HSE National Wound Guidelines 2018
The purpose of the HSE National Wound Guidelines 2018 is to provide a standardised consistent approach for wound care in Ireland. The guideline will support safe, quality care for patients, who access healthcare across the HSE and HSE funded agencies. This revised publication is informed by international guidelines and aims to support pathways of care for patients with a wound. It is expected that it will be accessible to all clinicians in wound care practice and offer recommendations for best practice.
The recommendations the National Wound Management Guideline 2018 are divided into specific sections to enable the clinicians to directly seek the advice relating to a particular clinical practice situation which they need to address. The needs of special populations with wounds are addressed in the relevant sections:
- General Wound Care
- Diabetic Foot Ulcers
- Pressure Ulcers
- Leg Ulcers
- Palliative Wound Care
Whilst no single healthcare discipline can completely meet the complex needs of those presenting with challenging wounds, it is essential that healthcare professionals from all disciplines are aware of the standards and prevention strategies, knowing when and how to refer the patient with a challenging wound (O’Neill, 2006).
The quality agenda requires us to consider the principles of patient safety, clinical effectiveness and patient satisfaction (Ousey, 2010; Flynn, 2016).The application of these principles in the context of wound care challenges the clinician on occasions where wound healing is not always achievable and where patient satisfaction and quality of life are paramount.
One of the objectives of the HSE Corporate Plan (2008-2011) was to ensure that sufficient healthcare professionals have the appropriate competencies to deliver its objectives in maximising the level and quality of service delivery at an affordable cost. A key focus of The Patient Charter, You and your health service (2014) is committed to ‘supporting quality improvement throughout the health system to improve outcomes and reduce patient harm’. The complexity of wounds requires practitioners who are skilled in wound assessment, diagnosis, treatment and evaluation of outcomes (Harding et al., 2013). Continuing Professional Development (CPD) is essential to ensure optimal delivery of patient care (An Bord Altranais, 2000).
Ireland in the past decade has experienced an unprecedented rise in population growth. The number of people over 65 years of age is expected to triple in the next 30 years (DoHC, 2010b). Consequently, the prevalence and incidence of wounds is likely to continue to increase due to the ageing population and the on-going increase in prevalence of obesity, diabetes and lower extremity arterial disease (Chandan et al., 2009; HSE, 2009). The costs associated with wound care are substantial; four per cent of the United Kingdom’s (UK) health care budget is spent on wound care (Posnett and Franks, 2007). Chronic wounds of all aetiologies cost the Irish Health Service Executive an estimated at €285.5 million per annum (Mc Dermott-Scales et al., 2009).
The growing prevalence and incidence of non-healing wounds (acute and chronic) are a major source of morbidity to patients and a major cost to hospital and community healthcare providers globally (Posnett et al., 2009). Changing population demographics, increased prevalence and incidence of multiple comorbidities are challenging health care providers to provide ever more complex interventions with fewer resources (Moore etal., 2014). Additionally, it is estimated that more than 23% of all hospital in-patients have a pressure ulcer, many of which are acquired during hospitalisation for an acute episode of illness or injury and therefore are avoidable (EPUAP, 2002).
Wound therapeutics are continuously evolving requiring the clinician to keep abreast of the research evidence that will inform and underpin their practice to ensure that patients receive the evidence-based assessment and treatment options at the appropriate time. Wound healing is a dynamic process and normal wound healing occurs in a precise and timely manner. Wound management is also dynamic and is dependent on the clinician’s ability and skill in assessing, planning care and evaluating outcomes.
Based on the recommendations of the Wound Management Guideline a dietary advice leaflet called “How to Eat Well for Wound Healing: A Guide for Patients, their Families and Carers” has been developed by HSE dietitians and can be accessed using the following link:
The advice in this leaflet should be followed on the recommendation of a healthcare professional. The advice is for adults who have a normal body weight or who are overweight and is not suitable for those who are malnourished or who have had unintentional weight loss. Further information on nutritional screening and dietary advice for those at risk of malnutrition is available from www.hse.ie/nutritionsupports This leaflet is a support tool does not replace a full nutritional assessment and individualised dietary advice from a registered dietitian.
Director of Nursing
Project Lead: HSE National Wound Guidelines 2018
Office of the Nursing and Midwifery Services
Mobile: 086 6012195