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Following the evaluation of leg ulcer services in one NHS Trust, it was identified that staff did not perceive lower limb wound care as a priority. Vascular assessments were repeatedly deferred, and follow-up compression visits became irregular. The team had limited capacity due to job vacancies, maternity leave and long-term sickness, leading to practitioners working approximately 300 hours extra per month. A solution was required to allow effective skill mix use and to improve patient care while improving wound healing rates. This paper presents a 6-month quality improvement programme (QiP) that was introduced within the Trust to improve the referral process for people with leg ulcers by promoting the effective use of staff time, reducing excessive workloads and implementing the effective use of compression hosiery, improving clinical outcomes for patients. Evaluation of the QiP demonstrated an improvement in consistency and continuity of care of the lower limb, aligning with the Trust's 5-year strategy plan to reduce the risk of lower limb amputations. Wound healing rates improved and facilitated the timely identification of potential vascular issues, leading to appropriate referrals. An evaluation of staff time highlighted team savings of 15,840 minutes/264 hours/35.2 days of nursing time per month, equating to an average financial saving of £5,944.75 in nursing time and £1,066 in dressings per month. [ABSTRACT FROM AUTHOR]

The routine use of antimicrobial therapy to treat diabetic foot infections has been widely published. However, effective treatments can be interrupted with complications such as antimicrobial resistance, systemic toxicity and allergic reactions. This paper looked at 26 individual cases using calcium sulfate (Stimulan®, Biocomposites Ltd) as a carrier for delivering antimicrobials, in the form of beads, at a local level and at the site of infection. In 69% of patients, oral and parenteral antimicrobials were ceased at the point of treatment. Patients were managed under local protocols by the podiatry team to the point of wound closure. Additionally, average healing rates were seen to be significantly reduced. [ABSTRACT FROM AUTHOR]

Historically, information such as protocols and treatment pathways from specialist teams were shared with ward staff in paper format which proved cumbersome and difficult to update. Improvements were made with the addition of an intranet site, where protocols could be stored and accessed by clinical staff, however it was recognised that navigating the intranet site was not always straightforward and took up precious nursing time. The tissue viability team at the Royal United Hospitals NHS Foundation Trust (RUH) considered how such information might be made more readily available to clinicians. Inspired by widespread increased use of QR codes in public places during the COVID-19 pandemic, the team produced a poster containing multiple QR codes, enabling clinical staff to have instant access to wound care protocols as soon as the information was needed. [ABSTRACT FROM AUTHOR]

Wound healing is a dynamic and complex process, requiring an optimum environment to support wound repair, which can be influenced by the type of dressing used. With an increasing number of chronic wounds and increasing spend on the resources required to manage them (Guest et al, 2020), dressing selection remains an important aspect of wound care. For example, a dressing may be required that will manage exudate effectively but without detrimentally drying out the wound bed. With a plethora of different dressings in the same generic group being available it makes for difficult decisions when choosing products for wound formularies. Consideration has been given to this dilemma and had led to the setting up of a NHS Clinical Evaluation Team for consumables in healthcare. This paper describes the results of the local review conducted by the Skin Integrity Team at the Doncaster and Bassetlaw Teaching Hospitals (DBTH) following the publication of the NHS Clinical Evaluation Team (CET 2018) clinical review of foam dressings. [ABSTRACT FROM AUTHOR]

The impact of the Care Act (Department of Health [DH], 2014) and adult legislation such as the Mental Capacity Act (Deprivation of Liberty Safeguards, 2009) has resulted in closer scrutiny of care provision and outcomes for those living in residential and nursing homes. Issues are being raised concerning safeguarding and the incidence of pressure ulcers, and whether the two are inextricably linked. A literature review was undertaken searching EMBASE, MEDLINE, PsycINFO, BNI and CINAHL, using the key words 'pressure ulcers', 'risk', 'nursing', 'care home' and 'safeguarding' . No date limits were set. Five papers were retrieved and screened; all five were included in the review. Papers were retrieved from the USA and Australia, with none retrieved from the UK. In general, the findings did not show that the incidence of pressure ulcers is considered to be a safeguarding issue. A number of variables impacted pressure ulcer development, such as: staffing levels; ratio of qualified to non-qualified staff; and lack of education in recognising and prevention of pressure ulcers. Residential homes with a high incidence of pressure ulcers delivered poor quality care. As this was a literature review, it would be beneficial to undertake a systematic review of the literature in the future. [ABSTRACT FROM AUTHOR]

