Click here for the Wounds UK Home Page April 2006

Care Partners	Palliative care for patients with complex wounds This morning I met with the director of pastoral and spiritual care at a local hospice who was teaching my students on the subject of pain and suffering. Our discussion inevitably led to the issue of wound management and provision of wound care for palliative care patients. This patient group are not always cared for in the hospice setting and if we wander through our medical and surgical wards we will find patients in the terminal phases of illness. This in itself is not a problem, many acute sites have Macmillan nurses onsite to help guide staff in providing quality care for patients in need of palliation. One difference I have noted in the past between the two settings, having worked in a hospice early in my career, is the acceptance of death and dying. This is universal among hospice patients, relatives and staff. It is this acceptance which allows a more open approach to care, there are no futile attempts made to resuscitate, there is an open knowledge of the patients condition and there is no talk of cure. Instead, there is an emphasis on preventing and controlling those symptoms of terminal disease which can affect the quality of life of the patient. It is this change in emphasis which makes the hospice environment so successful. In acute care our emphasis is almost always on saving lives, often at any cost, which is why some patients may not receive the palliative treatments which they need and instead may be subjected to extra investigations, blood tests and needless surgery. So how does this relate to wound healing? In wound management, we often have one aim, that is to heal the wound and however hard we try, we find it difficult to accept that our patients' wounds may not heal. It is part of the reward of working in this field that we will have 'visible results'. So when is it ok to decide that a wound may not need to be healed? In many cases the patient will have so many concurrent problems, that healing will be almost impossible. The key for improving practice in this area is to accept that the wound may not heal and start to address the symptoms which are most distressing to the patients and their families. This patient group may have wounds which are painful, have excess exudate, odour, or are subject to haemorrhage and infection. In addition to these problems, if we attempt to heal the wound then we run the risk of causing further distress. For example carrying out sharp debridement, applying dressings which cause trauma on removal, using dressings which do not absorb sufficient exudate. It must also be remembered that not healing the wound is not equivalent to not treating the wound, but that it must always be our goal to improve the patients' quality of life. Just because we can't cure does not mean that we cannot provide appropriate care. The newsletter for the next year has been sponsored by Smith and Nephew Healthcare and the following article relates to an initiative which the company is currently involved in. John Timmons Editor Email: John.Timmons@gcal.ac.uk	References Latest journal references

Care Partners The NHS is continuing to undergo a period of rapid change with a patient-focused approach to improve patient outcomes but, also, to make the organisations within it accountable for both their performance versus the NHS core standards, and for achieving financial balance. Moving forward, all hospitals need to achieve foundation status by 2008, and there has also been the introduction of HRGs and the Payment by Results initiative. In primary care, PCTs are merging and will ultimately commission their own services, and the collaborative procurement hub initiative continues to roll out. As a result of these factors and in order for Smith & Nephew, as market leader, to be the preferred partner for the NHS, we have aligned our approach to mesh with these changes. We now have a team of 12, dedicated, Healthcare Partnership Managers reporting in to two Strategic Partnership Managers, supported by a team of clinical specialists. The team are trained to perform business needs analysis and look at how we can help each organisation within the NHS achieve its' objectives. As a company, we aim to be seen as honest, trustworthy and transparent in our approach, so that our partners in the NHS know exactly what they're getting and can also see exactly what we are getting from any agreements that are set up. It is our aim to provide the best, and most appropriate, products to the NHS, backed up by an outstanding support package, tailored to each organisation's requirements. Therefore, following extensive market research and taking into consideration the needs of both the current market and our customers, we have put together and launched the Care Partners programme. This new package was launched from our Head Office in Hull early in February. The new branding and support materials have been rubber-stamped by a focus panel, and these and our overall approach were very well received. Feedback from our customers shows that they are very impressed that we were not only interested in but also prepared to act on their opinions. Additionally, there was a consensus from them that a needs-based approach, aligned to NHS standards, and with a Care Partner package specifically tailored to each individual trust, would set us apart from the competition. Indeed, through the Care Partners approach, we will be providing a clinically and cost effectively proven support package, that helps reduce their costs, whilst at the same time improving patient outcomes, thus really adding value through a true partnership of equals. Keep reading for: Latest journal references Download this newsletter in PDF format References Ayello, E. A. (2006) 20 Years of Wound Care: Where We Have Been, Where We Are Going ADVANCES IN SKIN AND WOUND CARE VOL 19; NUMB 1; pp. 28-32 Hoggarth, A.; Waring, M.; Alexander, J.; Greenwood, A.; Callaghan, T. (2005) A Controlled, Three-Part Trial to Investigate the Barrier Function and Skin Hydration Properties of Six Skin Protectants OSTOMY WOUND MANAGEMENT VOL 51; ISSU 12; pp. 30-43 Mani, R (2006) Is the Scenario in Wound Healing Changing? INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS VOL 5; NUMB 1; p. 5 Molan, P. C (2006) The Evidence Supporting the Use of Honey as a Wound Dressing INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS VOL 5; NUMB 1; pp. 40-54 Pellard, S (2006) Body image and acute burn injuries: a literature review. JOURNAL OF WOUND CARE VOL 15; NUMB 3 pp. 129-132 Pieper, B.; Templin, T.; Ebright, J. R (2006) Chronic Venous Insufficiency in HIV-Positive Persons with and without a History of Injection Drug Use. ADVANCES IN SKIN AND WOUND CARE VOL 19; NUMB 1 pp. 37-42 Posthauer, M. E. (2006) The Role of Nutrition in Wound Care ADVANCES IN SKIN AND WOUND CARE VOL 19; NUMB 1pp. 43-51 Russell, P. S. S (2006) Self-injurious Behavior to the Lower Extremities Among Children With Atypical Development: A Diagnostic and Treatment Algorithm INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS VOL 5; NUMB 1 pp. 10-17 Satpathy, A.; Hayes, S.; Dodds, S. R. (2006) Measuring sub-bandage pressure: comparing the use of pressure monitors and pulse oximeters JOURNAL OF WOUND CARE VOL 15; NUMB 3 pp. 125-128 Schulz, G.; Stechmiller, J (2006) Wound Healing and Nitric Oxide Production: Too Little or Too Much May Impair Healing and Cause Chronic Wounds INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS VOL 5; NUMB 1; p. 6-8. Wilson, D. J. (2006) The non-pressurised boot dressing: an alternative for use in managing diabetic foot ulceration JOURNAL OF WOUND CARE VOL 15; NUMB 3 pp. 122-124   Download this newsletter in PDF format