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Can 10 minutes ever be long enough to do more than change a dressing?

  • Comments (2)

“You have to understand GP practices are businesses, and have to operate in that way as making money is one of their priorities.”

This may sound obvious, but it wasn’t until Carol Hedger, a tissue viability nurse specialist, showed me the effect this has on some practice nurses and their patients, that I realised the true impact of this statement.

GP practices receive funding for treating asthma among other conditions and for the number of flu jabs they administer, very little funding is allocated to wound care. Patients with chronic wounds are unlikely to be referred to a specialist clinic and tend to be managed in the community.

Frustrating for a nurse like Carol who is desperately trying to make people see that long-term wounds are both avoidable and treatable. Once you find out why a wound isn’t healing, the patient’s quality of life can be improved considerably.

Like most specialist nurses, Carol’s caseload is simply too large for her to offer individualised care herself.  Her priority has to be on educating nurses and patients. Carol visits practices and works with practice nurses to identify the causes of chronic wounds and teach them to assess why wounds aren’t healing.

When a woman attended Carol’s clinic with painful cellulitis, she discovered that both the doctor who had originally seen the patient, and the nurse at the follow-up appointment, had not assessed for oedema – a high risk factor for cellulitis. Luckily for this patient Carol did assess and was able to plan care appropriately.  

Similar patients attend some practices week after week with little or no change.  They are offered alternative dressings but the underlying problem is not assessed.

As Carol puts it: “It isn’t the dressing that heals the wound, it’s the body. If a wound isn’t healing you need to be asking why and treating the problem, not the symptom.”

Sound advice, but is this possible in a 10 minute appointment? And with funding diverted elsewhere, do practice nurses receive enough training to confidently assess the underlying conditions of chronic wounds?

  • Comments (2)

Readers' comments (2)

  • Martyn Butcher

    I fully agree with Carol that 10 minutes is insufficient time to fully assess a patient with a chronic wound, let alone initiate appropriate treatment.

    This lack of time, and possibly the understanding of the underlying aetiology of common chronic wound altered physiology explains the data identified by Guest et al (JWC 21 (8): 389-98). This group accessed the information available on The Health Improvement Network (THIN) database. Although their study was looking at the cost effectiveness of a skin barrier product in treating VLU's it is somewhat worrying that the database revealed that only 6-9% of patients treated for VLU in the community healed within 6 months. This is despite multiple national and international guidelines on best practice in VLU management being available (e.g. NICE, SIGN, CREST, EWMA etc)

    When are we going to accept that simply "slapping on a dressing" is never going to improve the outcome in managing these wounds and those clinicians guilty of doing so are simply throwing valuable money down the drain? Every £ wasted is money which could and should be spent on improving services and patient outcomes.

    Nurses are all too quick to point the finger of blame at NHS managers, but this is something which is within their power to make a difference. Yes, it's not without problems but these clinicians have the patient data and outcome measures to prove that simple 10 minute slots don't work.

    What clinicians need to do is present the facts, the research and the outcomes of their service and educate, inform and negotiate appropriate cost-effective management approaches to chronic wound care.

    Nurses need to take action and not just accept what has always been done otherwise they may just find themselves being called to account. Lack of time is never an excuse for poor and/or negligent practice - Failure to implement "best practice" care could land the clinician with having to answer serious (and potentially career-threatening) questions should their wound management practices be put under the spotlight of a professional standards committee or civil/criminal court.

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  • Anonymous

    I agree with comments above however I would like to disagree with Martyn Butcher as to who is to blame here - it is not the practice nurses in my experience who decide the slots, it is that they are only given very limited time slot to see patients because this is decided by their employers - in their case, GPs. Similarly district nurses are given less and less time to have to do more and more tasks, and their time spent is scrutinized and questioned.Nurses are not to blame for this situation, there is an ever rising population of elderly and obese patients and many other priorities and targets vying for attention. NHS managers and government bureaucrats are certainly not without blame for the pressures nurses are under and the limited time they have to spend with patients, as they set more and more tasks in the form of boxes for them to tick at each visit on top of everything else. I work in this specialism and am frustrated too at the way other nurses are given so little time to undertake their assessments but I understand that in our specialist leg ulcer clinics we have a luxury of being able to decide our own schedules which other nurses do not have. Unfortunately nurses are indeed being called to account - and being silenced too from speaking out, it is certainly not that simple to just change the way they work.

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