Cambridge and Peterborough NHS Foundation Trust had planned to assess and implement the impact of managing chronic oedema and wet legs more effectively in the community in 2020. The article outlines how the service reacted to the sudden change of direction needed in response to COVID-19 pandemic and how the work we had already undertaken in this project facilitated this new way of working. When the TVN team was redeployed, they used information from our original audit to target the patients who had been deemed the highest risk. Ensuring the patient had the most appropriate care began to improve outcomes and reduce visits. A small dip check audit was completed to prove the impact of appropriate compression in the community. This paper highlights the positive impacts made in the first 3 months of the pandemic. [ABSTRACT FROM AUTHOR]

The need to implement and deliver radical service redesign continues to present NHS systems and services with significant challenges. Leadership is frequently cited as being a key determinant of success in such large-scale redesign programmes. This paper describes the application of one leadership model - adaptive leadership - to the redesign of a complex set of clinical and inter-professional challenges that saw NHS Greater Glasgow and Clyde (NHSGGC) Podiatry Service take full responsibility for all foot and ankle wounds across all operating units in the Board area. The model is described, with practical, applied examples of the approach taken at each stage of the process. Qualitative and quantitative outcomes are reported, with the NHSGGC Podiatry Service now actively involved in all aspects of foot and ankle pressure damage for all patients, regardless of underlying pathology, with significant improvements delivered across all metrics, including a 56% reduction in Grade 2 and above hospital-acquired foot and ankle-tissue damage; a 55% improvement in the number of wards reporting more than 300 pressure ulcer-free days and a 107% improvement in the number of patients with diabetes receiving foot checks on admission. [ABSTRACT FROM AUTHOR]

Nursing documentation is an integral component of a nurse's day as it is a professional requirement. A recent improvement project carried out in NHS Greater Glasgow and Clyde (NHSGGC) revealed that this documentation was ritualistic and not person-centred. Up to 100% of what was documented in the nursing continuation notes was either documented already or not relevant, and the time dedicated to the 'writing up' took up to 8% of a nurse's working week, was the cause of nurses being late off duty and nurses feeling overwhelmed and took nurses away from hands-on care. NHSGGC also identified that despite this time being dedicated to record keeping, there was room for improvement regarding the quality, volume and relevance of record keeping. This article describes the improvement journey that NHSGGC went through to develop a framework for nursing documentation resulting in better clinical outcomes, time freed up for direct nursing care and positive impact on staff wellbeing. [ABSTRACT FROM AUTHOR]

Since the beginning of 2020, the COVID-19 pandemic has been a challenge faced by the world and one that all health professionals are facing. The impact of COVID-19 on patients receiving and accepting healthcare services have changed in the past few months. One of the main issues identified in NHS hospitals were increase in the pressure ulcers and this paper is an initial glance at what was identified at an acute setting during the first wave of pandemic. [ABSTRACT FROM AUTHOR]

A retrospective audit of clinical data of patients was taken who required treatment for the management of moderately to highly exuding wounds. The inclusion criteria for this retrospective audit included patients (n=30) from the Worcestershire Health & Care NHS Trust that have already been treated and that required a wound dressing for the management of moderately to highly exuding wounds. Results and discussion: The results of the "in use" evaluations showed a high use of foam secondary dressings with adjunct treatments to manage exudate. However, 65% of these treatments did not meet the clinical objectives related to exudate management. The assessment of how effectively the patient's treatment regimens managed exudate produced by the various wounds showed that exudate management was rated as "poor" or only "adequate" in the majority of cases. It is noteworthy that a proportion of patients suffered from peri-wound skin conditions, e.g. eczema, maceration and excoriation. Over 95% of patients received peri-wound skin treatments to prevent/treat these conditions. As a consequence, these additional treatments add to the product costs and nursing time required. The use of appropriate wound dressings for the management of moderate to high levels of exudate would have prevented these severe skin conditions and likely significantly reduce treatment costs. Conclusion: This paper shows that 65% of the patients included in this audit failed to meet the clinical objective of exudate management. Adverse event sequelae such as skin maceration/excoriation occurred and, consequently, direct and indirect costs associated with treating these patients increased. Using a more appropriate wound dressing such as superabsorbent polymer demonstrated significantly reduced costs when compared to these audit costs. [ABSTRACT FROM AUTHOR]

