Jeanette Milne

Wound-bed preparation: the importance of rapid and effective desloughing to promote healing.

This article describes effective ways of diagnosing and removing slough from a wound bed. It highlights how slough is a key contributor to wound chronicity, and gives practical clinical information on how to address this. The various methods of removing slough will be discussed including the mechanism of action of dressings and other mechanical methods. The ultimate objective of the article is to put the term desloughing on the clinical agenda and increase clinician familiarity with it. The practical focus of the article will help clinicians select a proven method to facilitate the rapid removal of slough, it is hoped that in doing so this will help to prevent chronicity, reduce the potential for bacterial proliferation and promote rapid and effective wound healing outcomes.

Negative pressure wound therapy

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Managing surgical wound care: review of Leukomed Control dressings

Optimal management of surgical wounds is an important part of postoperative recovery. The aim of postoperative wound care is to facilitate rapid wound closure, while preventing complications and promoting minimal disturbance, to achieve the best functional and aesthetic results. Health professionals should seek to optimise the process of acute wound healing, observe progress, and prevent wound complications. Dressings that permit extended wear time, and are transparent and so allow early recognition without the need for unnecessary changes, have the potential to minimise the effect on patients and the wider health economy. This article reviews recommendations for surgical wound care, and introduces the recently launched Leukomed Control dressing that is entirely transparent and allows greater flexibility, breathability, and visualisation of the wound.

Target areas in wound care

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The unknowns in tissue viability

I can’t think of a better field of nursing to work in than tissue viability. After 29 years as a nurse and 19 in the field of tissue viability I never tire of the adrenaline rush of healing a challenging wound. Despite the ageing population and austerity, nurses continue to rise to the challenge and are working harder than ever to meet the patient safety agenda. Tissue viability has played a central role in reducing the number of hospital-acquired pressure ulcers and raising public awareness, as a result of the NHS Midlands & East ‘Stop the Pressure Campaign’ that was adopted by NHS Improvement. We have also seen inspirational campaigns that have put the fun back into learning, such as ‘Heel Hero’, a caped character in foot form appearing on educational and awareness materials from Coventry and Warwickshire Partnership NHS Trust (reminding us to ‘deal with the heel’), and ‘Sally Sore’, the teaching-aid-come-mascot for pressure ulcer prevention at University Hospitals Coventry and Warwickshire NHS Trust. There are Twitter challenges such as #PressureAreaChallenge —(can you list all the pressure areas in 2 minutes)— initiated by University College London Hospitals NHS Foundation Trust, which will be announcing the winning Trust out of all those who have signed up for the challenge on 3 July 2017. Alongside pressure ulcer targets, this year sees the introduction of the community Commissioning for Quality and Innovation (CQUIN) target (NHS, 2017) for wound assessment, which seeks to improve wound diagnosis; the cornerstone of successful wound management. Also, launched under the NHS Right Care agenda (2017) is ‘Betty’s Case’, an example of an unwarranted variation in leg ulcer care that outlines the costs associated with inappropriate leg ulcer care to both the health economy and patient, and outlines the benefits of standardising care. I am excited by both challenges but a little anxious in relation to how I inspire colleagues against the backdrop of staff shortages and other competing health campaigns. The King’s Fund’s Making Integrated Care Happen (2013) discusses the challenges of change at scale and pace. NHS England (2015) has introduced the Sustainability Transformation plans and Accountable Care Organisations, which aim to reduce the barriers between organisation and encourage joint working to meet the health and EDITORIAL