Acute surgical wound care. 4: The importance of documentation

Problems identified in gaining non-expert consensus for a hypothetical Wound Assessment Form

A post-hoc analysis was carried out of a session on a wound management diploma level module that was intended to promote understanding of the complexity of wound assessment. Postregistration student nurses (n = 16) from both hospital and community settings participated in brainstorming of categories (i.e. verbatim expression) they thought should be included in a hypothetical Wound Assessment Form (WAF). Ranking of suggested categories indicated in terms of 'votes' that the most important was 'date', and the least was 'factors affecting healing'. Some categories were rejected (e.g. exudate). Category definitions and rationale were checked after 3 weeks, and compared with those of lecturers in adult nursing (n = 16) to test whether similar themes emerged amongst other non-experts. Postregistration nurses and lecturers gave similar definitions and rationale for categories. A limitation of the study was that it was opportunistic and methodology for researching consensus issues had not been investigated. Views represent nurses in a wide spread of disciplines and have to date only been compared with expert consensus derived from published literature. Themes to emerge were: the importance of WAFs to record-keeping, different understanding of terminology and the monitoring of progress and use of intuition. It was concluded that the purpose of WAFs needs clarification and research should investigate how change in wounds could take account of differences of personal perception. A new method of charting progress or deterioration is being developed.

Surgical wound benchmark tool and best practice guidelines

Surgical wounds that heal by primary intention are expected to heal without complication (Watret and White, 2001). Patients are frequently subjected to a variety of treatment regimens, often based on individual practitioners' preferences. This article discusses how one acute hospital trust developed a multidisciplinary approach to devise best practice guidelines. This was achieved through consensus and expertise of a working party, and a clinical practice benchmark tool for patients with surgical wounds to standardize and ensure the implementation of evidence-based practice. Clinical practice benchmarking is "a process through which best practice is identified and continuous improvement pursued though comparison and sharing" (Department of Health (DoH), 1999). The work has led to the development of a standardized assessment and documentation tool, which the working party hopes will be used trust-wide. In addition, ward staff are encouraged to undertake the benchmark process as a method of identifying areas where the use of this tool would ensure that standards of care could be improved.