WoundsWest education: taking the evidence on wounds to the clinician

The WoundsWest (WW) education programme is an innovative and ambitious subproject of the WW project in Western Australia (WA). It involves the interdisciplinary development of online wound management education modules, which are designed to assist health professionals and health services to reduce preventable wounds and adverse wound management outcomes. The aims, objectives and processes that underpin this development are outlined in this paper, which is illustrated with examples from the WW online education programme

The sorptivity and durability of gelling fibre dressings tested in a simulated sacral pressure ulcer system

Wound-dressing performances are affected by exudate viscosity, resistance to flow because of gravity, and bodyweight loads, the level of which is related to the body position. Here, we focussed on two dressing properties: (a) Sorptivity—the ability of dressings to transfer exudate away from the wound bed by capillary action—and (b) Durability—the capacity of dressings to maintain their integrity over time and during their removal. Both properties are critically important for avoiding further tissue damage but require the development of new laboratory tests for their measurement. A computercontrolled phantom of an exuding sacral pressure ulcer has therefore been developed and used to compare the performances of Exufiber (Mölnlycke Health Care) vs an alternative market-leading dressing. Sorptivity was determined using weight tests, and durability was measured through tensile tests of the used dressings. For a supine configuration, the Exufiber dressing demonstrated three times higher sorptivity and better durability, withstanding five times greater strain energy than the other product before failure occurred. This work paves the way for quantitative, standardised testing of dressings in all aspects of exudate management. The reported tests are further suitable for testing dressing combinations or how dressings interact with negative pressure wound therapy.info:eu-repo/semantics/publishedVersio

WoundsWest: delivering comprehensive strategies to improve wound management in Western Australian Health Services

It is well known that prudent, supported, early discharge of patients back to their home environment facilitates recuperation, rehabilitation or palliation. Patients with wounds are no exception to this.The provision of effective ambulatory wound care is gaining increasing attention and importance worldwide as health services seek to provide efficient and effective services to growing numbers of patients with wounds, often under burgeoning fiscal constraints. The lack of, or poor utilisation of, evidence-based clinical practice guidelines and protocols for wound care and inequities in terms of access to resources, whether wound dressings or education, are causal factors leading to inconsistencies in the clinical management of wounds that contribute to less than optimal outcomes for patients with wounds.Health services and health managers' ability to strategically plan and rationalise wound management services is often further hindered by a lack of data on the epidemiology and potential burden of acute or chronic wounds within and on local or state health services. Furthermore, where there is an absence of clinical governance in relation to wounds, these wounds are not subject to the same scrutiny as other medical conditions and, therefore, opportunities to improve service delivery in relation to wound management are missed.This article describes a tripartite and multidimensional approach to providing West Australian public health services and employees with a sustainable system for the prediction, prevention and management of wounds. WoundsWest (WW), a partnership between WA Department of Health (WA Health), Silver Chain Nursing Association (Silver Chain) and Curtin University of Technology (Curtin University) is a novel, 6-year project and a first for Australia. WW aims to facilitate clinical governance of wounds within health services, enhance clinicians? knowledge, skill and competence in wound management, improve clinical outcomes for patients with wounds and increase health services' ability to decrease the burden of wounds in Western Australian public hospitals.In order to achieve these aims, WW established a number of subprojects to ascertain the prevalence of wounds within WA public hospitals, improve access to educational resources for wounds, improve access to expertise in wound management and provide a repository for wound-related data for the purpose of ongoing research

STAR: A consensus for skin tear classification.

