wound care

The general consensus is that the majority of pressure ulcers are deemed ‘avoidable.’ Yet, as we approach another Stop Pressure Ulcer Day (19 November), I see avoidable pressure ulcers still occurring everyday across all sites of care. It seems to me that current guidelines, policies and training programmes are still insufficient to tackle this growing problem. Together with my industry colleagues, I have been calling for the inclusion of wounds, and particularly pressure ulcers, in national patient safety policies throughout because they are preventable . Pressure ulcers are an adverse event that have high costs for patients and health systems. Given the impact of pressure ulcers on health systems, I continuously have asked, “Why isn’t more being done to stop pressure ulcers? How can we support better prevention?” The fact is that preventing pressure ulcers, and wounds in general, means working across care silos and ensuring that healthcare professionals from all disciplines know how to manage at-risk patients. Prevention of pressure ulcers also means focused training and specialised care when necessary which requires investment at a time when many health systems are focused on cost-containment. Yet, we know that additional investment will be more than recouped through the avoidance of extended hospital stays and ongoing care. Surely, the avoidance of adverse events and complications results in benefits for both patients and health systems. Under the Italian Presidency, Member States called on the Commission to work towards a better understanding of the cost-effectiveness of patient safety policies, but little has been done since the adoption of the Council Conclusions to promote long-term investment in patient safety generally – much less specifically for the prevention and management of pressure ulcers. I therefore believe that as stakeholders we must urge both national and EU policymakers to commit to, and invest in, patient safety...
The European Parliament adopted another report this week focused on safety in healthcare highlighting the huge costs to healthcare systems, not to mention the enormous costs to patients, for preventable injuries, complications and infections. While I admire the Parliament’s attention to these issues, it is still clear that many of the calls for improved monitoring of patient safety and mitigating steps to avoid such events still fall on deaf ears at the national level. This is particularly relevant to the wound care community, given the stubborn incidence of pressure ulcers and surgical site infections which occur in healthcare facilities. Patient safety in wound care Safety is especially important in wound care where appropriate treatment can help prevent the development or prolongation of a wound as well as adverse outcomes such as infection or amputation. Advanced wound care treatments have a significant role to play in the prevention of patient safety events such as pressure ulcers and surgical site infections, particularly in hospital settings. When managed inappropriately these events can result in avoidable morbidity, extended hospital stays and even mortality. While the EU institutions recognize at a macro level that appropriate care and treatment can deliver improved efficiency – essentially improved outcomes at lower cost - at a national level the focus remains on cost containment. Driven by austerity measures and increasing demands, most healthcare decision makers revert to managing budgets on a short-term basis and look for cost savings, particularly in the procurement of medical supplies. This issue is worsened by an absence of accurate, routinely collected data on patient safety events across many EU health systems. Whilst some health systems, such as the English NHS, have implemented data collection on pressure ulcers and surgical site infections, this remains highly variable across member states. The absence of data means that...
When the European Commission published its secondary report on patient safety, it made me wonder why advanced wound care is not higher on the patient safety agenda at EU and national levels? Not that it’s a competition, but the incidence of wounds in the EU is approximately 4 million (!), which is on par with cancer (3,9 mill), cerebrovascular disease (3,9 mill), and diabetes (2 mill.). The wound care debated has progressed for sure, but there’s much more do to be done to make sure than wound care in Europe gets the attention it deserves. The EU’s on the right track, but…
Wound care
When most people think about chronic conditions, certain disease areas come to mind – diabetes, heart disease, obesity, asthma, allergies…the list goes on. However, it is unlikely that you think about chronic wounds as being part of that list. Why is that? Given that wounds impact 4 million Europeans per year (more than cancer and diabetes), it seems odd that so few people are aware of the impact on people, healthcare professionals and health budgets in Europe. For those who have heard about chronic wounds, it’s likely because a friend or relative has acquired a pressure ulcer in hospital, or had an infection after surgery, or maybe even faced foot amputation due to complications from diabetes. These wounds are often preventable with the right knowledge and treatment options available. A growing burden Yet, even though health systems are spending anywhere from 2 – 4% of healthcare expenditure on wounds, the burden of wounds continues to rise and will likely increase dramatically as the population ages and the incidence of diabetes grows. The average cost of a treating a wound is €6.000 – €10.000 per year and complications and readmission can significantly drive up costs (Gottrup et al. 2010). And on any given day in Europe, 27-50 % of acute hospital beds are likely to be occupied by patients with a wound (Posnett et al. 2009). So how can we reduce the burden of wounds on health systems? We can do it through smart investment in smart technologies. Because chronic wounds can cause multiple hospital readmissions and prevent individuals from working, EU Member States must begin to invest in solutions outside of acute settings that allow patients and healthcare professionals to prevent, treat and cure chronic wounds at home and in the community. Products and services such as Portable Negative Pressure...
Design meets medtech
The work we do at the Helen Hamlyn Centre for Design at the Royal College of Art in London focuses on developing projects with a strong emphasis on identifying and understanding everyday situations that people have difficulty with. Our approach is inclusive: we work with many ‘users’ of a product, service or system in order to develop design solutions for and with them. Ultimately what we aim for is to create something that will improve lives in a small or big way. Roughly a third of our work is dedicated to addressing current and future healthcare challenges by collaborating closely with patients, clinicians and industry. In this particular project, we partnered with ArjoHuntleigh (a company specialized in patient handling and care) and set out to look at the bedsore issue from a people centred design perspective, aiming to define a new approach to managing and preventing pressure ulcers outside of hospital care. Finding a solution to bedsores requires a deep understanding of the complexities of community healthcare delivery and a creative approach to problem solving, two areas where designers have a lot to offer. Putting bedsores under pressure Pressure ulcers, also known as bedsores, normally develop when an area of the body is under pressure for a relatively long time, and are usually an avoidable side-effect of poor patient care. While healthy people adjust their position when the body feels sore, patients in many cases are not capable to do so (they may not feel the pressure or won’t be able to shift position). About 1 in 5 patients in hospital are at risk of developing pressure ulcers, adding to 320,000 new wounds annually (Bennett, G., et. al, 2004. The cost of pressure ulcers in the UK. Age and Ageing, 33(3), p.230-235.). Outside hospitals however, the numbers are much harder...
Despite the overwhelming impact that wounds have on healthcare systems, many people are still unaware of the risks for developing wounds when entering a healthcare setting. In fact, 27-50 percent of acute hospital beds are likely to be occupied on any day by patients with a wound. Many of these patients will be at high risk of infection, which can result in extended hospital stays and for some, amputation. Yet, patients can be better protected against such risks by instituting evidenced based guidelines in healthcare settings that include multidisciplinary approaches to wound care treatment.