It has been estimated that 3.8 million people in the UK live with a chronic wound (Mölnlycke, 2022a). Wounds can negatively impact an individual's social, psychological and physical well-being, causing pain, discomfort and loss of mobility, affecting their quality of life (Fearns et al, 2017). Unhealed wounds can have a notable effect on a patient's mental health, leading to anxiety and depression (Fearns et al, 2017).
A report published by Making Wound Care Work estimated that one in fifty people in Britain currently rely on wound care services, but variation in standards means that patients are having mixed experiences across the country (Mölnlycke, 2022a). During the COVID-19 pandemic, 42% of wound care patients stated that the place where they usually receive care had changed, with 29% trying to receive care in person (either at a clinic or via home care services), but failing (The Patient Association, 2021). More so, 33% of patients reported managing their own wounds due to the pandemic (Blackburn et al, 2019).
Taking all of this into consideration, the Making Wound Care Work co-authors, healthcare company Mölnlycke, and The Patients Association, brought together health professionals and patients, to create a set of recommendations that aim to highlight areas of focus, which will drive improvements to wound care services.
Among the areas highlighted, was the need for senior management to protect time for healthcare professionals in a community setting, allowing them to increase their wound care knowledge and skillset. This is especially important, given the high volume of wounds that are treated in the community, and the limited focus on wound care as part of the formal nurse training.
Other key recommendations were for healthcare professionals to adopt a shared decision-making model, empowering patients to become more involved in their care, together with their clinician; and for supported self-care to be carefully considered as part of the treatment mix available for wound care patients, while accepting that it will not be suitable for all.
The full list of recommendations, which were created by panels of patients and professionals, respectively, are as follows (Mölnlycke, 2022b):
Upskilling generalist healthcare staff on wound care
Non wound care specialists need more training in wound care
- One of the primary concerns of both nurses and patients was the lack of specialist wound care knowledge in community care settings, and among non-specialist staff, such as staff nurses and community nurses
- For example, a survey of pre-registration nursing students found 68% reported that they had received fewer than 10 hours' formal teaching on skin integrity over their 3-year course
- To help alleviate the wound care skills gap, we recommend the implementation of a more accessible programme to upskill these staff to gain a better understanding of, and expertise in, wound care, wound healing stages, the appropriate pathways for patients with chronic wounds, effective treatment and management of wounds, the right time to refer, and how to manage wounds to get better outcomes for patients
- All of this requires prioritisation by the senior leadership team to allow non-specialists the protected time for learning.
Shared decision-making
There should be a greater focus on shared decision-making in wound care
- Patients should have a greater voice in their care, to help avoid the kind of frustration that they often feel; and clinicians should operate a shared decision-making model in wound care. Patients with chronic wounds can sometimes feel like experts by experience, they also have diverse needs depending on the nature of their wound and how it is impacting their quality of life
- Equally, patients need to be supported in understanding the nature of their wound, and provided with information to help optimise wound healing, helping them to become experts in their own care, together with their clinical team.
Maintained support in supported self care
The role—and application—of supported self-care needs to be carefully considered as part of the treatment mix available for wound care
- There has been a rise in supported self-care throughout the COVID-19 pandemic, but as the health service has opened back up, levels of supported self-care varied
- It should be acknowledged that supported self-care is not the preferred or best option for all patients.
- There should be a discussion between the patient and the clinical team to understand the best approach, thereby providing the best chance of a positive outcome
- For those patients who choose supported self-care, consistent standards should be set across the country to reduce variation in outcomes and empower patients.
Joined-up service across community and secondary care to allow for the adoption of existing care pathways for improved outcomes
There needs to be a coherent wound care service delivered across different NHS settings and teams
- One of the reasons wound care outcomes vary so much is that chronic wounds are often managed as part of wider care for another condition. This can lead to them not receiving the specialist attention they need
- We need a specific and dedicated wound care patient flow between care settings, to build upon existing pathways and work from diagnosis to healing. A flow that details specific interventions for those living with a chronic wound to help guide non-specialist staff working with patients in other disciplines, providing clarity on when greater intervention on wound management is necessary
- Methods such as wound care passports (to aid continuity of care), and wound care specialists' involvement in the MDT from the outset could further increase the chances of identifying complications earlier helping to ensure patients get the right care at the right time.
Improved data collection
A wound care registry or similar should be created to standardise the measurement of wound care outcomes across England:
- A wound care registry or similar should be created to standardise the measurement of wound care outcomes across the country – such a facility has been created in Wales, and has around 19 000 entries, which is helping to inform clinical practice, as well as support research in the subject (Welsh Wound Innovation Centre, 2017).
- In addition to recording and monitoring healing rates, this should include data on treatments and dressings, to ensure that clinicians can understand what interventions work well
- Patient centric measurements, such as Patient Reported Outcomes Measures (PROMs) and quality of life questionnaires should also be included
- Health leaders should consider opening this data to industry to aid innovation in wound care across both product and digital solutions
- Including this data requirement, or further wound care measurement/outcomes, within a Commissioning for Quality and Innovation (CQUIN), Quality and Outcomes Framework (QOF) points, or some other form of incentivisation, would help to elevate the attention wound care receives.
Improved public health messaging
Public health messaging to educate people about the importance of wound care
- Improved public health messaging, targeted at addressing health issues that can cause and/or make wounds worse. With proper intervention, much more can be done to improve wound healing, and so spotting difficulties earlier, or even preventing them from happening, can help to reduce complications and alleviate pressures on the healthcare system.
For further detail on the recommendations, please visit: https://www.molnlycke.co.uk/campaigns/making-wound-care-work/