The NHS is facing significant financial and operational pressures, with services struggling to deliver high-quality care due to increasing demands and limited resources (Dowsett, 2016; McKenna, 2018). Now, more than ever, local and national NHS service leaders and services need to focus on improving the quality of care provided, reducing variation and delivering better-value care (NHS England, 2017). Improving quality is about making healthcare safe, effective, patient-centred, timely, efficient and equitable (Department of Health [DH], 2016). In terms of leg ulcer care, this means ensuring patients receive evidence-based leg ulcer assessments and treatments to ensure their leg ulcer heals in an optimum timeframe and that they have a good experience of their care (Wounds UK, 2016). Improving leg ulcer healing not only benefits the patient but also the health economy with costs reducing when complications are prevented and the patient's leg ulcers heal in a shorter timeframe (NHS RightCare, 2017). This paper outlines a project that focused on improving venous leg ulcer (VLU) assessment and management for housebound patients, using quality improvement (QI) methods. [ABSTRACT FROM AUTHOR]

Challenges in the modern National Health Service cannot be underestimated. Workforce pressures alongside increasing demands for healthcare requires creative adaptation to services. This article describes the introduction of interim wound dressing kits into residential homes and the resulting positive improvements to patient care. It details how a clear baseline investigation of a clinical issue, the use of modern technology and adherence to a structured process can achieve project goals. The objective of maintaining patient safety in relation to interim wound care was met, resulting in a reduction of same-day and out-of-hours community nurse visits. [ABSTRACT FROM AUTHOR]

The recently published 'Burden of Wounds' study (Guest et al, 2015a) not only highlighted the cost of delivering wound care in the UK but also revealed a number of shortcomings in the method of care delivery, many of which could potentially have adversely affected patient outcome. This paper looks more closely at some of the clinical and service issues raised by the published data from the study and combines this with observations made by the research team when reviewing the patient records to generate a number of recommendations for improvements in staff engagement, documentation, clinical management and service delivery. By implementing these recommendations variations in care standards should be reduced, delayed and nonhealing be recognised earlier and as a result cost savings generated. [ABSTRACT FROM AUTHOR]

The Pressure Ulcer Improvement Nurse (PUIN) was a new role secured through funding from Healthcare Improvement Scotland (the Continuous Quality Improvement funding). The PUIN sits within the Acute Quality Improvement Team in Ayrshire and Arran. This position is filled by two employees: the author and a colleague (role split: 30 hour/7.5hr, sharing a full time role). NHS Ayrshire and Arran already have a Falls Coordinator in post who collaborates with the Quality Improvement team. Recent data show a decrease in falls since this approach was adopted. As a result, it was decided to test a similar 2-year post for a PUIN. The aim of the PUIN role is to identify and support change in areas with an increasing incidence of acquired PUs using a collaborative approach based on Quality Improvement methodology. The PUIN is in charge of monitoring pressure ulcer (PU) incidence at two acute hospital sites with approximately 830 beds. This monitoring includes identifying ward areas, grades, and incidence of PUs. These figures are sent monthly to senior management staff, which includes general managers, lead nurses and chief nurses. [ABSTRACT FROM AUTHOR]

In 2008, following a successful pilot within Central Essex Community Services, the Online Non-Prescription Ordering System was introduced. The system has continually evolved over time offering many benefits to the organisation, the health professional and the patient. Working in collaboration with industry, it has been possible to develop the system and local process to maximise the benefit to the organisation and the patient.This paper reflects on and discusses the benefits of introducing the system across community nursing services, podiatry and three community hospitals. [ABSTRACT FROM AUTHOR]

