Somebody asked me recently how I decide what to write about in the Editorial for BJN's Tissue Viability Supplement. I took a moment to think and gave the briefest of answers. When I reflected on it and really took the time, challenging myself, I concluded that it was a cumulative process of my experience of the past, the present and the future.
Concerning the past, I do think it is important to remember how far we have come. I have been a nurse for 43 years and I have certainly seen momentous change, much of it for the better. The delivery of evidence-based care and the access to such has profoundly changed in the past 4 decades.
I remember using egg white and oxygen on pressure ulcers and ordering the first waterbed. When Judy Waterlow launched her risk assessment tool, I invited her to come to my ward. Well, she came and wow, what a difference she made to us all! Her visit and the use of her scoring system led to real understanding, commitment and engagement by everyone on the ward. The whole ward learning together and being ready to embrace change really did improve our care and our data at the time could prove it.
Despite my small-scale achievements, it is well known that we still face challenges within pressure ulcer prevention, both nationally and internationally. One of my favourite Florence Nightingaleattributed quotes is that ‘the journey of learning never ends’. Thus, I challenge myself to focus on the latest evidence on pressure ulcer risk assessment.
Purpose-T is now the advocated evidence-based risk assessment tool by the National Wound Care Strategy Programme (NWCSP, 2024a).
Thinking of the present and when changes are proposed to current practices, it is important that they are evidence based. The proposed changes to pressure ulcer categorisation led to a number of Wound Care Alliance UK (WCAUK) members expressing concern. The WCAUK trustees made the decision to develop a questionnaire and to gather the views of the wider membership, which are shared in this journal.
Crucial though risk assessment tools are, what is important is how care delivery is based on that assessment and although there have been huge strides in care planning, there is no doubt that sustained improvements are required.
Positive outcomes are reported by the NWCSP in the evaluation report relating to implementing the lower limb recommendations (2024b):
- Healing rates: 52% of leg ulcers healed within 0–12 weeks, with an overall healing rate of 84% at 52 weeks for all lower limb wounds
- Recurrence rates: the recurrence rate for leg ulceration was 14%, significantly lower than the implementation case assumption
- Cost-effectiveness: a 27.6 benefit-cost ratio based on outcomes achieved, indicating strong value for money
- Environmental impact: an estimated net zero impact from patients receiving optimal care with 473305 kg of CO2 emissions saved, equivalent to 277 cars driven in a year.
These are interesting results, and I encourage you to read the report carefully and consider lower limb care delivery in your own workplace.
When I think of the future I am always looking at current research. The internet is of course a wonderful place but so are the journals and my daily Times newspaper. Attending conferences, webinars and scientific discussions is also essential. Yet the challenge remains that while evidence clearly exists, much of tissue viability care delivery is variable. The past and the present do influence the future and as I look to the future, I know there are challenges. The call to improved productivity is ever present. In tissue viability we have the evidence, now we must ensure we deliver the care.
This is my final Editorial of 2024, thank you for your feedback and seasons greetings to you all.