clinical focus
Dressing down
The basics of wound
management in aged
care are being neglected,
and it’s become a sore
point for one expert.
Jan Rice interviewed by Dallas Bastian
W
ound prevention for at-risk residents should be front
of mind for aged care professionals. But if a resident
does develop a wound, knowing the basics, including
how to correctly use dressings, is crucial.
Jan Rice, a wound management clinician, shared this advice
in an interview with Aged Care Insite. Rice said many wounds
become chronic because they haven’t been managed well in the
beginning, and as knowledge is not always as strong as it could
be, it’s important to focus on prevention.
She said this requires good assessment of residents and follow
through, and put forward two prevention strategies.
“We need to ensure that the limbs are padded on those
vulnerable people who are taking aspirin and anticoagulants. They
bruise easily, and the bruise then will predispose them to a skin
tear. So padding limbs is a good prevention strategy.
“The second thing is ensuring that there’s minimal lower leg
oedema. Many residents shouldn’t sit all day with their legs down.
They should elevate their legs for a period during the day.”
Rice said aged care professionals do an outstanding job in
difficult times.
“Their resources are being cut fairly heavily and we may see
this continue, and many are working very hard in quite difficult
circumstances. So I think they do a great job overall, but we can all
learn further.”
Rice spoke with Aged care Insite about some of the basics of
wound management that are missed and talked about recent
developments in the field.
ACI: So what are some of the newer wound care technologies
and materials available in the aged care space?
JR: Well, they’re still at dressings that contain something that would
modulate the inflammation, so settle down the inflammation in
a wound and modulate the proteases, so they’re called protease-
modulating dressings. So those are some of the newer technology,
or where they’re heading, because inflammation is believed to
be one of the key components to why a wound may turn into a
chronic wound and not follow a normal healing trajectory.
There are other technologies looking at skin substitutes which
have been around for some time, but they’re obviously advancing
some of those. And then there are dressings that would change
colour to let someone know the dressing needs changing. That’s
another component to save time so that nurses wouldn’t have to
go to patients’ homes every day and check. If the patient can say
it’s changed colour, the nurse can then plan an appointment.
Other ideas include looking at things from the ocean.
Researchers are constantly studying sea snails and things like that
which have specific enzymes in their saliva or excretions that are
able to help in pain management, so having dressings that are able
to modify the pain is also something we’re very interested in.
You r ecently presented on this topic to aged care professionals
at the OfficeMax Wound Care & Funding in Aged Care online
seminar. What are some of the wound care practices you
homed in on there?
I mentioned some of the modern, newer technologies, but said
that we’re not really, in many cases, ready to adopt some of these
newer technologies because we’re still getting the basics wrong.
And if we concentrated more on the basics, we probably wouldn’t
need to go down the path of expensive newer technologies for
some of our wounds. I mean, clearly, in a life-saving situation, you
want everything that’s the biggest and the best to save a life, but
many of the wounds we see turn into chronic wounds because
we haven’t managed them well at the very beginning.
So, managing the exudate, good dressings that soak up fluid,
managing the bacteria – there are many choices of antimicrobials
– and understanding those dressings. Even this morning I saw a
dressing on upside down.
Nurses need to concentrate on the basics, which are feed and
hydrate your residents or patients; ensure you have best practice
skin management – we know elderly people need moisturiser
applied twice a day; ensure you check who’s at risk of a pressure
injury and then relieve that pressure, and constantly check that
pressure is being relieved. These are some of the basics that are
still not being done well.
What are some of the other missteps in wound care that you
would like to see stamped out?
We did go through a phase where, when we saw black tissue,
everybody immediately reached for a hydrogel. We’re trying to
educate that this not always the case, specifically when the wound
is related to ischaemia of some sort, and that’s easy to work out
when you are looking at a black toe. You’re pretty sure that the
blood flow is not getting down there, and that’s why it’s changing
to dry gangrene. We have learned over the years that it’s better to
leave that dry cap there, and in fact keep the dry cap as a dressing.
If the body wants to get rid of it, it will separate it in time, and then
we’ll take action. But unless you have blood supply to an area,
you’re not going to heal it, so it’s better to keep that wound dry
while you see if there are other interventions that can be followed
through to ensure better blood flow to the area.
So, where is wound care heading? What do you think we might
see in the next five years?
I think because of the ageing population, and we know that wounds
and ageing are linked, we’re going to see a lot more wounds. We
need to learn the basics and learn how to use the products that we
currently have. We will not be able to afford the fancier products, so
it will drive us all to learn how to use what we have more efficiently
and, in fact, to be more proactive in preventing some of these
wounds. Preventing folds, skin tears and pressure injuries are all
things that would be considered basic, general care for the elderly. ■
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