Pressure ulcers are an expensive and all-too common problem, which cost the NHS billions to treat annually, not accounting for the impact on patients' quality of life. This paper presents the results of one trust's efforts to introduce a standardised reporting mechanism to reduce the incidence of care-acquired pressure ulcers using root cause analysis (RCA). It details lessons learnt, resulting initiatives and perceived future challenges following implementation of local guidance and reporting. [ABSTRACT FROM AUTHOR]

The article presents a personal experience of a patient who has faced challenges and dismissive attitudes in receiving proper care for venous issues over several decades. It highlights the harmful effects of the artificial separation of mind and body within the medical paradigm and the need for a more holistic approach. It emphasizes the importance of patient agency, being heard, and receiving proper care within a functioning healthcare system.

Tissue viability services have been reconfigured and developed as a result of increased pressure on the NHS to deliver more efficient services that maintain quality of care. There is a need for tissue viability clinicians to develop the skills to outline and effect positive changes in practice. For this, they need business development skills, one of the most important of which is presentation skills. This article describes how to put together a presentation that will successfully promote a business case for change in clinical practice. [ABSTRACT FROM AUTHOR]

An editorial is presented on National Wound Care strategy update with improving data, digital and information. Topics include learning alongside the FImps and other organisations will provide an opportunity for collective learning; and improve understanding about how to deploy data, analytics, and information to drive change.

A personal narrative is presented which explores the author's experience of being increasingly starting to believe the old adage that the more know the more realize know nothing for certain and that some things that I repeat as a mantra are very one sided.

Background: Health systems globally are facing unprecedented challenges in attempting to balance sharply rising demand against constraints on the availability of financial and other resources. These challenges have led to pressures to constrain expenditure growth through cost containment. But cost containment alone cannot be a sustainable solution if focus on short-term costs ignores the effect on long-term outcomes. Aim: The aim is to raise awareness of the concept of value-based healthcare (VBH) and to illustrate its application to the procurement of wound care products. VBH is about achieving the best possible health outcomes with available resources: either by producing better outcomes with the same resources or by producing the same outcomes with less. Minimising short-term costs is not consistent with the principles of VBH if it leads to higher costs on the long run or if the potential to improve patient outcomes is lost. Method: The impact of different dressing characteristics on the costs of nurse time, dressing spend, and the total annual costs of treating a cohort of patients is estimated. Conclusions: Dressing characteristics other than price are an important factor in determining the total cost of healing a wound. For example: fluid handling capacity impacts wear time that in turn impact the frequency of dressing change. Reducing dressing change frequency adds value by releasing nurse time for other uses and reducing annual dressing spend. Similar considerations apply to other dressing characteristics. The lowest cost dressing is not necessarily the one which adds most value. [ABSTRACT FROM AUTHOR]

Background: Health systems globally are facing unprecedented challenges in attempting to balance sharply rising demand against constraints on the availability of financial and other resources. These challenges have led to pressures to constrain expenditure growth through cost containment. But cost containment alone cannot be a sustainable solution if focus on short-term costs ignores the effect on long-term outcomes. Aim: The aim is to raise awareness of the concept of value-based healthcare (VBH) and to illustrate its application to the procurement of wound care products. VBH is about achieving the best possible health outcomes with available resources: either by producing better outcomes with the same resources or by producing the same outcomes with less. Minimising short-term costs is not consistent with the principles of VBH if it leads to higher costs on the long run or if the potential to improve patient outcomes is lost. Method: The impact of different dressing characteristics on the costs of nurse time, dressing spend, and the total annual costs of treating a cohort of patients is estimated. Conclusions: Dressing characteristics other than price are an important factor in determining the total cost of healing a wound. For example: fluid handling capacity impacts wear time that in turn impact the frequency of dressing change. Reducing dressing change frequency adds value by releasing nurse time for other uses and reducing annual dressing spend. Similar considerations apply to other dressing characteristics. The lowest cost dressing is not necessarily the one which adds most value. [ABSTRACT FROM AUTHOR]

