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Wound Management Policy

Policy Statement

This care service considers that every person who uses services should be given the highest possible quality of care in the management and dressing of wounds. This policy thus sets out this care service’s approach to wound care management in line with the current best practice guidance. {{org_field_name}} ensures that wounds affecting people who use its services are managed and dressed appropriately to minimise the distress that they cause and maximise healing. The policy should be read and used in relation to other policies and procedures on:

• Leg Ulcer Care and Prevention (England and Wales)
• Management and Prevention of Pressure Sores
• First Aid
• Cleanliness and Infection Control.

Wound Care Management

This care service considers that accurate assessment and diagnosis is the key to the successful treatment of wounds. This is especially the case in the management of some ulcers where compression bandaging can be used to improve blood circulation, but is contra-indicated or dangerous in other types of wounds (see policy on Leg Ulcer Care and Prevention (England and Wales)).

People with chronic wounds should therefore have a fully documented assessment of their wound carried out by an appropriately qualified healthcare professional. When making an assessment, the following factors should be considered: the person’s medical history; treatments currently being undertaken; and the local wound environment.

In this care service, the following guidelines for wound management will be followed.

• Wounds, other than very minor ones, should only be assessed, treated and dressed by suitably qualified healthcare staff.
• Accurate wound measurement or mapping should be used to fully document the wound and evaluate treatment. Irrespective of the shape of the wound objective non-contact measurement should be performed. Wound measurement or mapping should be repeated at least every four weeks, or more often if necessary. Wound mapping in that it involves careful observation to identify signs of change or infection can be carried out by all suitable trained care staff.
• Modern evidence-based wound care management (see National Institute for Health and Care Excellence (NICE) ESMPB2: Chronic Wounds: Advanced Wound Dressings and Antimicrobial Dressings (2016)) will be studied and employed. The guidance states that it is not necessary or cost-effective to cleanse wounds at every dressing change. If the wound is clean and has minimal potentially infectious discharge, little benefit is derived from routine cleansing, which can damage delicate new tissue. However, the rationale for any procedure adopted should be recorded in the person’s notes.
• If cleansing is indicated, healing and reduction from discomfort can be achieved by using non-toxic (eg salt based) solutions and warm sterilised water.
• Decisions to use a specific procedure, eg to drain a chronic wound or to dress a sutured wound (with stitches), will always be made by appropriately qualified healthcare staff, who will normally be responsible for the wound care (eg registered nurse/community nurse).
• The choice of wound care product should be appropriate to the wound, and the most appropriate to promote healing for each individual/wound type (NICE does not recommend any specific product and suggests the evidence for the effectiveness of most products is not clear cut). The service will always seek medical advice and guidance on the choice of dressing for other than minor cuts and non-problematic wounds that do not present any risk of infection or deterioration provided that the appropriate care is given.

Taking Swabs

All wounds are likely to contain bacteria which do not necessarily delay or affect healing, however wounds are always at risk of infections developing and, on medical advice/nursing guidance, appropriately trained care staff might need to take swabs to send off for pathology inspection. Before taking a swab, and to ensure that they are taken correctly in the right circumstances, staff should observe the following.

• Swabs should only be taken if clinical signs of infection are present, and on medical advice.
• Swabs might be taken if there is any discharge or pus.
• Staff must document the reason for taking a wound swab in the appropriate person’s notes.
• Only appropriately trained staff should carry out these procedures.

Training

Non-nursing trained care staff will receive relevant training in their roles to contribute to a person’s wound management in line with the service’s policies and procedures. They should only undertake procedures they feel confident and competent to do.

Nurse trained staff are expected to keep up to date with current clinical guidance from NICE and other professional sources. They will be offered appropriate skills training or refresher courses in modern (NICE) evidence-based practice as identified in appraisal or learning plans and as dictated by their need for continuous professional development.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

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