Any Negatives with Negative Pressure Wound Therapy
The author works in a trust which delivers care to a population of 1.6 million. There is also another demographic which relies on the service as the author is based in a tourist destination with over 18 million visitors to the area. The area is also a popular a retirement destination having a significant impact due to its ageing population.
Wound care is an increasing cost in clinical practice1and the trust is always looking to deliver effective care within the financial pressures present in the National Health Service. This places an increasing burden on health care professionals to find cost effective methods to manage wounds. The evidence supporting Negative Pressure Wound Therapy (NPWT) is increasing with clinical benefits such as maintaining a moist wound healing environment and increasing granulation tissue to help wound closure2. NPWT limitations can involve issues with air leaks and conformability. The author has used NPWT on multiple wound types from chronic wounds, surgical incision and performance on peri-wound skin. This case study will include six patients with multiple comorbidities to guide future selection of patients receiving negative pressure therapy.
The wound care specialist team aims to see all patients referred in a 48-hour period in community and acute settings to aid early intervention. The author set a two-week inclusion period for all patients referred into the specialist service that was suitable for NPWT with a Hydrofiber® contact layer. During this two-week period 6 patients needed negative pressure and agreed to the treatment therapy. The patients between them had multiple co-morbidities including Diabetes, Oedema, Dementia and Heart Disease. The wound care specialist implemented an education session to support patient and clinicians in the management of NPWT. All six patients where followed through their patient journey and data was collected to guide clinical decision on the effectiveness of disposable NPWT.
All 6 patients found the disposable NPWT with a Hydrofiber® contact layer to be comfortable and had no seal issues were reported throughout treatment.
5 of the wounds had dehisced prior to the application of NPWT and one wound was a new surgical wound applied in theatre. 60% of the wounds went on to heal after the application of disposable negative pressure system with a Hydrofiber® layer (fig 1). The largest length of the wounds was 18cm, the largest width was 4.5cm and the largest depth was 1.7cm. All the patient’s exudate was documented as moderate which is in line with where the clinician believes disposable NPWT should be used. All the peri-wound skin improved post application of the NPWT, as skin integrity was important feature to the clinician.
Hydrofiber® was used as a wound filler on four of the wounds which the clinician found to be effective with the disposable NPWT with a Hydrofiber® contact layer which distributes -80mmHg negative pressure at the wound bed3
Emergency readmissions can be a problem in the NHS with costs more than 2.4 billion (4). This has a significant negative impact on patients experience and wellbeing. As a service, Wound care specialists are faced with time restraints and cost pressures when planning and implementing wound care management plans. Wound care specialists are constantly looking for innovative ways to maintain high levels of effective care within their budget. This can be difficult in a trust which has a high level of tourism and an aging population. The author wanted a NPWT system that was versatile and could be used on multiple wound types including incisions and chronic wounds. The choice for a clinician to use negative pressure can be difficult especially with cost pressures. Therefore, the treatment outcomes need to be met and show cost saving without compromise on effective treatment and product performance. The patient with the surgical incision was identified as being high risk of postoperative complications due comorbidities. The author believes that the prophylactic application of the disposable negative pressure system as part of a holistic care plan optimised wound healing and aided in preventing any incision complications. Whilst delivering the education session the author highlighted that a treatment pathway would have been beneficial to support clinical decision making.
Correct treatment selection is important and wound care specialists are looking for ways to save money and deliver high levels of care. NPWT can be used on multiple wound types to promote and optimise wound healing. Prophylactic application within surgery performed best resulting in full wound closure within a timely manner improving patient outcome. The author has had positive results from the disposable NPWT with a Hydrofiber® contact layer and if used correctly as part of holistic care can have a positive impact on practice.