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Kathy Leak - Wound Care Sister, Doncaster and Bassetlaw Foundation Trust As a member of the UK T.I.M.E Advisory Board for the past 18 months and having recently attended the 6th board meeting, it came to mind to write about our personal experiences within the Doncaster and Bassetlaw Foundation Trust regarding T.I.M.E. The use of the concept of T.I.M.E was initially seen as way to improve documentation and wound descriptions. Following wound care training sessions during lunch breaks, an audit of wound care knowledge was performed prior and post the training on a vascular and diabetic ward. The results showed conclusive improvements in descriptions of wounds terminology used. In addition a reduction in the cost of dressings used on the wards following the teaching sessions was identified. This seemed to be because nurses took control and ownership of the concept of T.I.M.E and changed dressings as prescribed. I am sure you will agree this was a very successful exercise. To compliment this T.I.M.E has been cascaded throughout the trust on all Tissue Viability study days. The concept has been incorporated into our wound care formulary and into our leg ulcer, and wound care IPOC (INTEGRATED PATHWAY OF CARE). Students shown the acronym of T.I.M.E found the tool extremely easy to understand, highlighting the fact that novice and expert can adopt this process and adapt it to their level of learning. Today T.I.M.E is used across our trust. Recent work has changed practice from the theatre to healing, producing data highlighting reductions of cost healing times. An example where this approach has been adopted is in the treating of Pilonidal Sinus disease. A simple technique of which we all, as nurses, see and know are problematic wounds of the young adult. The implementation of T.I.M.E is continually improving our practice with regard to wound assessment and documentation of wound assessment, whilst ensuring appropriate wound management. With the improvement in documentation regarding wound care and with the implementation of IPOC associated with wound care our medical colleges are now recognising the importance of TIME
The Wounds UK Summer Conference on the 27th June is set to be bigger than ever. Not only are there 3 conferences running concurrently but now there is an opportunity for all TVNs, Podiatrists and associated wound care professionals to come on the afternoon of the 26th for two free symposia. Synergy, who bring Exsudex to the negative pressure therapy market, have a symposium from 1630 - 1830, followed by Biofisica, the makers of PosiFect RD, from 1830 - 1930. These events will be followed by a free champagne reception and dinner.
Audiences have reviewed the days very favourably which have provided the opportunity for reflection on a way forward on chronic oedema management particularly in the lower limbs through talks from Lymphoedema specialists and TVNs on epidemiology of lymphoedema, recognition of the different types of chronic oedema, management of cases, and who to and when to refer to other specialists. A practical demonstration of a full leg bandaging technique signals what could be achieved for a wider group of patients with full leg oedema following suitable training. One little practical snippet I picked up from attending was that there is only one prescription charge payable for a pair of lymphoedema stockings, unlike the per leg charges for the British Standard products used for care of varicose veins and prevention of venous ulcer recurrence. In fact you can have multiple pairs prescribed on a single script, which is all remarkably sensible. If you would like a place on one the remaining days contact the Activa Customer Line 08450 606707 or your local representative. Click here to view more information
The days will cover the management of chronic oedema by talks and practical workshops.
Last month I found myself reading a fascinating piece in the Times on an interview with an American Medic Dr Jerome Goodman, a Haematologist Oncologist at Harvard Medical School. In the interview about his new book, How Doctors Think, Dr Grossman muses on the fact that doctors often diagnose too quickly under the pressure of time and overwork and sometimes get it wrong. He cites research showing that the average doctor interrupts the patient within 18 seconds of them starting telling their story signalling that they have already reached their diagnosis and that further information is irrelevant. For 30 years as a practising doctor he says he has looked to traditional information sources such as textbooks, journals and colleagues to help him in his diagnostic thinking, only now realising that he has another vital partner to help him in his work, the patient! Mind you it is not just doctors who diagnose under pressure, TVNs should reflect on the need to let the patient speak unhindered and keep checking back with them for more details as they progress through assessments. I like Dr Groopman, it takes considerably courage to raise the obvious that can be so easily overlooked. Reference - Bonsor S (207) Trust me I'm a patient. The Times May 1st:Suppl (Times2); 4 - 5 Bullfrogs and superbugs Scottish scientists have found a novel antimicrobial peptide in the skin secretions of American bullfrogs. Antimicrobial peptides are naturally occurring molecules produced by all living creatures as pathogen defence. The compound, ranalexin, when applied with an existing agent, lystostaphin, had a significant effect on MRSA infected wounds. The combination of two agents helps lower the risk of resistance developing and enables the individual doses to be lowered reducing risk of toxicity. Dr Peter Coote at St Andrews University said their findings represented " a potentially novel way to combat MRSA via surface treatment or impregnation of wound dressings". Remember you heard it here first! Reference - Bell G (2007) Bullfrog hops in to fight with superbug. The Herald. May 1st: 12
Ever been to Hospital Episode Statistics online? Sounds a bit dull but it is a mine of useful information to help you in proving the need for your service. For example I discovered that there were 231398 bed days in England and Wales during 2005 - 06 for ulcers of the lower limb and 536 days of this total were spent in my local District General. Well by my reckoning using the £250 per bed day figure this amounts to £134,000, now that is a few TVNs in my book that could be undertaking prevention of admission and early discharge work.
