Wound Assessment and Documentation
The skin is the largest organ of the human body that makes up around 16% of the body weight. It has several functions, related to immunity, regulation of temperature regulation, production of vitamins and sensation. A disruption of the normal structure and function of the skin results in wound formation (Dargaville et al. 2012). This essay will elaborate on two different procedures or policies for wound care management. The first one is ‘Wound Management Policy” by the Rotherham Doncaster and South Humber, NHS. The other policy that will be discussed in the essay is the “Wound: Wound assessment and Management” by South Eastern Sydney Local Health District. These policies and procedures refer to the techniques that need to be followed for assessing and managing the incidence of several kinds of wounds. Wound healing can be defined as a complex process that involves natural response for restoration of injured tissues. It occurs due to interplay of interactions between a series of cellular events, which reconstruct and restore the injured tissues of the skin. This paper will further illustrate the similarities and differences between the abovementioned policies and will shed light on the more rigorous policy, based on evidences.
Wound care management encompasses a series of techniques and interventions that are followed by healthcare professionals in order to prevent the wound from getting severe. Therefore, a prior assessment of the wound that involves collection of patient information, observing the wound, surveying the patient and identifying relevant data from the patient’s medical history is essential (Pilen et al. 2012). Both the wound management policies, the NHS (2012) and the South Eastern Sydney Local Health District (SESLHD) (2015) provide adequate information on wound assessment.
The methods associated with evaluation of the wounds and re-assessment are mentioned in both the policies. Wound evaluation and re-assessment are imperative to its management as they involve documentation of the wound, which in turn helps the nursing staff to review previous wound status and the history of its management (Dreifke, Jayasuriya and Jayasuriya 2015). This directly influences improvement patterns and reduces chances of wound deterioration. Although, SESLHD provides a concise explanation on the different methods that need to be adopted for wound healing and also contains adequate information on the pharmaceutical interventions, it does not contain any information on the use of antibiotics. On the other hand, the NHS policy contains a detailed account of the topical and systemic anti-microbial solutions and antibiotics that should be applied in case of acute or chronic infections (Daeschlein 2013).
Wound Dressing and Antibiotic Applications
In addition, both the policies present information regarding the audit and documentation of any wounds as a part of the assessment procedure. However, the information present in the SESLHD policy is quite limited and only focuses on plan for wound assessment and management (S0056 form number), CHIME wound care templates, transfer documentation and discharge plans. On the other hand, the policy formulated by the NHS presents a plethora of content on written document related to assessment screening. The policy also ensures showing compliance to the audit requirements. The NHS illustrates the different techniques of wound cleansing in order to cause minimal trauma or pain to the patient while removing gross contamination. It suggests that wound cleansing should be properly followed for the removal of excess exudates, remnants of old dressings, slough and necrotic tissue, promoting patient comfort, and facilitating correct wound bed assessment. However, the SESLHD only mentions that intensive cleansing of the wound is necessary to prevent further infection. In addition, the ways by which heavy colonization can interfere with the stages of wound healing are illustrated in the NHS policy. It further explains about critical colonization, wound swabbing and exudate control. However, the SESLHD fails to provide adequate data on this topic.
The NHS policy also proposes to provide education and expert professional advice on the control and prevention of infection to patients, carers, multi-disciplinary groups, and other healthcare professionals. It aims to educate on wound management, leg ulcer management and prevention and management of pressure ulcer. It also provides education on the footwear that need to be put on to prevent diabetic foot ulcers and formulates training programs that addresses comprehensive dressing selection and wound management (Bakker and Schaper 2012). The SESLHD policy also proposes providing timely and continuous education and training to the nursing staff would work towards minimising complications, and makes it mandatory for all clinical staff to attend the annual Wound Care Management programs. Therefore, it can be deduced that both policies exert equal importance on the training and education of healthcare staff. In addition, the NHS policy states that holistic wound assessment should be accurate, precise and patient-centred. This will help in ensuring that the carers as well as the concerned patients are well acquainted with the potential complications that can arise during wound management. However, no information on holistic assessment or comprehensive treatment plan that meets the needs of the client is present in the SESLHD policy.
