Jenny Ashworth, RN, PGDip (Wound healing and tissue repair); Marc Chivers, BA (Hons), MSc, RN, PGCE.
Jenny-Clinical Nurse Specialist, Tissue Viability; Marc-Lecturer in Healthcare, The Royal West Sussex NHS Trust, St Richard’s Hospital, Chichester, West Sussex
Nurses regularly undertake this mode of treatment because ‘excision of necrotic tissue by sharp debridement is undoubtedly the most rapid method available’ (Vowden and Vowden, 1999). Despite this, until now, there has been limited formal education available to prepare nurses to undertake this role. In the authors’ view this anomaly has led to variation in practice, role insecurity and uncertainty in relation to the nurse’s legal position in the event of complications.
Within the Royal West Sussex NHS Trust, only five named tissue viability link nurses who have achieved a pass in an accredited specialist course and passed the practice assessment will be permitted to undertake conservative sharp debridement.
The evidence supporting one method of wound debridement over another is inconclusive (Vowden and Vowden, 1999; Bale, 1997; Poston, 1996; Edwards, 2000; NICE, 2001). Holistic patient assessment has to be the determining factor in the treatment decision process and this has to be matched against employer policies and guidelines and the skill and competence of the practitioner undertaking the procedure (UKCC, 1992a; 1992b; DoH, 1998). Failure of the practitioner to do this is a breach of the duty of care to the patient. Where the patient suffers harm through either an act or an omission, then the practitioner is negligent (Dimond, 2002).
The authors would like to acknowledge Mark O’Brien, Clinical Nurse Specialist, Tissue Viability (Education), The East London Wound Healing Centre, for his work in helping to develop the Masterclass in Methods of Wound Debridement.
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