Patients continue to develop skin damage and pressure ulcers (PUs). The aim of this audit was to explore the prevalence of PUs and the adherence to the fundamental elements of the aSSKINg framework across hospitals in England. A cross-sectional survey was conducted on 10,144 patients from 36 hospitals representing 18 NHS trusts. The PU status of all patients was determined by two independent nurses who assessed the skin and ensured data capture was completed. The overall prevalence of PUs recorded, in terms or proportion of patients with 1 or more PUs, was 9.04% (95% confidence interval (CI) 8.48% to 9.60%). There were 689 (64.0%) PU allocated a category (i.e., 1,2,3,4, unstageable (US) or deep tissue injury (DTI)) were superficial, involving only the skin (categories 1 and 2). A further 218 (20.3%) were in an evolving category, i.e. US or DTI. There were 7086 patients (69.8%) that had a risk assessment completed within six hours, 6576 (81.4%) patients considered to be at risk had a care plan in place, but only 5216 patients (51.3%) had a planned repositioning regimen in place. This audit has identified areas of care that require improvement to prevent PU occurrence, including patient education and keeping patients moving and repositioning. There continues to be over-prescription of equipment, with patients being allocated higher specification equipment than their risk score identifies and no clinical reason apparent. [ABSTRACT FROM AUTHOR]

The article explores how to improve pressure ulcer (PU) prevention has been a quality driver for over a decade within all National Health Service (NHS) provider organisations with PU data being used to measure improvement. It mentions that PU data collection and reporting has become a time-consuming priority for tissue viability specialist nurses who have been required to be responsible for PU classification, validation and allocation of attribution.

The article offers information about the importance of including patients' perspectives and experiences in healthcare discussions and decision-making. It emphasizes the need for healthcare professionals to understand the impact of their language and actions on patients and to actively listen to their concerns. It also mentions ways which aims to improve patient safety through a patient safety culture and system, involving patients, and driving effective and sustainable change.

The article presents Pressure ulcer prevention in prisons. Topics discussed include the charity Age UK discussed that the 50+ age group is the fastest growing population in prisons and in recognition of this undertook a review of health and social care to determine; and their recommendations highlighted a number of areas including; recognizing the diversity of the older individuals and the provision of the same basic health and social care as non-prisoners.

The authors discuss the Wounds UK Harrogate event to be held November 12-14, 2012, which will be focusing on 'Sharing best practice' across UK. They discuss the publication "Innovation, Health and Wealth" by the Department of Health (DoH) on the importance of promotion, development and implementation of quality healthcare services through three key stages: invention, adoption and diffusion.

Skin tears are common in an acute setting. They have a negative impact on patient quality of life and increased healthcare costs. In the first of two articles, the authors describe the ideal first-line approach to managing skin tears. Its application in practice is illustrated using the Doncaster and Bassetlaw Teaching NHS Foundation Trust skin tear pathway, which has been audited and enhanced to incorporate the latest ISTAP definition of skin tears as traumatic wounds and the recommendation to use light compression as a component of treatment in skin tears of the lower limb. [ABSTRACT FROM AUTHOR]

Background and local problem: The objective of this quality improvement project (QIP) was to identify a) the number and type of wounds treated in primary and community care within a single Clinical Commissioning Group (CCG) and b) compare current wound care practice against local policy and best practice. An eight-step quality improvement plan was implemented and wound care practice and documentation re-audited a year later. Results: Pre-implementation: Sixty nurses and healthcare support workers were observed to deliver wound care, with the majority being registered nurses (n=44/60; 73.3%). Over the 3 week evaluation period, wound care was delivered to 147 patients with the majority treated in the patients' own home (n=98; 66.7%). The majority of patients had their skin assessed in both GP practices and in their own homes (x²=1.11,df=2, p=0.57). Wounds were more likely to be photographed in patients' homes (x²=4.28; df=1, p=0.04). All other direct observations of care occurred less frequently when care was delivered in patients' homes (appropriate wound care advice provided x²=6.38, df=1, p=0.01; comprehensive wound assessment x²=5.67, df=1, p=0.02; and appropriate primary dressing x2=10.80, df=2, p=0.005). Post-implementation: Over the 1-week evaluation period, Welsh Wound Innovation Centre and CCG staff observed wound care provided to 77 patients. Thirty-four patients received wound care in GP practices, 43 patients in their own home. Notably, fewer omissions in wound care were observed and this difference approached statistical significance across four aspects of care with the sole exception of use of an appropriate primary dressing in GP practices (x²=3.31, df=2, p=0.19) in both audits. Conclusions: This QIP identified that there were weaknesses in current practice (for example, under 40% of patients received an appropriate primary wound dressing when cared for in their own home) and documentation (for example, 50% of patients treated in their homes did not have a correct wound diagnosis). Re-evaluation after implementation of an eight-step improvement plan showed marked improvements in both wound care delivery and documentation especially where care was delivered in patients' homes. This project has shown how complex health care delivery across primary and community care can be improved through a focused QI approach. [ABSTRACT FROM AUTHOR]

