Click here for the Wounds UK Home Page January 2007

Best Practice Statement   Wounds UK Book Offer   Wounds UK Awards	Welcome to the first and slightly belated e newsletter Christmas is now a distant memory and most are back at work picking up those jobs we said we would do after the holidays. Resolutions have been made and the gym has never been so busy or so I heard from a third party. 2007 promises to be an incredible year for wound care. Towards the end of last year a number of companies were trialling topical negative pressure devices and this looks set to bring new competition to the market. We have all had success in using TNP in the past and it is an interesting development that there will be a choice of products available. Among the newer technologies on show at Harrogate in November was that of Electrical Stimulation (Posifect from Biofisica). Posifect is a dressing which delivers a small electric current to the wound bed which in turn stimulates healing. Early research has found that wounds which are healing emit a low voltage current which can be detectable- termed the current of injury-. This would appear to be common sense, as wounds heal as a result of chemical messages transmitted between the cells. Chronic wounds which are slow or non-healing appear not to have the 'current of injury' or 'current of healing' as some have suggested. The new dressing is designed to create a low level current in the wound which seems to stimulate key cells to function normally. From a political perspective, the issues raised in 2006 regarding the role of tissue viability nurses are sure to continue to cause concern among specialist nurses in wound care. As agenda for change bandings are awarded there is bound to concern among those who feel undervalued by their health boards. To add to the ill feeling, the letter from AMS is still causing concern among TVN's and there should be a joint response to their assertions this year. John Timmons Editor Email: John.Timmons@gcal.ac.uk	Bandage Agreement reached in Greater Manchester Area 3M announce new 2 layer compression bandage system bandage Notes and feedback from the meeting of Consultants and Specialists in Tissue Viability   References Latest journal references

Best Practice Statement Towards the end of last year, Wounds UK and 3M joined forces to produce a Best practice statement for the skin care of elderly patients. The statement entitled' Care of the older patients' skin, has been written by leading clinicians and researchers namely Pam Cooper, Dr Mike Clark and Professor Sue Bale. Best practice statements are designed to give practical clinical information and advice to nurses who are involved in caring for the respective patient group. In the absence of concrete evidence these statements are invaluable to help guide clinicians in providing the best possible care for patients. The Best practice statement (BPS) aims to address the needs of the older patient who as we know are at high risk of developing skin problems. The first section of the statement highlights some of the key concerns which may impact on the patient such as pressure ulcers, incontinence and skin breakdown. The statement then goes on to give practical advice on skin inspection, prevention of skin breakdown and the treatment of damaged skin. It is hoped that this will form the basis for an ongoing educational resource for all those involved in caring for the older person. To access a copy of the statement follow the link below or click on Best Practice on the Wounds UK home page. http://www.wounds-uk.com/cgi-bin/link.cgi?t=bestpractice&l=downloads/best_practice_older_skincare.pdf   Keep reading for: Wounds UK Book Offer Wounds UK Awards Bandage Agreement reached in Greater Manchester 3M announce new 2 layer compression bandage system bandage Minutes from the meeting of Consultants and Specialists in Tissue Viability References Download this newsletter in PDF format Wounds UK Book Offer This month's book offer is Professor Christine Moffatt's new title, Compression Therapy in Practice is to be published by Wounds UK in May 2007. There is the opportunity to pre-order this publication at the special price of £20.00 on the Wounds UK website throughout February and March. Also, on special offer this month is Essential Wound Management: An introduction for undergraduates. This book focuses on the patient, providing a comprehensive review of wound management issues and addresses the needs of undergraduate students. An ideal resource when completing wound management modules   Keep reading for: Wounds UK Awards Bandage Agreement reached in Greater Manchester 3M announce new 2 layer compression bandage system bandage Minutes from the meeting of Consultants and Specialists in Tissue Viability References Download this newsletter in PDF format Wounds UK Awards The Wounds UK Awards ceremony will take place on 8th June 2007 at the Hippodrome, Leicester Square, London. The Wounds UK awards proved to be a huge success last year with a large number of nominees in every category. What is important about the awards is that they seek to reward everyday practitioners for their hard work, dedication and innovation. From February this year you will be able to nominate someone you feel has worked hard to improve patient care in the field of wound healing. This person may be you. Details of how to put forward nominations will be on the Wounds UK website from February and in the next issue of Wounds UK journal, good luck.   