1 / 17

KEYS FOR SUCCESS IN WOUND MANAGEMENT

KEYS FOR SUCCESS IN WOUND MANAGEMENT. Associate Professor Michael Woodward Austin Health Heidelberg,Victoria. HOW DO WE DEFINE SUCCESS? . Establish a successful service Establish a reputation for high-quality care Conduct high-quality and influential research

renardo
Download Presentation

KEYS FOR SUCCESS IN WOUND MANAGEMENT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. KEYS FOR SUCCESS IN WOUND MANAGEMENT Associate Professor Michael Woodward Austin Health Heidelberg,Victoria

  2. HOW DO WE DEFINE SUCCESS? • Establish a successful service • Establish a reputation for high-quality care • Conduct high-quality and influential research • Establish a successful teaching program

  3. SUCCESS OR……heal wounds BUT….what do we mean by healing? • Full healing • ?time frame • ?all wounds • ?remain healed • % healing • ?volume • ?surface area • ?which wound, if several

  4. SUCCESS OTHER MEASURES • Control of microbial burden • Improved quality of wound tissue • Control of pain • Improved quality of life • Failure of a healed wound to recur

  5. TEAMWORK However defined, essential to success in wound management. Many disciplines play a role, including: • Doctor (GP, geriatrician, various surgical specialties, dermatologist) • Nurse • Podiatrist • Pharmacist • Patient

  6. ASSESSMENT • FULLY ASSESS THE PATIENT “treat the whole patient,not the hole in the patient” • THIS INCLUDES • Full history • Examination • Patient • Wound • Investigations as indicated • Blood tests • Imaging • Doppler • Biopsy • Cultures

  7. APPRECIATE THE ROLE COMORBIDITIES AND SOCIAL CIRCUMSTANCES PLAY • Medications • Reduced mobility • Reduced dexterity • Nutrition • Incontinence • Psychiatric illness • Dementia • Poor living conditions • Financial problems

  8. TREATMENT SHOULD BE EVIDENCE-BASED “Theories, no matter how persistent they are,cannot eradicate the existance of fact” Jean Martin Charcot

  9. EVIDENCE IN WOUND MANAGEMENT The gold standard (even if a little tarnished) is the RCT- randomised, controlled, trial • Also ideally prospective, concurrent, double- blinded Rarein wound management • This would not be acceptable for a new drug • Yet many new wound products are pharmaceutically active • Industry and practitioners can and should do better

  10. RESEARCH IN WOUND Mx There have been successfully-conducted RCTs involving Australian sites • One coordinated out of Adelaide (GroPep) • Others: • PAI-2, a protease inhibitor • Proguide vs Profore • At least 2 in progress currently

  11. SUCCESSFUL WOUND MANAGEMENT NEEDS SUCCESSFULLY CONDUCTED RESEARCH

  12. SO WHAT GUIDES PRACTICE UNTIL EVIDENCE IMPROVES? • Faith “Our faith comes in moments,our vice is habitual” (R.W.Emersen) • Hearsay • What we are taught/ mentored is this if not evidence-based • Marketing • Experience • But some of this may be faith and theory

  13. …AND OTHER EVIDENCE • We do have some,even if not RCT • In-vitro studies • Case studies • Case series • Non-randomised/non-comparator trials

  14. ..AND GOOD SENCE • Even without direct evidence, successful wound management is guided by basic,sound principles • Control microbial burden • Ensure adequate blood supply • Relieve/avoid pressure • Compress if venous • Moist wound management principles • Control pain • Enhance nutrition • Treat comorbidities

  15. SUCCESSFUL CHOICE OF DRESSING • Appropriate for wound • Eg foam if heavily exudative • Appropriate for patient • Affordable • Comfortable • Patient can apply,or someone available to do so • Successful • Wound quality improves • Wound size/volume reduces • In reasonable timeframe

  16. THE NON-HEALING WOUND • Reassess patient/wound • ?wrong diagnosis • ?comorbidities missed • ?poor compliance • Consider change of dressing type • Even within same class • Seek help if needed • Try completely different approach • Eg HBO2

  17. SUCCESSFUL WOUND MANAGEMENT • Is more science than art • Is almost always achievable • Is extremely satisfying • To the patient • To you!

More Related