Data on chronic wounds and how it affects people who live with such conditions as well as its impact on health services (Guest et al, 2015) brought into sharp focus the need to have a more unified and strategic approach to wound care -- NHS England's Leading Change Adding Value programme (NHS 2016a) has taken up the challenge. This article aims to highlight the extent of the burden of chronic wounds in relation to the lower limb and to describe the national workstream project that supported a nationwide conversation about services and care, and the development of a framework for lower limb management. [ABSTRACT FROM AUTHOR]

The annual cost to the NHS for managing the 2.2 million wounds and their associated comorbidities is estimated to be between £4.5 billion and £5.1 billion. Improving the quality of wound care should reduce healthcare spending and improve patients' quality of life. The new NHS England wound care management project, which is part of the Leading Change, Adding Value nursing and midwifery framework, seeks to reduce unwarranted variation in the assessment and treatment of wounds across the patient pathway by developing a number of wound-focussed initiatives. This article introduces the project and outlines the development of an evidence-based wound assessment minimum data set that will be monitored by a wound assessment Commissioning for Quality and Innovation (CQUIN) indicator. This initiative demonstrates the need for good quality economic data to identify clinical issues of concern that can then be addressed by appropriate policy initiatives to improve patient care and make the best possible use of NHS resources. [ABSTRACT FROM AUTHOR]

An introduction is presented in which editor discusses various articles including the World Union of Wound Healing Societies conference held in Florence, Italy in 2016; resignation of Richard White as scientific editor of the periodical and research on pressure ulcer prevention.

The prevention of pressure ulcers (PUs) has become a hot topic, with significant investment of both time and money being devoted to reducing the number of pressure-related injuries acquired within the NHS. A number of babies on our neonatal unit developed facial PUs that were caused by continued pressure from non-invasive ventilation. This lead the unit to develop a team to review the causes, and formulate a plan for reducing PU incidence, focusing on premature babies of 25 to 30 weeks gestation. This article outlines the literature around neonatal pressure ulcers, and how the review team adapted practice on the unit. [ABSTRACT FROM AUTHOR]

The Hownslow Richmond Community Health NHS Trust (HRCH) has adapted a SSKIN bundle for use in the community. It incorporates visual prompts aimed at non-English speakers and instructions for wheelchair user instructions. It was launched in April 2015 alongside a dedicated HRCH webpage for carers and their patients. A multidisciplinary group led by the pressure ulcer (PU) clinical lead was set up in January 2015 and it is hoped that this collaboration will help make the community SSKIN bundle successful in reducing rates of PUs among patients being cared for at home. [ABSTRACT FROM AUTHOR]

The article presents a debate regarding the issues related to the practice of washing and/or cleansing as part of effective skin care of patients with ulceration of the lower limb. Topics discussed include the Leg Club approach, the Sheffield Teaching Hospital Foundation Trust Community Leg Ulcer Clinics and the infection control risks associated with leg washing and feet with ulceration.

The author discusses the use of the Strategic Executive Information System (STEIS) and the Incident Reporting System (IRS) in pressure ulcers (PU). Also explored are the properties of the high specification foam mattress (HSFM). It also suggests on bed frame purchase and on the implementation of profiling electronic bed.