Until now the Payne-Martin Classification System for Skin Tears has been the only skin tear classification system reported in the literature. Considering that the development of this taxonomy began over twenty years ago, it is rather puzzling that it has been poorly utilised in Australia. especially in light of the fact that skin tears are perceived to be common wounds amongst frail older or disabled persons 1, 2, 3 and their prevalence can be expected to escalate in line with our ageing population. Stage one of the Skin Tear Audit Research (STAR) study aimed to gain a consensus from Australian nurse experts in wound management on a classification system for skin tears and to test the reliability of the resulting classification system. This paper reports on the processes undertaken to achieve a consensus, the STAR Skin Tear Classification System that resulted, and the reliability testingthat it underwent

Improving pressure ulcer management in Australian nursing homes: results of the PRIME Trial organisational study

Pressure ulcers are a significant cause of morbidity and mortality in the aged care population with prevalence rates reported to be as high as 43% in some aged care facilities. The PRIME Trial was designed to investigate the effectiveness of an integrated pressure ulcer management system in reducing pressure ulcer prevalence and incidence in nursing homes. A total of 1956 residents from 23 nursing homes in NSW, Vic, SA and WA were enrolled in this Commonwealth funded study.This paper presents the results from phase 1 of the trial and indicates that the prevalence of pressure ulcers in the cohort of 1956 residents was 25.9%. Significant associations between the development of a pressure ulcer and comorbidity level (Charlson Index) (p=0.01), risk assessment level (Braden Scale) (p=0.00) and the lack of appropriate equipment (p=0.00) were detected. Residents who developed a pressure ulcer whilst in an acute hospital showed a trend to develop more than one ulcer and ulcers that were of higher severity than those developed in a nursing home.The results from phase 1 of the PRIME Trial suggest that emphasis needs to be given to appropriate risk assessment of the elderly nursing home resident that should include comorbitity status and the provision of suitable pressure relieving equipment

Robotics to enable older adults to remain living at home

Given the rapidly ageing population, interest is growing in robots to enable older people to remain living at home. We conducted a systematic review and critical evaluation of the scientific literature, from 1990 to the present, on the use of robots in aged care. The key research questions were as follows: (1) what is the range of robotic devices available to enable older people to remain mobile, independent, and safe? and, (2) what is the evidence demonstrating that robotic devices are effective in enabling independent living in community dwelling older people? Following database searches for relevant literature an initial yield of 161 articles was obtained. Titles and abstracts of articles were then reviewed by 2 independent people to determine suitability for inclusion. Forty-two articles met the criteria for question 1. Of these, 4 articles met the criteria for question 2. Results showed that robotics is currently available to assist older healthy people and people with disabilities to remain independent and to monitor their safety and social connectedness. Most studies were conducted in laboratories and hospital clinics. Currently limited evidence demonstrates that robots can be used to enable people to remain living at home, although this is an emerging smart technology that is rapidly evolving.<br /

Enhancing pressure ulcer prevention using wound dressings: what are the modes of action?

Recent clinical research has generated interest in the use of sacral wound dressings as preventive devices for patients at risk of ulceration. This study was conducted to identify the modes of action through which dressings can add to pressure ulcer prevention, for example, shear and friction force redistribution and pressure distribution. Bench testing was performed using nine commercially available dressings. The use of dressings can reduce the amplitude of shear stress and friction reaching the skin of patients at risk. They can also effectively redirect these forces to wider areas which minimises the mechanical loads upon skeletal prominences. Dressings can redistribute pressure based upon their effective Poisson ratio and larger deflection areas, providing greater load redistribution.info:eu-repo/semantics/publishedVersio

Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital-acquired pressure injuries

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.info:eu-repo/semantics/publishedVersio

Clinical performance characteristics for bordered foam dressings in the treatment of complex wounds: an international wound dressing technology expert panel review

The aim of this article is to identify and describe clinical practice performance characteristics for bordered foam dressings in the treatment of complex wounds. Our recently published systematic review of outcomes and applied measurement instruments for the use of bordered foam dressings in complex wounds has led to us identifying a range of important clinical and patient-centred issues related to this dressing class. Specifically, here, we focus on an overview of performance criteria in the areas of application, adhesion, exudate management and debridement functions of bordered foam dressings. Our hope is that by highlighting the clinical performance criteria, future testing standards for wound dressings will more closely match our clinical expectations and, thereby, assist clinicians to make better wound treatment choices based on meaningful and clinically relevant dressing product performance standards. complex wounds, complex wound care, treatment, bordered foam dressings, dressing performance.info:eu-repo/semantics/publishedVersio