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ABSTRACT: Pressure ulcers generally occur at body sites where there are sustained soft tissue stress concentrations associated with either bodyweight or medical devicerelated mechanical forces. These sustained mechanical forces caused by pressure and shear result in localised tissue/cell distortion. This leads to deformation-induced damage, inflammation and ischemia resulting in tissue death and, ultimately, a pressure ulcer (Katz and Gefen, 2023).
In order to reduce the risk of pressure damage occurring, it is common in clinical practice to select a pressure redistributing support surface (mattress or cushion). It is also important to reposition the patient in order to both change the areas that are load bearing and — as much as possible — increase the surface area of the body that is supporting the load, while avoiding positioning on the most at-risk areas, for example the bony prominences.
KEY WORDS
Interface pressure
Pressure mapping
Pressure ulcer
JACQUI FLETCHER
Independent Nurse Consultant
ABSTRACT: In order to provide structured and equitable interventions in relation to identification and management of wound infection, an NHS Trust has implemented an evidence-based pathway for non-healing wounds. Following the introduction of the pathway there were reduced nurse visits for wound assessment, a reduction in wound area, a reduction in necrotic tissue and improved healing rates.
KEY WORDS
Case study
Evidence
Infection
Pathway
Silver dressing
UrgoClean Ag
Wound
ANITA KILROY-FINDLEY, Clinical Lead Tissue Viability, Leicestershire Partnership NHS Trust
KAREN OUSEY, PhD, Professor of Skin Integrity, Institute of Skin Integrity and Infection Prevention, University of Huddersfield
Objective: This article highlights challenges of wound care in low resource settings, considering opportunities for frugal innovation and our experiences while creating virtual wound care clinics across two global communities. In addition, we will discuss four real cases presented within the virtual clinics. An adaptation of the widely accepted tissues, infection, moisture, edge, regeneration and repair of tissue, and social factors (TIMERS) wound assessment is also proposed with considerations for low-resource setttings.
Method: From March to December 2021 the University of Salford engaged in a virtual wound clinic initiative with colleagues in Fort Portal Regional Referral Hospital.
Results: The clinics provided opportunities for professional and academic development of students on postgraduate tissue viability module in Salford, while empowering nurses and midwives in Uganda in taking their place at the centre of multidisciplinary teams in care delivery Furthermore, it created links between the university and clinicians in Uganda to develop the delivery of evidence-based wound management. Throughout this period, challenges associated with low resources were highlighted and, in some cases, innovative approaches to managing wound care were adopted to account for this.
Conclusions: The development and delivery of the virtual wound care clinics between the University of Salford and Fort Portal Regional Referral Hospital provided an opportunity for reflection on practice. This led to development of a Fit4purpose wound dressing, revision of evidence-based guidelines, deeper understanding of the scarcity of essential items and frugal practice, and examination of skin tone bias in the signs and symptoms of wound infection in patients with dark skin tones.
KEY WORDS
Case series
Dressings
Frugal innovation
Low resource
Uganda
Wounds
DR MELANIE STEPHENS
PhD, RGN, Senior Lecturer in Adult Nursing and Lead for Interprofessional Education, School of Health and Society, Mary Seacole Building, University of Salford, UK
MATTHEW WYNN,
MSc, RN Adult, Lecturer in Adult Nursing, School of Health and Society, Mary Seacole Building, University of Salford, UK
SHEBA PRADEEP
MSc, RN Adult, Lecturer in Adult Nursing, School of Health and Society, Mary Seacole Building, University of Salford, UK
LOUISE ACKERS
Chair in Global Social Justice, Director Knowledge, Health and Place Research
RACHEL NAMIRRO
Registered Midwife, Assistant Nursing Officer, Knowledge for Change, Fort Portal, Kabarole District, Uganda
BECKY MASKEW,
BSc Nursing (Adult), Staff nurse, Fairfield General Hospital, Northern Care Alliance, UK
SARAH SULEIMAN
Student Nurse CYP, School of Health and Society, Mary Seacole Building, University of Salford, UK
JANE BOARDMAN, BA Hons, Student Nurse, School of Health and Society, Mary Seacole Building, University of Salford, UK
DEREK BAHANDAGIRA, Registered Nurse, Assistant Nursing Officer, Surgical, Paediatrics, and Diabetes Clinic, Fort Portal Regional Referral Hospital, Uganda
ANGELA MUGUMBA,
Certificate of Registration Midwife, Assistant Nursing Officer, Knowledge for Change, Labour/Gynaecology Ward, Fort Portal Regional Referral Hospital, Uganda
KAYLEIGH THORNTON,
MA, Registered Midwife, Stockport Foundation Trust, UK AUGUSTINE SSEMUJJU, MMed (Obstetrics & Gynaecology), Specialist in Obstetrics and Gynaecology, Fort Portal Regional Referral Hospital, Uganda
YASMIN CAPEL, MBBS, Doctor, Knowledge for Change, Fort Portal Regional Referral Hospital, Uganda ODUR JOE, BSc, Pharmacist, Fort Portal Regional Referral Hospital, Pharmacy Stores
NALUKENGE PROSCOVIA,
Senior Theatre Assistant, Fort Portal Regional Referral Hospital, Uganda
HANNAH RANK, MBChB,
Doctor, Knowledge for Change, Fort Portal, Kabarole District, Uganda
AGNIESZKA SZYMKOWIAK,
MSc, CYP Nurse, Guy's and St Thomas NHS Trust, UK
JACQUI FLETCHER OBE
Senior Clinical Advisor Stop the Pressure Programme/National Wound Care Strategy NHS England Clinical Implementation Manager