Search

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 in

WoundsWest is an innovative Western Australian (WA) project under Ambulatory Care and Chronic Disease Management Reform undertaken in partnership with the Western Australian Department of Health, Curtin University of Technology and Silver Chain Nursing Association. WoundsWest's Online Wound Management Education Program is a core component of WoundsWest. It involves the interdisciplinary development of an anticipated 16 online wound management education modules, which are designed to assist health professionals and health services to deliver best practice in wound management and reduce preventable wounds and adverse wound management outcomes. The development of these modules involves an extensive search of the literature to ascertain the evidence for best practice. In preparation for the development of the forthcoming online Leg Ulcer Module a considerable number of atypical leg ulcer presentations and associated comorbidities were identified. This paper outlines some of these presentations and comorbidities and reminds health professionals of the need for further diagnostic investigations when leg ulcer signs and symptoms are atypical, or the ulcer fails to heal in an orderly and timely manner.

Pressure ulcers are a significant iatrogenic cause of morbidity and mortality in the aged care population, with prevalence reported to be as high as 43% in some aged care facilities. The PRIME trial was a 15-month pre- and post-intervention study designed to investigate the effectiveness of an integrated pressure ulcer management system consisting of pressure ulcer risk assessment tools, Australian Wound Management Association (AWMA) guidelines, digital imaging and clinical education in reducing pressure ulcer prevalence in residential aged care facilities. A total of 1228 residents from 23 residential aged care facilities were enrolled in this Commonwealth-funded study. The findings suggest that the PRIME intervention significantly reduced pressure ulcer prevalence risk by 52% (p<0.001) and highlighted the association between cachexia, Braden sub-scales for activity, nutrition, friction/shear and pressure ulcer risk. The study also demonstrated that following the PRIME intervention, the use of appropriate pressure ulcer risk reducing equipment was significantly increased. Overall, the results suggest that an integrated approach combining the elements of the PRIME intervention is effective in reducing pressure ulcer prevalence in the frail elderly population in residential aged care facilities.

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.

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 tof 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 of this 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 comorbidity status and the provision of suitable pressure relieving equipment.