Wound Cleansing and Infection Control
Wound healing is an extremely complex procedure and requires a cascade of specific biochemical and molecular events that help in promoting and enhancing the integrity of the tissues. This cascade also helps in restoring tissue functions (Gantwerker and Hom 2012). While comparing the aforementioned two polices regarding wound management programs, it was found that the policy proposed by the NHS is more rigorous than the one proposed by the SESLHD. This is due to the fact that the former policy contains exhaustive information on the different procedures of wound management, education and training in the field, dressing, antibiotic applications, colonization, wound cleansing and exudates control.
The NHS policy focused a great deal on the different aspects of wound assessment. It states that it is essential to thoroughly assess all wound types prior to establishing the management needs and selecting appropriate dressings for the wound. Further, it mentions that holistic wound assessment should be able to detect presence of health complications, general factors that can cause a delay in the healing process such as, dietary patterns, chronic infection, diabetes and concomitant medications like steroids. It also takes into account the type, location and dimensions of the wound. It focuses on considering the presence of foreign body in the wound region and also emphasizes on the wound history. These factors can play a major role in either accelerating or delaying the wound healing process. Evidences suggest that prior and detailed information on patient history is imperative while designing any wound management program as it helps the carers to determine any underlying factors that might contribute to risks or adverse outcomes in the patient. Therefore, a detailed medical record of the concerned patient is essential.
Additionally, the NHS policy states that an adequate supply of macronutrients and micronutrient is required to facilitate the wound healing process. The patient should also be adequately hydrated. This is due to the fact that any kind of nutritional deficiency reduces the tensile strength of the new tissues that are being generated and increase the risks of infection and formation of fragile scar tissues (Chow and Barbul 2014). This interferes with the wound healing process. An increase in nutritional requirements in a patient with wound further increases the chances of malnutrition. The policy further states that the underlying circulation and blood supply should be considered while designing debridement options (Kolluru, Bir and Kevil 2012). The association between smoking and wound healing is also established by the policy. Smoking acts as a major risk factor and results in several health complications, such as, vasoconstriction and hypoxia, increased atherosclerosis, and reduced synthesis of collagen (Sørensen 2012).
Education and Training for Healthcare Professionals
Obesity also plays an important role in increasing the risk of infection and wound dehiscence due reduction in wound perfusion (Pence and Woods 2014). The risks of infection can get further enhanced with old age that results in weakening of inflammatory responses. Psychosocial issues also contribute to wound healing process (Broadbent and Koschwanez 2012). Therefore, the policy by NHS not only emphasized on the well known physical factors, it also elaborated on the different environmental and psychological factors, which play a role in wound healing and patient recovery.
Furthermore, the policy focuses on the principles of TIME wound assessment tool for selecting dressings. TIME assessment refers to Tissue, Inflammation or Infection, Moisture and Edges. It helps in providing comfort to the patients (Leaper et al. 2012). This acronym was developed by International Advisory board. However, no mention of this assessment tool is found in the SESLHD policy. Moreover, the size, shape, colour, infection, exudates and pain of a wound are essential to be determined for preparing an exhaustive care plan. This was followed by the NHS policy.
Furthermore, evidences suggest that an effective wound care is often associated with clean dressing techniques that are followed under aseptic conditions (Broussard and Powers 2013). The policy focuses on the use of anti-microbial solutions or dressings for heavy colonization and also states that all dressings should be adequately designed in order to provide an optimal environment for wound healing to the patients. It focuses on the use of hydrogels, alginates, hydrocolloids, foams, Maggot Therapy, and Cadexamer iodine for different wound types (Metcalf and Bowler 2013). Thus, this policy provides detailed and relevant information on the wound dressing procedures.
In addition, it provides a clear concept on wound infection and colonization. There is a need to closely monitor bacterial colonization at the site of wound infection owing to the fact that colonization delays the wound healing process (Almeida et al. 2014). Therefore, the NHS policy is more effective in providing an explanation on this matter compared to the SESLHD policy, which makes no mention of effects of colonization. In addition, the wound infections can be detected by the process of wound swabbing (Asada et al. 2012). This further helps in developing various interventions. The NHS policy also contained detailed guidelines on wound swabbing procedure.
It further recognized the importance of debridement for optimal healing rate. Debridement is an essential part of wound management and is generally practiced by autolysis, mechanical, biological, surgical and sharp debridement methods (Doerler et al. 2012). It promotes wound healing and heals ulcers faster.
