1. Wound management using ‘TIME’ Jeannie Randles RN Grad cert wound care PG Cert & PG Dip Primary Health

2. Manage whole patient not just hole in patient

3. overview • Patient outcomes • Wound outcomes • Cleansing • Products • On going assessment • documentation

4. What the patient wants!! • Work in partnership • Expectations • General health • Palliative wound care • Curative wound care

5. Set your goals! • To heal • palliative • To treat infection • To reduce exudates • To protect • Remove Escher • To create wound healing environment • To control odour • To control pain

6. TIME • Devitalised tissue • Slough • Escher • Dry/wet • Granulation • Epithelial islands • Bacterial burden

7. TIME

8. TIME • Moisture balance • Too wet? (macerated) • Too dry? (desiccated) • Moist healing required?

9. TIME • What is happening at the margins • Rolled • Epethelialising • Granulating • Punched out • undermining

10. cleansing • Consider why cleansing is required • How to cleanse i.e. aseptic or clean • Products used to cleanse • Temperature of cleansing fluid • Environment patient is in

11. products • Think about goal • Debriding • Protection • Pressure • Pressure relief • Moisture control • Bacterial control

12. foams • Example above is allevyn non adhesive • Variety of dressings available for use with low to heavily exudating wounds • Available with antimicrobial additives • Check absorption of dressing

13. Antimicrobials • Inadine • Iodosorb • AG dressings • Honey • Polyhexamethylene biguanide

14. films • Used to protect • Waterproof • Avoid multiple layers • Used to secure primary dressings • Monitor for folliculitis • Damaged skin easy to monitor

15. Hydrofibre • Vertical wicking • Moderate to heavy exudating wounds • Protects periwound • Available added to waterproof backings • Available as antimicrobial

16. Alginate • Seaweed dressing • Haemostatic • Available in sheets or ropes • Available with antimicrobial addition • Moderate to heavy exudating wounds • Horizontal wicking properties

17. Hydrocolloid • Occlusive dressing creating bacterial and viral barrier • Maintains moisture preventing desiccation • Patient can shower • Pain reduction due to moist environment

18. Secondary dressings • Comfort • Absorption • Compression • Cosmetic appearance • Compliance • Hygiene

19. Adjunctive treatments • Compression • Pressure relief • Medication • Psychological support • Education • Financial support

20. Case study • 73 year old female • Congestive heart failure • COPD • Diabetic • Venous hypertension • Ulcer present 6 weeks • Now necrotic

21. Case study • 63 year old male • Dementia • Smoker 10/day • Dietary intake poor • #patella after fall • Developed pressure ulcer to heal whilst in hospital

22. 34 year old female • Depression • Lichen planus (inflammatory condition) • Oedema to lower limb

23. conclusion • Think about goal of care • Tissue • Infection or inflammation • Moisture control • Edges or epithelialisation • Document

24. Further reading • Hard-to-heal wounds: a holistic approach (May 2008) • Topical negative pressure in wound management (May 2007) • Management of wound infection (spring 2006) • Identifying criteria for wound infection (fall 2005) • Focus Document: Lymphoedema bandaging in practice (fall 2005) • Wound bed preparation in practice (spring 2004) • Understanding compression therapy (spring 2003) • Pain at wound dressing changes (spring 2002)

25. Sites to check out • ewma.org/english/position-documents.html • www.awma.com.au • www.worldwidewounds.com • www.woundsinternational.com • Wound care education resources • Also remember courses at CPIT include wound assessment and management courses! • www.wounds-uk.com/pdf/content_9364.pdf