guidelines for the management of leg
ulcers and diabetic foot ulcers state
that the assessment of peripheral
perfusion is a recognised requirement
for leg ulcer and diabetic foot
management, yet only 16% of all
cases with a leg or foot ulcer had a
Doppler ankle brachial pressure index
(ABPI) recorded in their records.
This means that 84% of patients
who should have had peripheral
perfusion assessed didn’t and/or
findings were not documented in the
patient notes.
6 WOUND CARE TODAY 2017,Vol 4, No 1
WOUND WATCH i
Working as a community nurse today is not for the faint-hearted. Caseloads are
busier than ever and patients have many complex comorbidities, making care
delivery challenging. It is easy for community nurses to undertake wound care that
is ritualistic, rather than based on structured holistic patient assessment. This is
due to the considerable demands being made on the community nursing teams and
sometimes it is easier to continue with current care, rather than undertaking an
assessment or reviewing the outcomes of wound care delivery, which can be seen
as too time-consuming. However, this may result in false economy, as the patient
will continue to have a non-healing wound and need time-consuming visits. Investing time in a structured
holistic assessment will, in the long term, contribute to reducing healing rates, lessening the need for
lengthy visits and delivering clinically effective wound care. It will also result in better patient outcomes.
Kirsty Mahoney, clinical nurse specialist, wound healing, Cardiff and Vale University Health Board
In each issue of Wound Care Today we investigate a hot topic in wound care.
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