Assessment, prevention and management of skin tears.

Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears). A recognised classification system should be used to identify and document skin tears and guide treatment decisions in line with local wound management protocols. Nurses and carers are in a prime position to prevent, assess and manage skin tears.

Safety, tolerability and acceptability of KTwo.

Part 1 of the KTwo evidence review concerned the efficacy and reproducibility of the bandage system in the management of leg ulceration and lymphoedema. Here, in Part 2, the focus shifts to its tolerability and acceptability to both patients and clinicians. The evidence presented here ranges from a randomised controlled trial to anecdotal reports in conference posters. The aim of this review is to describe the evidence, and not to critique it.

An introduction and guide to effective Doppler assessment.

Accurate and timely diagnosis of leg ulceration is an essential factor in making evidence-based, effective decisions regarding patient management with the aim of swift wound healing and/or referral to the appropriate specialty. Nurses are professionally responsible for ensuring that patients receive the appropriate assessment and evidence-based management. This article examines the most up-to-date guidance on Doppler ultrasound as a key element of this assessment. Approaches to assessment will be explored, with emphasis on the need to include a Doppler ultrasound as one key element of a larger, holistic assessment. An introduction to the ankle-brachial pressure index (ABPI) will be given, followed by a step-by-step guide to standard procedures for carrying out a full Doppler ultrasound. Alternative options for measuring ABPI are also provided.

Efficacy and reproducible compression of KTwo.

To achieve good patient outcomes, clinicians must ensure that clinical decision making is informed by valid and reliable evidence. This review examines the evidence on the clinical efficacy and reproducibility of compression applied by the KTwo bandage system. Its aim is to describe the evidence, not critique it. However, it clearly shows there is a body of evidence, from simple comparative evaluations to a randomised controlled trial, demonstrating the effectiveness of this system

Achieving consensus in pressure ulcer reporting.

Pressure ulcers are considered to be a key quality indicator and healthcare providers in England are required to report local pressure ulcer rates. However, there is a lack of standardisation in reporting due to lack of national guidance. The Tissue Viability Society has sought to develop consensus amongst all concerned parties on the most useful and robust methods of data collection. This document has been developed following a consensus meeting and consultation with the majority of Tissue Viability Nurses across England and provides guidance on reporting pressure ulcer rates. It is intended for use all organisations that are involved in the reporting of pressure ulcers. It represents the consensus view of a large number of Tissue Viability Nurses from across England and we recommend its adoption.

Exudate, infection and patient quality of life.

Efficient and cost-effective management of excessive wound exudate continues to present unique challenges to nurses. Accurate patient and wound assessment is essential to inform the treatment and selection of suitable dressings. The wide range of modern wound management products should be sufficient to meet the needs of every wound type at all phases of healing, and as circumstances change. However, there are still situations in which nurses are having to change dressings a number of times in 24 hours to prevent maceration (i.e. the softening and whitening of skin that is kept constantly wet), soiling, and the potential for cross-infection. There is no easy solution to the problem, but as nurses become more knowledgeable about identifying and managing the causes of excessive exudate, the available management options, and, as dressing materials become more sophisticated, practice should improve in this area.

Assessing the risk of pressure ulcer development.

Assessing patients in all care settings for their risk of pressure ulcer development has become the foundation on which appropriate clinical interventions should be based. This article will explore the current drivers and guidance for conducting pressure ulcer risk assessment and the practical issues and problems surrounding best practice. It will define 'risk' in relation to pressure ulcer development, identify the purpose and benefits of using a pressure ulcer risk assessment scale, discuss evaluating pressure ulcer risk, identify some of the interventions that can be implemented based on the patient's risk assessment score, and examine nurses' professional responsibility for the safety of patients.

A practical guide to reducing pain in patients with wounds.

Pain in patients with wounds is a largely underestimated problem in spite of it being highlighted as a significant factor that adversely influences patients' biopsychosocial wellbeing; it also adversely affects wound healing. This article considers the impact of wound pain on patients' quality of life, and how quality of life may be measured. The article explores the pathophysiology of pain, its manifestation and how an assessment of a patient's pain may be carried out using a variety of tools. Finally, it provides practical guidance for reducing pain associated with wounds, including consideration of the method and frequency of dressing changes, and the types of dressing used.

Pressure ulcer prevention and pressure-relieving surfaces.

Although rarely subject to media attention, political interest or research funding, pressure ulcers, and their almost inevitable increase in incidence, detrimentally affect the quality of life of thousands of patients, both in the hospital and community setting. In addition, the costs to the NHS of pressure-ulcer-related care in hospitals is estimated to be pounds sterling 1.8-pounds sterling 2.5 billion annually. Many pressure ulcers that develop could have been prevented, and there are several up-to-date, easily-accessible sources of evidence to guide decision-making regarding appropriate interventions in pressure care. Consideration and assessment of the patient holistically, followed by appropriate intervention and evaluation, is the key to any prevention strategy.

Exploring the concept of moist wound healing and its application in practice.

The concept of a moist wound environment for optimal healing has been promoted since the early 1960s. With few exceptions, improved healing rates, less painful dressing changes and better quality scarring result from wounds treated with dressing products that manage exudate effectively. An understanding of how wounds heal is necessary to both predict and anticipate how they will react to different dressing products so knowledge of those dressing products is essential.

Guidelines for the prevention and treatment of pressure ulcers.

An 'all-in-one' guideline on pressure ulcer prevention and management in primary and secondary care was published last year by the National Institute for Health and Clinical Excellence (NICE 2005a). The guideline is published in two parts. The first part is The Management of Pressure Ulcers in Primary and Secondary Care (Royal College of Nursing (RCN) and NICE 2005). The second part concerns pressure ulcer risk assessment and prevention, including the use of pressure-relieving devices (NICE 2003). A quick reference guide (NICE 2005b) summarises the recommendations made in both parts and is the focus of this article.

Best practice in wound assessment.

Accurate and considered wound assessment is essential to fulfil professional nursing requirements and ensure appropriate patient and wound management. This article describes the main aspects of holistic assessment of the patient and the wound, including identifying patient risk factors and comorbidities, and factors affecting wound healing to ensure optimal outcomes.

Urgotul: alternative to conventional non-adherence dressings.

This article describes a novel dressing product that was developed from existing technology: hydrocolloid. The main benefits of Urgotul relate to the fact that it does not adhere to the wound surface, so both wound trauma on removal and the build up of moisture under the dressing are avoided.