Who Administers Wound Care?
– An International Guide
What is Wound Care?
In an ageing population, such as that of the UK, wound care is a critical issue because of the burden it places on patients, carers and healthcare providers. “As obesity, diabetes, cardiovascular disease and an ageing population all increase, so do the number of people with chronic wounds.” The way in which healthcare services respond to this challenge will determine how long people suffer from their wounds, and what the overall cost of their treatment is.
Wound care contributes to the healing process in 4 ways by:
- Protecting the wound fluids
- Preventing or managing infection
- Minimising scar formation
- Aiding collagen maturation process
What Does Wound Care Cost the UK?
A study carried out in 2013/14, led by Professor Peter Vowden, found that over the course of a year, the NHS managed 2.2 million patients with wounds requiring more than 4 weeks of follow-up care. The cost was £5.3 billion, annually.
Leg ulcers and surgical wounds were found to be the most costly wounds to treat. Patients’ wounds were cared for predominantly in the community, incurring 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million general practitioner (GP) visits and 3.4 million hospital outpatient visits.
The Vowden study was updated in 2017/18. It found that the number of patients needing wound care had increased, and this lead to an increase in the use of healthcare resources. The NHS cost of wound care in 2017/2018 was an estimated £8.3 billion.
What is the UK Strategy for Wound Care?
In response to the 2013/14 study NHS England and NHS Improvement established the National Wound Care Strategy (NWCSP) with the aim of improving the care of pressure ulcers, lower limb ulcers and surgical wounds. The work of the programme seeks to “reduce unnecessary variation, improve safety, and optimise patient experience and outcomes.”
LDA Research – A Global Wound Care Team
LDA Research works on wound care research projects across the world with our international partners. We have access to specialist nurses, practice nurses, community nurses, GPs, clinicians and patients across the world, all of whom understand and deal with wound care on a daily basis.
We invited our partners in France, Germany, the US and Mexico to tell us about who administers wound care in their professional healthcare structures. In each case wound care is carried out by an interdisciplinary network of nurses, doctors and specialists.
- Community Nurses treat wounds and prescribe wound care products
- Community-Based Wound Care Nurses have a recognised qualification in wound care. They treat wounds and prescribe wound care products.
- Hospital Nurses treat wounds using wound care products prescribed by physicians. A few of them are qualified to prescribe the products themselves.
- Surgeons are the first prescribers of wound care products for surgical wounds. They are not necessarily the most knowledgeable in terms of wound care products as nurses are the ones who use them when prescribed.
- GPs may prescribe or renew prescriptions for wound care products but they do not provide wound care themselves.
- Ambulatory Nursing Care (Outpatient Care) is provided by nurses who are wound experts. They use wound care products prescribed by physicians, although the nurse may suggest a particular product. Often budgetary restraints determine whether or not their request is met. In some cases patients are willing to pay to get the dressing recommended by their nurse. Most accept the products made available to them.
- Specialised Wound Care Hospital Nurses are available to consult, or assist nursing staff with wounds that require specialist treatment.
- Surgeons will deal with severe surgical wounds.
- ICU Physicians deal with severe wounds (using a vac pump, for example).
- Specialist Outpatient Structures for Patients With Diabetes comprise networks made up of surgeons, diabetologists, GPs and nurses/wound experts. They work together to prevent severe wounds leading to necrosis and amputation.
- GPs deal with simple or more complex wounds in the local surgery or patient’s home.
- Geriatric Nurses offer specialized care and work together with other professionals to achieve the objectives. They write reports related to the care of wounds and other ailments typical of the age or physical state.
- Intensive Care Nurses provides care to patients with critical clinical situation who present a severe imbalance of one or more major physiological systems including the care of wounds produced by these conditions.
- General Nurses are involved involved in surgical wound care. They work in hospitals, public health centres, specialist doctors’ offices, clinics, prisons, and private companies. Some nurses visit patients in their own homes and this may involve changing wound bandages.
