Wound Care Today

7 / 56

Twelve per cent of all wounds
included in the study had no
diagnosis recorded at all, making
wound type unidentified in the note.
These findings are alarming and
raise the question of how wounds
can be managed and monitored
effectively if assessment is not
carried out and documented. On
what basis are treatment decisions
made and against what baseline is
progress monitored?
Unsurprisingly, only 43% of
chronic wounds healed during the
year of the study. It is well known
that healing rates vary depending
on wound type and the general
health and comorbidites of the
individual patient, but the majority
of wounds for the majority of people
should heal within three months
with accurate assessment and
appropriate management decisions.
When wounds become chronic (for
example, a venous leg ulcer is defined
as chronic if present for longer than
four weeks), assessment should be
carried out to identify the route cause
and to guide management decisions,
and findings recorded as a baseline
against which to measure progress.
Wounds should not simply
be allowed to become chronic
for prolonged periods without
questioning why healing is not
occurring and what can be done
to improve the situation. For those
patients for whom healing is not a
goal, symptom management should
be the aim.
Guest et al (2015) concluded
that their findings are reflective of
the practical difficulties experienced
by non-specialist healthcare
professionals in the community,
and highlighted a need to raise
awareness of the impact of wounds
on the healthcare system and to train
non-specialist clinicians in the
principles of wound assessment
and management.
These recommendations have
now been acted upon in England;
‘improving the assessment of
wounds’has been specified as a
key goal of the Commissioning for
Quality and Innovation (CQUIN)
scheme for 2017–2019 (NHS
England, 2016).
This means that a proportion of a
healthcare service provider’s income
will be conditional on demonstrating
improvements, such as reducing the
number of wounds that have failed
to heal after four weeks of treatment,
by focusing on wound assessment
and documentation, and introducing
targeted healing rates.
Indeed, using CQUIN guidance
and taking the time to conduct a full
holistic assessment of the patient
WOUND CARE TODAY 2017,Vol 4, No 1 7
WCT
Wound care is a major aspect of community nursing. As patients may be treated by
numerous healthcare professionals, it is vital that an appropriate wound care document
is accurately completed to facilitate continuity of care and enhance healing rates. It is
essential that wounds undergo a thorough baseline assessment, utilising a wound chart
to document findings, and that ongoing assessment and documentation occurs regularly
to identify effectiveness of the care plan and to facilitate a change in care if necessary.
In addition, holistic assessment will aid identification of the cause, guide the most appropriate treatment
plan, and identify any factors that may inhibit healing. In relation to leg ulcers, the ‘gold standard’ is
that a Doppler assessment is undertaken once a wound has been present for two weeks. This assessment
will indicate if compression can be used safely, and if so, this treatment will aid healing, reduce nursing
input and save money. Doppler assessment should be undertaken by a suitably trained professional, so
in view of the benefits that can be gained, investment must be made into the training and professional
development of nurses.
Annette Bades, district nursing specialist practitioner, Lancashire Care NHS Foundation Trust
WOUND WATCH i
and their wound will save time and
improve practice in the long term.
With an ageing population and
declining district nurse workforce
(Royal College of Nursing [RCN],
2012), it is clear that now, more than
ever, there is a need for efficiency
in community wound care service
provision if increasing demand and
reduced funding are not to impact
on the quality of care provided.
The CQUIN target for 2017–19
ultimately aims to reduce wound
care workload by improving practice
and patient outcomes.
REFERENCES
Guest J, Ayoub N, McIlwraith T, et al
(2015) Health economic burden that
wounds impose on the National
Health Service. BMJ Open 5(12).
Available online:
com/content/5/12/e009283
NHS England (2016) CQUIN 2017–19
Guidance. Available online:
Royal College of Nursing (2012) The
Community Nursing Workforce in
England . RCN, London. Available
online:
assets/pdf_file/0003/450525/09.12_
The_Community_Nursing_
Workforce_in_England.pdf