Keep reading for: Bandage Agreement reached in Greater Manchester 3M announce new 2 layer compression bandage system bandage Minutes from the meeting of Consultants and Specialists in Tissue Viability References Download this newsletter in PDF format Bandage Agreement reached in Greater Manchester Area Spend in the NHS has increased year on year on items such as dressings and bandages and there has been much effort expended to ensure the development of cost-effective strategies without compromising on quality to ensure optimal patient care. The Greater Manchester Collaborative Procurement Hub (GMCPH) is a pathfinder hub set up to undertake the procurement of nonpay expenditure on behalf of the constituent stakeholders, including Primary Care Trusts (PCT) and Acute Hospital Trusts. Click here to view more information Keep reading for: 3M announce new 2 layer compression bandage system bandage Minutes from the meeting of Consultants and Specialists in Tissue Viability References Download this newsletter in PDF format 3M announce new 2 layer compression bandage system bandage Click a link below to view information regarding the Coban 2 Layer Compression System: Patient information Leaflet Application & Removal Poster   Keep reading for: Minutes from the meeting of Consultants and Specialists in Tissue Viability References Download this newsletter in PDF format Notes and feedback from the meeting of Consultants and Specialists in Tissue Viability Notes and feedback from the meeting of Consultants and Specialists in Tissue Viability held in the King's Suite Harrogate Conference Centre on Monday 13th November 2006. A meeting was held on the 13th November attended by approximately 80 specialists in Tissue Viability. The meeting was convened in response to the many political issues that had arisen over the last few years which had frequently arisen and been managed in an unsatisfactory and haphazard manner. A small group of practitioners had decided that rather than rumbling and grumbling amongst themselves a national initiative was required. The timescale for this was, in many ways forced forward by the submission from AMS to the House of Commons Select committee on NH Deficits and although this was not in any way the focus of the meeting, it certainly acted as a catalyst to spur people on. Issues covered at the meeting included: The Supply Chain Excellence programme in 2004, which tried to reduce the cost of wound care products and rationalise availability via the supplies catalogue The Department of Health Consultation on the Provision of stoma care, incontinence, wound care products and chemical reagents which focussed again on cost savings, nurse specialists being funded by industry and the cost / value of value added services such as education. Agenda for Change and the discrepancies in bands allocated to staff ( 5 - 8D for Nurses Specialists and 7 - 8D for Nurse Consultants) Connecting for Health: the national computerisation of records which in some areas has proceeded without consulting specialist in the field NHS deficits: (DoH 2007) the role of Tissue Viability in managing / reducing this. Several other issues were discussed but what was apparent were the key themes that ran through each of these; the lack of consultation with the specialists, the lack of supporting information available when requested and a feeling of almost inevitability on the part of the specialists. Following the presentation a very lively debate ensued, this was supported by many telephone calls and emails received after the meeting. These could be categorised into 4 main areas: Communication Audit Education Regulation Communication It was felt that TVNs do not have a strong political profile and this is reflected in the lack of consultations on projects which are clearly within their specialist remit. There is acknowledgement that as a speciality we have complicated this by having many specialist organisations but no single one that can be used to quickly contact everybody or be seen as a central point for consultation. The email cascade system which had been set up in response to the AMS document had appeared to work well and most people were keen to maintain this. Many TVNs accept that they are very clinically focussed and therefore do not always work strategically or give due importance to larger issues such as those discussed above where the bulk of the work was done by a very small number of people. Indeed most admitted to 'parking' communications of strategic or national nature. Many problems in relation to communication also stemmed from lack of audit. These issues do not negate the fact that specialists should be consulted when relevant and therefore their profile must be raised nationally. Audit There is no recognised audit tool used within TV whichever type of wound is considered we do not have good comparable data. Several TVNs admitted they 'don't do' audit as they have neither the skills nor the understanding of what they can do with the information. Although there have been several attempts to get people to agree for example on pressure ulcer grading tools this is seen as a 'political hot potato' with too many people having individual preferences which they