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Objective: This audit was designed to identify the need of the population and the clinical activity associated with wounds and the management of lower limb swelling. The exploration focused on lower leg wound management, access to diagnostics and compression therapy across each audit site. The variation across the sites was explored to gather insight into the real-world barriers to providing evidence-based management for leg ulceration. Method: We undertook wound prevalence audits across six diverse community provider sites in England. The audit was undertaken by the local providers, with the inclusion of tissue viability and podiatry leads and key local stakeholders, often local quality leads, primary care leads and nursing directors. Each audit was undertaken with full engagement of local clinicians. Data were collected centrally, and each audit site received their own local analysis and report, with additional analytical support from the local tissue viability lead to ensure the feedback was contextualised for their stakeholders. Analysis was provided by Accelerate CIC Lymphoedema & Leg Ulcer Clinic. Results: A total of 2885 patients were reviewed via an online or a paper audit tool. In total, 2721 patients had one or more active wounds. However, 1350 patients had one or more lower leg wounds, with 164 patients being managed for lower limb swelling or prevention of leg ulceration; bilateral conditions ranged from 11–43% across audit sites. Of the six sites, two included both community and primary care providers, thus generating wound point prevalence data. The remaining four sites audited community nursing and podiatry services only, with two sites collecting data on lower limb wounds only rather than all wounds, generating point prevalence for their services only. Compression usage varied across care locations, with the greatest use being seen in community leg ulcer clinics, where it was >96% for 234 residents. Compression usage was lower in the home with a range of 14–62% among 692 residents. For 263 residents, where the cause of their lower leg wound was unknown, compression usage was very low at 12%. Compression usage decreased with age; for three audit sites this was noteworthy, with 65% of those aged >80 years not in receipt of compression. Compression usage had a direct impact on nursing activity; non-use of compression increased activity by 37%. Conclusion: Through the identification of wound location, this series of wound prevalence audits identified a greater number of patients with lower limb wounds than those recognised and classified as a leg ulcer. Substantial variation in access to diagnostics and compression therapy was observed between audit sites, and also between locations within their boroughs. The factors that reduced access to compression therapy included not classifying the lower leg wound as a leg ulcer, being cared for in the home and increasing age of the patient. Lack of compression usage increased nursing activity. Where there is lack of access to therapeutic intervention, the resultant patient harm is not systematically recognised or documented. [ABSTRACT FROM AUTHOR]

Aim: This paper explores wound care for people living with mental health difficulties from a nursing perspective and considers what can be done to improve it. Objective: To analyze policy and practice relating to wound care for people experiencing mental ill health using the ideas of 'wicked problems' and 'problems of many hands' Methods: Policy and practice analysis informed by theory. Results: Recent UK policy is to ensure parity of esteem so that people with mental ill-health receive the same quality of care as those with physical ill-health. However, the provision of physical care to people experiencing mental ill health, including the provision of wound care, constitutes a 'problem of many hands' arising in the context of the mental health system being a complex one replete with wicked problems. Wicked problems are resistant to solutions and problems of many hands are complex and multifaceted, and involve the interplay of different actors. Addressing problems of many hands in this context requires systems thinking and solutions enabling different people to work collaboratively. Conclusions: The wound care of people experiencing mental ill health has been largely overlooked, as it transcends the domains of mental health and tissue viability policy and practice. A strong system level approach is needed to improve care, characterized by closer interprofessional teamworking. The wound care of people experiencing mental ill-health is largely overlooked. People with mental illness receive their wound care from tissue viability nurses. Wound care can be conceptualized as a 'problem of many hands'. System level policies are needed to improve this aspect of health care. [ABSTRACT FROM AUTHOR]

Poorly designed wound trials that generate knowledge that does not inform clinical practice constitute an example of research waste that undermines evidence-based healthcare. Well-designed trials that generate clinically relevant and robust knowledge are integral to improving health nationwide and achieving universal health coverage. This paper critically analyses the existing challenges associated with improving trials as well as how these challenges can be overcome through a research community of practice, such as the Wounds Research Network (WReN). Although a wide range of people have a stake in improving wound trials, they often belong to different social or professional groups that can make collaborative work challenging. In the UK, WReN demonstrates how a unifying national research community of practice can help people work together to design and conduct studies that generate knowledge that may help improve patient care. Key Message * Communities of practice such as the WReN are a useful resource for improving wound trials to generate knowledge that informs clinical practice and contributes to the establishment of universal health coverage. [ABSTRACT FROM AUTHOR]

The author conveys his thoughts on the importance of considering how inspirational leadership can be utilized to the best effect to make sure that high-quality wound care is consistently delivered and mentions related topics such as patient care, wound healing, and quality improvement.