Device-related pressure ulcers in community settings.

Understanding the differential diagnosis between device-related pressure ulcers (DRPUs) and pressure ulcers ensures that appropriate prevention, management and intervention plans are identified. National reporting systems now include DRPUs alongside other categories of pressure ulcers listed by international pressure ulcer advisory panels. Medical devices are not the only cause of DRPUs, and, in the community setting, other objects can also cause pressure ulcers, such as spectacles and hearing aids. Skin assessment around the site of devices is essential to ensure the skin is intact, the micro-climate is considered and the skin is properly cleansed. Risk assessment for devices should be undertaken, and prevention according to the device itself may include fixation and the use of prophylactic dressings. Advice and support must be given to patients and carers to facilitate self-care and identify signs of skin damage and infection.

Updated leg ulcer pathway: improving healing times and reducing costs.

Regardless of the amount of literature and evidence on leg ulcer management, there are still significant variations in treatment. Implementing a standardised leg ulcer pathway to ensure patients are appropriately and timely assessed could help reduce nursing time and overall costs, while improving healing outcomes and patients' quality of life. Such a pathway was introduced in Lincolnshire and Leicestershire, UK, to treat venous leg ulcers (VLUs). The results showed improved healing times, reduced costs and fewer nurse visits, among other findings.

ReadyWrap®: case studies in practice.

The cost that chronic wound care imposes on both patients and health services worldwide is well recognised. Most patients with venous leg ulcers require compression therapy over the long term, for both treatment as well as to prevent recurrence of these wounds. Caring for patients with chronic wounds makes up a large part of the workload for district and community nurses, and encouraging self-management among patients is a worthwhile effort to limit the costs and resources directed for this purpose. The present article describes the practical use of the ReadyWrap range of compression garments, which are available in various different styles, and aid patients, their families and carers in the self-management of venous leg ulcers. These products are designed with their long-term use in mind, and, as described in the case studies in this article, patients show good concordance to compression therapy involving ReadyWrap.

Mitigating the damaging effects of tissue distortions by using a low-friction heel protector.

This article reports the finding of a small non-controlled evaluation over a 2-week period in three different care settings: a residential care home, an acute stroke unit and a community intermediate care hospital. At initial recruitment 30 patients were identified by clinical assessment as being at high risk of developing a heel pressure ulcer. Further inclusion criteria were identifying heels that had signs of pressure damage occurring, blanching and non-blanching erythema, blistering and category 2 ulceration. In all, 15 patients fully completed the evaluation over a 14-day period. The mean age was 86 years. The low-friction bootee was worn constantly while in bed and seated in chairs, only being removed for heel checks and hygiene care. No patients were independently mobile during the evaluation; products were not worn to walk in due to a risk of falling-patients in the community hospital who had to mobilise for rehabilitation removed the bootees for this activity. All had pressure mapping and ultrasound of pedal pulses prior and after evaluation by the tissue viability specialist nurse. Results of pressure mapping showed a reduction of peak heel pressures on application of the bootees and a final review of reduction in visual signs of heel damage, reduced pain, increased comfort and ease of use. These results indicate that a standardised care pathway approach to heel protection using low-friction heel bootees is effective in all care settings for the reduction and prevention of heel pressure damage.