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Implementing a dressing (Urgoclean) to enable quicker assessment of pressure ulcers and wound bed preparation within a large acute trust.

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IMPLEMENTING A DRESSING (URGOCLEAN) TO ENABLE QUICKER ASSESSMENT OF PRESSURE ULCERS AND WOUND BED PREPARATION WITHIN A LARGE ACUTE TRUST

GEMMA MCGRATH

INTRODUCTION

Medway NHS Foundation Trust is Kent’s largest and busiest hospital with 588 beds and 400,000 patients seen annually (www. medway.nhs.uk). • A wound care formulary review has been undertaken, the aim to reduce variation between dressings, reduce cost and improve dressing usage within the Trust. • Urgoclean, was evaluated within a ward to demonstrate its suitability with a further evaluation via the tissue viability nurses prior to confirmation of formulary inclusion for all sloughy wounds.

METHOD

Any patient with a sloughy wound was eligible to be treated with the desloughing dressing, UrgoClean (Urgo Medical) to remove slough and debris from the wound and prepare the wound bed for healing. • 10 patients with a range of wound types including 5 unstageable pressure ulcers were identified within a designated ward and Urgoclean was applied to these wounds. • A further 2 patients were evaluated via the tissue viability service. • Patient 1 was referred to the TV service with an unstageable pressure ulcer to the left shoulder blade with 100% slough. • Patient 2 had bilateral leg ulceration, wound 1 which was situated to the back of the right leg measuring 9cm x 6cm, with 5% necrosis, 80% slough and 15% granulation tissue. The left leg had 3 wounds to the gaiter area the assessment of these ulcers were wound 1.  6cm x 2cm with 80% slough, 20% granulation, wound 2. 2cm x 2cm, 100% slough and wound 3 1cm x 1cm, 20% necrosis (showing signs of lifting) and 80% slough.

RESULTS

All 10 patients evaluated within the ward rated UrgoClean as excellent for all evaluated criteria: ease of application, ability to stay in place, patient comfort, exudate handling, conformability, patient comfort on dressing removal, ease of removal and condition of surrounding skin. • For the patients seen via the Tissue Viability service, Patient 1 had UrgoClean applied on 28th July 2016. No secondary dressing was needed and UrgoClean was held in place without fixation due to anatomical position of
pressure ulcer. UrgoClean was changed every three days. 2nd August 2016, the wound showed 90% granulation with only 10% slough remaining. • Patient 2 had UrgoClean applied to all leg ulcers on both legs 21st July 2016. UrgoClean was changed as required dependant on exudate level and modified compression conforming to the Silver Standard (Hedger, Connolly, 2014) was instigated for right leg.  Review on 1st August 2016 showed all wounds on both the right and left leg to have 100% granulation.

DISCUSSION

Being able to correctly identify and classify pressure ulcers can be challenging, particularly if slough, eschar or necrosis obscure full view of the wound bed. • Implementing a dressing (UrgoClean) that quickly and efficiently de-sloughs the wound bed enables quicker assessment of pressure ulcers and wound bed preparation.  • Within Medway NHS Foundation Trust, to be able to correctly stage and document pressure ulcers is vitally important.  • To ensure the patients have the correct treatment and management in place. • All Trust Pressure Ulcer Incidents are internally investigated to establish the root cause; the true Pressure Ulcer grade must be determined at this point to ensure it is reported correctly and the Investigation is heard at the correct level. 

CONCLUSION

The use of UrgoClean for sloughy wounds has been effective for the patients included in this case study. • UrgoClean was quick and easy to apply and remove and its fast desloughing capability has allowed for an accurate assessment of pressure ulcers and also provided a clean moist environment for wound healing. • As a result of this successful evaluation UrgoClean is now listed on formulary for all sloughy wounds in Medway NHS Foundation Trust. • As a result of this successful trial and following other success of this dressing UrgoClean is now listed on formulary for all sloughy wounds in Medway NHS Foundation Trust. • This will enable quicker grading of pressure ulcers and guide staff to be able to put a care plan in place which can correctly manage sloughy wounds.

 

CASE STUDY

A new patient was admitted to the hospital on the 24th June 2016. This patient was not previously known to the District Nursing Team. Past medical history included CVA (2006), Hypertension, Hiatus Hernia, Agoraphobia. Patient appeared neglected and malnourished and MUST Score was 3. On arrival patient appeared very unkempt and had been incontinent of urine and faeces. • On the 30th June this patient was referred to the Tissue Viability Service for wound assessment and
management. Various wounds were identified located to the left side of the body. It was thought that the patient may have been lying on his side for some time for this to happen. (Photo 1) • One particular wound located just below the left shoulder was classed as unstageable pressure ulcer despite unusual location and presentation. Plan of care was issued and staff was asked to refer back to the TVN if further assessment was required.
• On the 28th of July patient was referred back to the TVN as the ulcer remained nearly 100% sloughy despite following the care plan with Hydrogel and adhesive foam dressings. (Photo 2) • At this point UrgoClean dressing was introduced to de-slough the wound. The plan was to change dressing every 3rd day or as required. • Tissue Viability reviewed the patient  5 days later on the 2nd August  (Photo 3) and diagnosis of Stage 3
Pressure Ulcer was issued. The plan was to continue the treatment with Urgoclean dressings. • Final review by the TVN was on the 16th of August with 85% granulation and minimal exudate from the wound. (Photo 4) • Upon discharge from the hospital care plan was issued recommending continuation of treatment with UrgoClean

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