and Care Excellence (NICE) highlighted the need to assess
each patient’s skin on presentation rather than on a ritualistic
schedule (NICE, 2014). A final example is the continued use
of the same dressing on a patient without assessing whether it
is achieved the desired effect because ‘I like it’ and ‘it usually
works on everybody else’. Clearly, there is still a need to
explain and demonstrate how to implement holistic patient-
centred care into day-to-day practice. This cannot be achieved
without effective patient communication. For example, it
might be necessary to explain to the patient why his or her
wound does not require cleansing, in case they regard its
omission as poor practice.
Although there is limited evidence from randomised
controlled trials to support this, anecdotal evidence suggests
that topical antimicrobial dressings appear to be effective in
the treatment of critical colonisation and localised wound
infection. The final question asked respondents to select the
correct criteria for the use of these dressings. While almost
all delegates (95%) selected the correct answer, the responses
from the remainder revealed a profound lack of understanding
about the treatment of infected wounds. It is particularly
disappointing that 0.9% still believed that antimicrobial
dressings can be used, even if a wound is not infected or
critically colonised, to prevent an infection; this implies
these dressings could be used inappropriately on a wound
that is proceeding through the healing process in a timely
manner. This is both costly and potentially detrimental to the
patient (Wounds UK, 2013). Given the current project being
undertaken by NHS Supply Chain as part of Lord Carter’s
programme to develop a generic specification for wound-care
dressings (Carter, 2015; 2016), and following examples such
as the VULCAN trial (Michaels et al, 2009), which cast doubt
on the efficacy and cost-effectiveness of silver dressings, the
inappropriate use of such products could limit their availability,
if their use is perceived to cause additional expenditure
without observed clinical benefits.
As this was short survey, there are inevitably some
limitations. While the survey questions enquired about the
setting in which the delegates worked and how frequently
they cared for patients with wounds, it is not clear from the
results how many of those who said they worked in ‘other’
settings or did not answer one or more of the questions were
still students or if they worked in industry and thus were not
practising clinicians. Similarly, it is not clear how long those
who were qualified had been in practice. This should be borne
in mind when considering the results selected by a small
percentage of the overall sample. While practical necessity
led to the use of a multiple-choice style format, this could
have introduced a small margin of error—for example, some
delegates may have had difficulty reading the questions or
selecting the right answer in time. Finally, it is possible that
the wording of some of the questions may have been open
to misinterpretation. For example, respondents may not have
been sure if the question on wound cleansing was referring
to the wound bed or the wound edges. These factors will
therefore reduce the generalisability of the results, although
in the author’s opinion they do reflect anecdotal evidence,
as experienced in day-to-day practice. In short, the results
provide interesting preliminary data and highlight the need for
and Care Excellence (NICE) highlighted the need to assess each patient’s skin on presentation rather than on a ritualistic schedule (NICE, 2014). A final example is the continued use of the same dressing on a patient without assessing whether it is achieved the desired effect because ‘I like it’ and ‘it usually works on everybody else’. Clearly, there is still a need to explain and demonstrate how to implement holistic patient-centred care into day-to-day practice. This cannot be achieved without effective patient communication. For example, it might be necessary to explain to the patient why his or her wound does not require cleansing, in case they regard its omission as poor practice.Although there is limited evidence from randomised controlled trials to support this, anecdotal evidence suggests that topical antimicrobial dressings appear to be effective in the treatment of critical colonisation and localised wound infection. The final question asked respondents to select the correct criteria for the use of these dressings. While almost all delegates (95%) selected the correct answer, the responses from the remainder revealed a profound lack of understanding about the treatment of infected wounds. It is particularly disappointing that 0.9% still believed that antimicrobial dressings can be used, even if a wound is not infected or critically colonised, to prevent an infection; this implies these dressings could be used inappropriately on a wound that is proceeding through the healing process in a timely manner. This is both costly and potentially detrimental to the patient (Wounds UK, 2013). Given the current project being undertaken by NHS Supply Chain as part of Lord Carter’s programme to develop a generic specification for wound-care dressings (Carter, 2015; 2016), and following examples such as the VULCAN trial (Michaels et al, 2009), which cast doubt on the efficacy and cost-effectiveness of silver dressings, the inappropriate use of such products could limit their availability, if their use is perceived to cause additional expenditure without observed clinical benefits.As this was short survey, there are inevitably some limitations. While the survey questions enquired about the setting in which the delegates worked and how frequently they cared for patients with wounds, it is not clear from the results how many of those who said they worked in ‘other’ settings or did not answer one or more of the questions were still students or if they worked in industry and thus were not practising clinicians. Similarly, it is not clear how long those who were qualified had been in practice. This should be borne in mind when considering the results selected by a small percentage of the overall sample. While practical necessity led to the use of a multiple-choice style format, this could have introduced a small margin of error—for example, some delegates may have had difficulty reading the questions or selecting the right answer in time. Finally, it is possible that the wording of some of the questions may have been open to misinterpretation. For example, respondents may not have been sure if the question on wound cleansing was referring to the wound bed or the wound edges. These factors will therefore reduce the generalisability of the results, although in the author’s opinion they do reflect anecdotal evidence, as experienced in day-to-day practice. In short, the results provide interesting preliminary data and highlight the need for
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