Factors Affecting Wound Healing
There are many underlying reasons that contribute to the differences between the two aforementioned policies. The primary reason could be cultural and ethnic differences between England and Australia. The NHS policy is from the UK, while, the NSW government has proposed the SESLHD policy. There exists different healthcare funding in these two nations. Furthermore, most of the healthcare services by the NHS are free of cost in England. Events that involve emergency situations or accidents are sent for referrals (Mindell et al. 2012). However, the entire cost of GP services is not funded in Australia. Moreover, the Australian Government provides complete subsidy to only state funded hospitals (Lopes, Carter and Street 2015). Therefore, it can be stated that the funding and healthcare services are better in when compared to Australia. This might have contributed to the differences in the wound management policies. Another probable reason of difference lies in the date of formulation. While the NHS policy was issued on 17 August, 2012, the SESLHD was published in October 2015. The earlier publication of the former policy provided better chances of improvement and revisions. This can attribute to its rigorous nature. Thus, if the SESLHD policy gets adequate time, it might work towards improving the areas that lack sufficient information.
Conclusion
To summarise, this assignment focused on two wound care management policies. One policy was “Wound Management Policy” by the Rotherham Doncaster and South Humber, NHS and the other was “Wound: Wound assessment and Management” by South Eastern Sydney Local Health District. There are several similarities and differences in the information they contain. The assignment elaborated on some of the easily observable similarities and differences. On analyzing the differences, it was found that the policy propose by the NHS was more rigorous than the other. Evidences from several researches were used to establish the information presented in the policy.
A thorough evaluation and consideration of the collected evidences led to the conclusion that the wound management policy by the NHS is of a higher quality as it contains exhaustive information regarding assessment and management of wounds. To conclude, it can be stated that differences in culture, ethnicity, and health funding systems might be the possible reasons for the variations in the policies. Therefore, there is a need to adopt evidence based strategies in order to manage wounds, which in turn will help in promoting the complex healing process.
References
Almeida, G.C.M., dos Santos, M.M., Lima, N.G.M., Cidral, T.A., Melo, M.C.N. and Lima, K.C., 2014. Prevalence and factors associated with wound colonization by Staphylococcus spp. and Staphylococcus aureus in hospitalized patients in inland northeastern Brazil: a cross-sectional study. BMC infectious diseases, 14(1), p.328.
A Comparison of the Two Policies
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Bakker, K. and Schaper, N.C., 2012. The development of global consensus guidelines on the management and prevention of the diabetic foot 2011. Diabetes/metabolism research and reviews, 28(S1), pp.116-118.
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Daeschlein, G., 2013. Antimicrobial and antiseptic strategies in wound management. International wound journal, 10(s1), pp.9-14.
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Doerler, M., Reich?Schupke, S., Altmeyer, P. and Stücker, M., 2012. Impact on wound healing and efficacy of various leg ulcer debridement techniques. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 10(9), pp.624-631.
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Kolluru, G.K., Bir, S.C. and Kevil, C.G., 2012. Endothelial dysfunction and diabetes: effects on angiogenesis, vascular remodeling, and wound healing. International journal of vascular medicine, 2012.
Leaper, D.J., Schultz, G., Carville, K., Fletcher, J., Swanson, T. and Drake, R., 2012. Extending the TIME concept: what have we learned in the past 10 years?. International wound journal, 9(s2), pp.1-19.
Lopes, E., Carter, D. and Street, J., 2015. Power relations and contrasting conceptions of evidence in patient-involvement processes used to inform health funding decisions in Australia. Social Science & Medicine, 135, pp.84-91.
Metcalf, D.G. and Bowler, P.G., 2013. Biofilm delays wound healing: A review of the evidence. Burns & Trauma, 1(1), p.5.
Mindell, J., Biddulph, J.P., Hirani, V., Stamatakis, E., Craig, R., Nunn, S. and Shelton, N., 2012. Cohort profile: the health survey for England. International journal of epidemiology, 41(6), pp.1585-1593.
Pence, B.D. and Woods, J.A., 2014. Exercise, obesity, and cutaneous wound healing: evidence from rodent and human studies. Advances in wound care, 3(1), pp.71-79.
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Sørensen, L.T., 2012. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Annals of surgery, 255(6), pp.1069-1079.
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