Jackie Stephen-Haynes

Making change work.

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The development and implementation of an acute traumatic wound guideline.

Accident and emergency (A&E) departments and minor injury units (MIUs) are faced with a wide variety of acute traumatic wounds on a daily basis. Yet despite the existence of a county-wide tissue viability policy, guideline and formulary in Worcestershire, there had been no attempt to standardize treatment for traumatic wounds in the county. This article describes the process of developing a guideline for acute traumatic wound care by a wide multidisciplinary team. It identifies key points that may be considered when developing similar guidelines, including planning, leadership, communication and the motivation to finish the project. Development of guidelines is advocated as a means not only of improving and standardizing care to patients, but as a means of fostering multiprofessional team building and improved communication between health professionals.

Fungating wounds: management and treatment options

This article defines fungating wounds and considers the underlying cause, location and presentation. The clinical challenges presented by fungating wounds are discussed, with reference to evidence-based care delivery. This includes wound assessment, cleansing, debridement and management of malodour, infection, bleeding and exudate. Guidance on the use of wound management dressings is considered in relation to symptom management. The importance of clinical decision-making and educational preparation in the delivery of evidenced-based care for those with fungating wounds is emphasised. A conclusion is made that the clinician can support the patient with a fungating wound by the delivery of evidenced-based care.

Zinc-impregnated and odour- control two-layer compression

This article presents the results of 40 patients using two versions of a new two-layer compression system in a large primary care organisation. The evaluation was undertaken to explore the following areas formulary inclusion consideration: ease of use, clinical acceptability, clinical outcome and additional patient benefits of an alternative new low-profile bandage system containing zinc (n=30) and odour-control properties (n=10).

Evaluation of clinical and financial outcomes of a new no-sting barrier film and barrier cream in a large UK primary care organisation.

The study involves 95 subjects within a UK Primary Care Organisation and was undertaken in two arms. The objective was to determine the clinical outcomes and clinical acceptability of a newly available range of no‐sting barrier film and no‐sting barrier cream products offering significant financial benefits. The importance of undertaking this study is underpinned by evidence in the literature relating to the use of no‐sting barrier preparations within clinical practice. The first part of the study (arm 1) involved extensive evaluation of either the film or cream barrier in 36 patients and was compared to existing standardised barrier protection care within the organisation. The results indicated that the new product range met all the criteria for formulary inclusion and following this the barrier range was further evaluated in arm 2, 33 patients with barrier cream and 26 patients with barrier film. The entire study was conducted over a 3‐month period with patient treatment lasting a minimum of 2 days to a maximum 4‐week period adhering to the agreed evaluation protocol as approved by clinical governance. In arm 1 (n = 36), the clinical expectation of the product was met in 32 cases relating to ease of use, conformability, no‐sting, quick drying, ease of absorption, compatibility with devices, frequency of application, prevention and management including visual skin improvement resulting in a recommendation for formulary listing in 31 of 36 cases. In arm 2 (n = 59), barrier film and barrier cream performance was consistently rated same as, better than or much better than the existing barrier used. A formulary listing recommendation was made in 51 of 59 cases.

Product evaluation of an absorbent, antimicrobial, haemostatic dressing

This article reports on a product evaluation of KytoCel, an absorbent wound dressing used in the treatment of 30 wounds treated in community care and 10 split-thickness skin-graft donor sites treated in acute care. Within the community-treated cohort, unspecified leg wounds were the most common wound type (n=6) with the mean wound area of the 30 wounds being 17.6 cm2 (standard deviation (SD) 31.7) and mean volume being 8.4 cm3 (SD 21.4). Most community treated wounds (27/30; 90%) were reported to have moderate to high levels of wound exudate with the majority (n=19) either healed or improved during treatment. All ten split-thickness skin graft donor sites healed during the evaluation. A semi-structured focus group consisting of 17 nurses provided their opinions on KytoCel, with positive comments offered on the dressing during the focus group and of the 17 participants, 10 commented that the KytoCel dressing was available on their local wound care formulary.

An audit of chronic oedema within the care home setting

This articles outlines the important issue of chronic oedema, its definition and the physiology of the three main categories. The care delivered in the care home (nursing) sector was the subject of a printed questionnaire and the results are presented here. They are discussed and the implications for practice and an evidenced-based approach to care delivery are considered. Several conclusions can be drawn from this study but would be strengthened by a larger study. Care for patients with chronic oedema could be enhanced and this would improve clinical outcomes; significantly fewer patients would need to be referred for GP management if an appropriate and timely first-line treatment was agreed and provided by nursing staff. An educational resource should be developed, including: a resource folder; e-learning, patient information, and a patient leg exercise regime; a crib sheet and myth buster information; and clinical competencies. A further study would be required to confirm whether fewer patients experienced falls or presented with chronic oedema when lower leg swelling was managed.

Evaluating the performance of a new carboxymethyl cellulose dressing in the community setting

This article describes a single-centre, non-comparative evaluation set out to assess the clinical performance and patient acceptability of a new carboxymethyl cellulose (CMC) wound dressing. Twenty patients in a community setting, aged between 34-97 years, were recruited. The progression of various types of wounds with different levels of exudate was documented over 4 weeks. No adherence to the wound bed or painful removal was reported in 18 patients, and the peri-wound skin was the same or had improved in all patients. When compared with the previous CMC dressing used by the authors, the new CMC dressing reported a longer wear time. These findings show a positive clinical performance and suggest a potential financial advantage when using the new dressing.

Change for the better

Jackie Stephen-Haynes, Professor in Tissue Viability, Professional Development Unit, Birmingham City University and Consultant Nurse, Worcestershire Health and Care NHS Trust.

A 100 patient clinical evaluation of an alternating pressure replacement mattress in a home-based setting

BACKGROUND alternating pressure air mattresses (APAMs) support the prevention and management of pressure ulcers. A health and care NHS trust was seeking an APAM that would improve clinical outcomes in relation to pressure ulcers while considering financial cost. An APAM existed that could meet the trusts needs but there was a lack of evidence over its use in a community/home setting. This study examined the effect of using the Dual Professional (IQ Medical) APAM for patients at a high risk of pressure ulceration. It also determined patient and family satisfaction, and the views of clinicians in relation to clinical outcomes. Additionally, infection prevention and control, servicing, maintenance and electrical biomechanical engineer input were considered. METHOD a prospective observational study was undertaken of 100 patients in their own homes following a pilot study of 10 patients. The period of the evaluation was from one day up to 295 days, with a mean average of 83 days, and a total of 5809 bed days. RESULTS with a regimen of regular repositioning of patients and a good diet, the APAM was effective in preventing pressure ulceration in the 100 patients who were at a high or very high risk of skin breakdown and pressure ulceration. CONCLUSION selection of pressure redistributing surfaces should be based on holistic patient assessment, including risk assessment, mobility levels, grade of pressure damage and clinical judgment.