Patient ethics can be defined as part of the system of medical ethical principles that focuses attention on the best interests of the patient. It is important to recognise the right of patient autonomy, where self-determination exists. This ensures that the healthcare professional is treating the patient or acting to prevent complications in a way that will provide the best result for that individual. This is often termed patient-centred care, which is discussed in further detail. This article aims to explain the need for ethics in a clinical setting, not only for the benefit of the patient but for the benefit of the healthcare professional and wider healthcare industry. Furthermore, it is through compliance and regulatory measures aimed at healthcare professionals -- specifically nurses in the context of this article -- that these ethical values can be upheld and standards adhered to. In turn this promotes a safe and effective method of care, ultimately providing the highest quality outcome for the patient. [ABSTRACT FROM AUTHOR]

Effective record keeping underpins service delivery and provides a record of the quality of care delivered. Pressure ulcer risk assessment, prevention strategy and pressure ulcer care provision are a key element in the nursing process and are correctly a focus area within the safety agenda. This article reviews issues related to the documentation of pressure ulcer risk assessment and prevention and asks whether the time is right to move towards a universal system of pressure ulcer care documentation, linked to reporting within the NHS. [ABSTRACT FROM AUTHOR]

The article presents a panel discussion about the role of the Any Qualified Provider (AQP) scheme in managing venous leg ulcers (VLUs) in Great Britain. The panelists include would care consultant nurse Sylvie Hampton, vascular nurse specialist Alan Elstone and general practitioner (GP) Catriona Anderson. Topics covered include the potential of AQP to increase VLU healing rates, the awareness of GPs on VLU incidence and cost in primary care, and the future of community VLU care.

Interviews with Barrister Daniel Bennet (DB), Nurse Expert Cathie Bree-Aslan (CBA), and Nurse Consultant Fiona Downie (FD) are presented. Bennet discusses the irrelevance of the risk-scoring system from a legal perspective and states that care provider is obliged to take risk assessment system. Bree-Aslan states that cachexia should be considered while assessing the evidence in claim. According to Downie risk assessment tools do not provide enough justice in mobility and awareness of medicines.

Acute traumatic skin injuries are increasing in both acute and community settings. Multiple comorbidities, complex medication regimens and increasing age, all contribute to the risk of their occurrence (Bateman, 2012). Damage to the skin and underlying tissues poses an increasing challenge to the clinician due to ever reducing wound care resources and financial budgets, which in turn can have an detrimental effect on the patient and carer through increased pain, scarring and overall reduction of quality of life (Gardner, 2010). Effective and timely assessment and management, including accurate documentation and utilisation of the appropriate dressing products is paramount to reduce further tissue damage and risk of infection, improving the wound bed environment to ensure effective healing can occur (Stephen-Haynes and Carville, 2011). This product review evaluates ten patients who presented to an NHS nurse-led minor injuries unit within Wales with acute or chronic skin tears. It explores the benefits of Cutimed® Siltec non-bordered foam (with a non-adhesive silicone wound contact layer ) with set outcomes pertaining to ease of product use, non-adherence to the fragile wound bed, atraumatic removal, wear time, absorbency and patient satisfaction. [ABSTRACT FROM AUTHOR]

Effective wound management comprises the informed selection and application of products matched to the patient being treated, and to a clearly defined and achievable clinical objective shared by both the clinician and the patient. The authors detail an in‑practice case series appraisal process used to examine the performance of ALLEVYN Life (Smith & Nephew Healthcare Ltd) in order to determine its suitability for a formulary listing. [ABSTRACT FROM AUTHOR]

Ethical behaviour must be inherent within the behaviour of any healthcare professional. This assures other professionals, industry and, most importantly, the public, who must be able to trust implicitly those professionals within the health system on which they are reliant. [ABSTRACT FROM AUTHOR]

It remains widely quoted that 95% of pressure ulcers (PUs) are avoidable. However, in the second year of reporting on six acute Trusts within NHS Midlands and East, pooled data collected between April 2013 and March 2014 on hospital-acquired category III-IV PUs again found the percentage of avoidable PUs to be less than a third of this 95% figure. In addition, this report includes category II PUs. The implications of these findings with regard to looking at avoidable PU prevention will be discussed in this article. [ABSTRACT FROM AUTHOR]

