Keeping up with the evidence in wound management

The Champions for Skin Integrity (CSI) program was originally developed in 2009, then tested, evaluated and adapted for aged care, primary health care, acute and transitional care settings in Australia.  The aim of the program is to facilitate evidence-based management and prevention of wounds. Evaluations from a number of projects from 2010–2019 have found significant increases in uptake of evidence-based care and significantly reduced prevalence and severity of wounds.1-3

One aspect of the program is the production of a range of resources giving easy access to the evidence, in forms to suit a variety of needs,  e.g. evidence summaries and flow charts on a range of wound topics for health professionals, brochures with information targeting self-management and prevention of various wound types for patients, carers and families. The third edition of these resources with updated evidence was completed at the end of 2019 and are now available freely online: https://research.qut.edu.au/ccm/csi-resources/

Topics covered include general skin care, skin tears, venous and arterial leg ulcers, diabetic foot ulcers, pressure injuries, wound assessment and management, surgical wounds and nutrition and wound care. All topics cover assessment, management and prevention of the wound type as appropriate. For example, one area included is venous leg ulcers – what does the evidence say on assessment of venous leg ulcers?

  • All individuals with a venous leg ulcer need comprehensive, ongoing assessment of history, their leg ulcer and the healing environment; undertaken by a health professional with training and expertise in leg ulcer management 4-6
  • Screen individuals with a leg ulcer for arterial disease, which may include history, clinical assessment, examining pedal pulses, and Ankle-Brachial Pressure Index (ABPI). Doppler ABPIs should be undertaken by health professionals with training and expertise in the area, and patients referred for specialist assessment if there is uncertainty or abnormal ABPI measures 4-7
  • Reassess ABPI regularly g., every 3–12 months, according to the individual’s condition 5,8
  • Measure and document ulcer area and characteristics regularly to monitor progress 4-6
  • Complex needs requiring specialist referral include uncertainty in diagnosis, ABPI <0.8 or >1.2, ulcers of multiple aetiology, signs of spreading infection, uncontrolled pain, deterioration or recurring ulcers, ulcer does not reduce in size by 20-30% within 4-6 weeks, or fails to improve within three months 4-7,9

Authors:   Kathleen Finlayson (RN, PhD), Christina Parker (RN, PhD), Helen Edwards (RN, PhD)
Contact for further information:   Kathleen Finlayson,  [email protected]

References

  1. Edwards, H., et al., Reduced prevalence and severity of wounds following implementation of the Champions for Skin Integrity model to facilitate uptake of evidence-based practice. Journal of Clinical Nursing, 2017. 26: p. 4276-4285.
  2. Parker, C., et al., Implementation of the Champions for Skin Integrity model to improve leg and foot ulcer care in the primary healthcare setting. Journal of Clinical Nursing, 2019. 28: p. 2517-2525.
  3. Edwards, H., et al., Improving wound management for residents in residential aged care facilities: National dissemination and implementation of the evidence based Champions for Skin Integrity program. 2015, Queensland University of Technology: Brisbane.
  4. Australian Wound Management Association, Australian and New Zealand Clinical Practice Guidelines for Prevention and Management of Venous Leg Ulcers. 2011, Cambridge Publishing: WA, Austra.
  5. Edwards, H. and K.P. Finlayson, C, Champions for Skin Integrity: CSI Guide and Resource Pack. 2019, Brisbane, Australia: Queensland University of Technology.
  6. Wounds Australia, Standards for Wound Prevention and Management. 3rd ed. 2016, Osborne Park, WA: Cambridge Media.
  7. Wounds UK, Best Practice Statement: Addressing complexities in the management of venous leg ulcers, in Wounds UK. 2019, Wounds UK: London, UK. p. 30.
  8. Wounds UK, Best Practice Statement: Ankle brachial pressure index (ABPI) in practice. 2019, Wounds UK: London, UK.
  9. Harding, K., et al., Simplifying venous leg ulcer management: Consensus recommendations. 2015, Wounds International: London, UK. p. 28.