- Public Wound Care Centres are for the treatment of wounds that have not begun to heal after 2 weeks, or continue to need treatment for up to 6 weeks. The wound is measured and examined and a treatment plan is created.
- Wound Care Specialists work in the Clinic of Vascular Ulcers and Wound Healing, diagnosing and treating patients with persistent wounds (ulcers) caused by poor circulation, diabetes and other conditions. The care team may include specialist doctors who specialise in vascular medicine and surgery, internal medicine, physical medicine and rehabilitation, and dermatology. And nurse specialists and nurses experienced in the care of ulcers and vascular wounds.
- Interdisciplinary Clinic of Wound Care and Stomas co-ordinates different medical and surgical specialisms to provide multidisciplinary management based on a comprehensive evaluation of vascular, infectological, mechanical and sociocultural aspects. Chronic skin wounds and ulcers are increasingly frequent in our population as evidenced by the increase in the number of leg ulcers (venous or varicose, arterial, lymphatic and mixed), diabetic foot, complications of surgery, pressure ulcers, autoimmune diseases, etc.
- Physiotherapist treats wounds with healing problems, mainly open wounds, with ultrasound treatments . Physiotherapists with a specialization in wound care develop a treatment plan that they will apply with different wound healing control factors, including nutrition, blood flow and circulation, inflammation, functional mobility and pressure relief. They use treatments such as ultraviolet light, pulsed washing, electrical stimulation, therapies for wounds with negative pressure, multi-layer compression and debridement with sharp objects.
- Endocrinologists (Diabetologists) treat topical complications, injuries or injuries such as diabetic foot.
- Physicians caring for wounds come from a range of disciplines including: general surgery, orthopedics, infectologists, vascular surgery, and podiatry among others.
- GPs assess, diagnose and prescribe wound products, normally in a surgery or home setting.
- General Practice Nurses are attached to a GP surgery. They treat wounds using products prescribed by the GP.
- Community Nurses manage the care of simple and complex wounds either in patients’ homes, or in clinics. They receive advice and support from nurses and medics with expertise in tissue viability, burns, vascular medicine or dermatology.
- Tissue Viability Nurses are a specialist nursing service for wounds that are taking a long time to heal, such as a surgical wound, leg ulcer or pressure ulcer. They carry out assessments and identify any problems that may contribute to delays in wounds healing.
- Clinicians caring for wounds come from a range of disciplines including: general surgery, vascular surgery, endocrinology, podiatry and dermatology.
- Wound Ostomy and Continence Nurses (WOCNs) provide day-to-day wound care both in acute care settings and in the community.
- Unit/Floor Nurses are responsible for wound treatments and changing dressings if wound care nurses are not available. Lines of communication need to be developed between Unit/Floor Nurses and Wound Care Physicians to ensure optimum patient care.
- Rehabilitation Therapists help patients to resume normal activities and increase their mobility as their wound heals. Occupational therapists help patients engage physically and mentally with day-to-day life. Where therapists are working with patients they will regularly communicate with wound physicians.
- Dieticians are an important part of the care team because good nutrition is key to effective wound healing.
- The Primary Care Physician (PCP) is responsible for the patient’s wound care when in the community. The PCP needs to be updated on the wound care specialist’s recommendations therefore.
- Physicians caring for wounds come from a range of disciplines including: general surgery, vascular surgery, podiatry and dermatology, among others. Plastic surgery may be another involved discipline. Doctors also attain certification through the American Academy of Wound Management to become a Certified Wound Specialist Physician (CWSP).
Working With LDA Research
LDA’s reputation for international research and global intelligence is built on our success in accessing patients and healthcare professionals worldwide. Wound care is one of our busiest areas of research; to date we have conducted more than 50 specialist research projects in this area. This means that we have access to patients and HCPs specialising in wound care from around the world.
Would you like to speak to someone from LDA Research about a wound care research project? Call us today on 01525 861436