will not compromise on. As we do not have audit data it is very difficult for individuals to prove their worth so when we requested evidence for the DoH submission only 11 examples from the whole of the UK were received. Many people identified difficulties in using the 'right language' when collecting / presenting audit data so for example were unable to articulate how they could use initiatives such as Payment by Results to support their service provision / development. The implications of Commissioning for Health have also to be considered. Education Education of nurses in training has undergone considerable changes over the last 15 years. It is noticeable that qualified nurses are now far less confident with 'basic' wound care and will frequently refer anything that constitutes a wound to the TVN. This is problematic as it is not good use of a specialists' time, but in order to ensure these patients are appropriately managed TVNs are having to provide increasing amounts of basic education which in the current financial climate few staff are able to attend. In terms of education for the specialists themselves there is little standardisation or cohesion in what is available at Post Qualification or Post Graduate level. Furthermore much of the focus is on clinical knowledge whereas in fact as highlighted above what many need are higher level skills such as audit, business planning staff management etc. Regulation This is a less pressing area but worth discussion. As reflected by the pay banding TVNs do a broad range of things their knowledge and skills are also very variable and there is nothing / no one to set minimum requirements. This means we already have a small number of inappropriate people in post and also there is no guidance for aspirant practitioner (of any profession). It has been suggested that the formation of a college or society of TV which you submitted evidence to including clinical and skills based information would provide some organisation / regulation of practitioners. This is increasingly important as more practitioners set themselves up independently in response to initiatives such as Practice Based Commissioning and also for fear of being made redundant. Suggestions for what is needed include: A baseline audit of TVNs, who they are, where they are, what qualifications / skills they have and what they do. Baseline audit of tissue viability services eg specialist units. Setting up of minimum databases to facilitate audit Provision of an educational framework to support TV practitioners Review of educational provision and support for pre registration nurses and newly qualified nurses. Raising of the political profile of the speciality. Activities are underway to develop these and as soon as anything is planned / available the information will be circulated via the cascade network of national regional groups. In the mean time if there are any further suggestions or ideas for how we achieve all of this please let me know!   Keep reading for: References Download this newsletter in PDF format References of interest from the journals Franks, P. J.; Moffatt, C. J Do Clinical and Social Factors Predict Quality of Life in Leg Ulceration? INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS VOL 5; NUMB 4 .pp. 236-243 Huang, Y.; Peng, Y.; Li, X.; Liu, X.; Luo, Q (2007) A randomized comparative trial between Acticoat and SD-AG in the treatment of residual burn wounds, including safety analysis BURNS -OXFORD- VOL 33; NUMBER 1; SUPP pp. S12 Kramer, A.; Kremer, J.; Assadian, O.; Schneider, I.; Dahne, H.; Schwemmer, J.; Muller, G.; Siegmund, W.; Jakel, C. (2006) The classification of antiseptic products to be administered to wounds - another borderline case between medicinal products and medical devices? INTERNATIONAL JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS VOL 44; NUMB 12 pp. 677-692 Mathieu, D (2006) Guest Editorial: Role of Hyperbaric Oxygen Therapy in the Management of Lower Extremity Wounds .INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS VOL 5; NUMB 4 (2006) pp. 233-235 Pancani, S.; E, P.; Messineo, A.; Rowan, S (2007) Conservative management of unusual wounds in children .BURNS -OXFORD- VOL 33; NUMBER 1; SUPP pp. S11 Percival, S. L.; Bowler, P.; Dolman, J (2007) Susceptibility of silver resistant bacteria to silver containing wound dressings BURNS -OXFORD- VOL 33; NUMBER 1; SUPP pp. S132 Pereira, T. M.; Flour, M.; Goossens, A (2007) Allergic contact dermatitis from modified colophonium in wound dressings: CONTACT DERMATITIS VOL 56; NUMBER 1 pp. 5-9 Pilipaityte, L.; Rimdeika, R (2007) Leg ulcers complicated by calcinosis in patient with rheumatoid arthritis BURNS -OXFORD- VOL 33; NUMBER 1; SUPP pp. S99 Trueman, P.; Posnett, J (2006) Guest Editorial: What Price Wound Care?. INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS VOL 5; NUMB 4; pp. 230-232 Yonezawa, M.; Tanizaki, H.; Inoguchi, N.; Ishida, M.; Katoh, M.; Tachibana, T.; Miyachi, Y.; Kubo, K.; Kuroyanag Y (2007) Clinical study with allogeneic cultured dermal substitutes for chronic leg ulcers: INTERNATIONAL JOURNAL OF DERMATOLOGY VOL 46; NUMBER 1 (2007) pp. 36-42 Zhu, J (2007) Surgical reconstruction of persistent wounds and defects in sacral and perineal regions-Clinical report of 28 cases BURNS -OXFORD- VOL 33; NUMBER 1; SUPP pp. S5   Download this newsletter in PDF format