Morris T, White G. (2007) Motivational interviewing with clients with chronic leg ulceration. Br J Community Nurs.12(3):S26-30. Freeman E, Gibbins A, Walker M, Hapeshi J.(2007) 'Look after your legs': patients' experience of an assessment clinic. Br J Community Nurs. 12(3):S19-20, S22-5. Gibb M. (2007) The Leg Club model in the Australian context. Br J Community Nurs. 12(3):S14-6, S18. Vuolo J. (2007) Why people with diabetes suffer foot ulceration. Nurs Times. 103(15):44-6. Pressure Ulcers Tonseth KA, Tindholdt TT, Hokland BM, Abyholm FE. (2007) Green urine after surgical treatment of pressure ulcer. Scand J Plast Reconstr Surg Hand Surg. 41(1):39-41. Bale S, Dealey C, Defloor T, Hopkins A, Worboys F. (2007) The experience of living with a pressure ulcer. Nurs Times. 103(15):42-3. Guy H. (2007) Pressure ulcer risk assessment and grading. Nurs Times. 103(15):38-40. Vanderwee K, Grypdonck M, DeFloor T (2007) Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial. J Clin Nurs. 16(2):325-35 Vanderwee K, Grypdonck M, De-Bacquer D, Defloor T (2007) Effectiveness of turning with unequal time intervals on the incidence of pressure ulcer lesions. Journal of Advanced Nursing. 57 (1) 59-68 Vanderwee K, Grypdonck M, DeFloor T (2005) Effectiveness of an alternating pressure air mattress for the prevention of pressure ulcers Age Ageing. 34(3):261-7 Russell L, Reynolds T, Park C et al (2003) Randomized clinical trial comparing 2 support surfaces: results of the Prevention of Pressure Ulcers Study. Adv Skin Wound Care. 16(6):317-27 Krause J Broderick L (2004) Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset. Arch Phys Med Rehabil. ;85(8):1257-64 Minor Trauma Roberts M (2007) Preventing and managing skin tears: a review. J Wound Ostomy Continence Nurs. 34(3):256-9 Burns Muangman P et al (2006) Comparison of efficacy of 1% silver sulfadiazine and Acticoat for treatment of partial-thickness burn wounds. J Med Assoc Thai. 89(7):953-8 Pain Hampton S (2007) Chronic pain in wounds: a report on 11 case studies. Nurs Times. 103(15):48-50. Gaufberg SV, Walta MJ, Workman TP (2007) Expanding the use of topical anesthesia in wound management: sequential layered application of topical lidocaine with epinephrine. Am J Emerg Med. 25(4):379-84 Exudate McColl D, Cartlidge B, Connolly P. (2007) Real-time monitoring of moisture levels in wound dressings in vitro. Int J Surg. 2007 Mar 12; [Epub ahead of print] Infection Stephen-Haynes J, Toner L. (2007) Assessment and management of wound infection: the role of silver. Br J Community Nurs. 12(3):S6, S8, S10-2. Ovington L (2004) The truth about silver. Ostomy Wound Manage. 50(9A Suppl):1S-10S. Nakamura Y, Daya M. (2007) Use of appropriate antimicrobials in wound management. Emerg Med Clin North Am. 25(1):159-76. Vascular Collins R, Cranny G, Burch J et al (2007) A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease. Health Technol Assess. 11 (20) 1 - 202 - www.hta.ac.uk/minisumm/min1120.htm Topical Negative Pressure Moues CM, van den Bemd GJ, Heule F, Hovius SE. (2007) Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: A prospective randomised trial. J Plast Reconstr Aesthet Surg. 60(6):672-81. Epub 2006 Jun 22 Braakenburg A et al (2006) The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg. 118(2):390-7; discussion 398-400 McCord SS, Naik-Mathuria BJ, Murphy KM, McLane KM, et al (2007) Negative pressure therapy is effective to manage a variety of wounds in infants and children.Wound Repair Regen. 15(3):296-301.
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Download this newsletter in PDF formatJune 2007 |
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