Significant NHS reforms mean tissue viability services need to implement new treatments and ways of working in order to deliver significant cost savings. In this two part article, the changing NHS is discussed, followed by an example of a new treatment, a monofilament fibre pad that can aid in the clinician in accurately assessing pressure ulcers. [ABSTRACT FROM AUTHOR]

This survey aimed to identify and quantify the demographic characteristics, treatment objectives, and wound characteristics of patients from five English NHS Trusts receiving wound treatment. Data from 4772 patients (59.8% female; 79.7% aged >65 years) were received. Approximately half were leg wounds. Most patients had one or more comorbidity,most commonly vascular and cardiovascular. The majority of wounds were <3 months' duration and had no associated infection indicators (a small minority had ≤3 infection indicators). Swabbing was considerably more common in wounds showing no primary infection indicators than in infected wounds. Nurses were most commonly involved with dressing changes. Protecting granulation was the most common treatment objective and dressings were changed most commonly twice-weekly as a scheduled care change. No significant differences in wound or patient characteristics were observed between Trusts. [ABSTRACT FROM AUTHOR]

In 1987, 1988, and 1998, Hibbs asserted her hypothesis that 95% of pressure ulcers (PUs) are preventable. But until recently, few UK healthcare organisations have collected data on PU incidence - or the avoidability or otherwise of the damage. In 2012, NHS Midlands and East launched a campaign to eliminate avoidable grade 2-4 PUs by year end. Five hospitals within NHS Midlands and East pooled data collected between April 2012 and March 2013 on hospital-acquired grade 3-4 PUs and found the percentage of avoidable PUs to be less than half Hibbs' figure of 95%. [ABSTRACT FROM AUTHOR]

The NHS is moving towards a more patient-centred service, with the Quality, Innovation, Productivity and Prevention and Any Qualified Provider agendas central to this transition. To ascertain whether a new cost-effective innovative compression product can improve a patient's quality of life during leg ulcer treatment. Two case studies were conducted to examine how quality of life issues identified during wound assessment can be classified and suitably overcome. Both patients began a regimen that involved the use of an instantly adjustable compression device. Both patients enjoyed an improvement in quality of life and mobility after using the device. The two case studies highlight the benefits of incorporating instantly adjustable compression devices into a treatment regimen, with pain and associated depression diminishing as a result. [ABSTRACT FROM AUTHOR]

Background: A leg ulcer prevalence audit carried out by staff working in community services within an NHS Trust identified an average wound duration time of 24 months, which impacted negatively on the patient and nursing capacity. Aim: To evaluate whether the implementation of evidence-based treatment pathways would lead to complete healing in 70% of people with venous leg ulceration at 24 weeks. Methods: Two evidence-based pathways were designed (standard and complex) with a key focus on wound bed preparation, appropriate compression and wound progression over 6 weeks. Patients (n=77) were assigned to a pathway – 61 to the complex pathway and 16 to the standard pathway. Data relating to wound size and pain levels were requested every 6 weeks for 24 weeks or healing. Results: Out of the 77 people starting on a pathway, 45 remained for 24 weeks or until healing. Of these, 71% (n=32) healed completely within 16 weeks, 20% (n=9) improved by >70% and 9% (n=4) remained static. There were 32 patients removed from the pilot for a range of reasons, predominantly poorly controlled co-morbidities and deterioration in their arterial status. Conclusion: Using an evidence-based treatment pathway can improve the healing rates of people with venous leg ulceration; however, a multidisciplinary approach to managing underlying co-morbidities is needed if outcomes are to be optimised. [ABSTRACT FROM AUTHOR]

Over the past 30 years, there have been various trends in diabetes foot care, but the overall aims and outcomes remain fundamentally unchanged. Diabetes patient numbers are increasing, and many of the new methods and products that have been developed in recent years have not proved effective enough to change regimens of care to any great extent. While new technologies are also important, working in a multidisciplinary way is crucial and needs to be a priority for practitioners. Although some progress has been made, this needs to continue and increase to meet the old and new challenges being faced. [ABSTRACT FROM AUTHOR]