A sharp debridement procedure devised by specialist nurses

Developing a grapefruit model for assessment and training of diabetic foot ulcer debridement

INTRODUCTION

Sharp debridement is the criterion standard treatment for diabetic foot ulcers (DFUs) and is performed by podiatrists in the United Kingdom. This study aimed to create a DFU model that could be used as a learning tool for trainees.

METHODS

In a pilot study, a penny-sized circle was drawn onto an orange to simulate a DFU. This was then critiqued by podiatrists, and the feedback received was used to create a grapefruit model with irregular shape. All podiatrists supported the switch to a grapefruit model due to improved contrast between skin and fruit. This grapefruit model was then reassessed by 50 podiatrists from the North West of England. Two freely available computer programs were assessed to measure the area debrided, and a depth scale was used to determine the depth debrided. A questionnaire was completed by the podiatrists as to the utility of the model.

RESULTS

A DFU was successfully simulated using a grapefruit and plastic template. After debridement, debrided area and depth were calculated using Image J and a depth score. Podiatrists rated this model for its utility as a training tool on a continuous rating scale with an average score of 61.9%.

CONCLUSIONS

This model has potential for development as it is inexpensive and easily accessible. This model's fidelity could be bolstered by using more accurate techniques for area and depth measurement. More research is needed to determine the superiority or inferiority of this model to previous simulated DFU models.

Conservative sharp wound debridement: an overview of Canadian education, practice, risk, and policy

PURPOSE

The purpose of this study was to describe the education, policy, practice, and risk management strategies of nurses performing conservative sharp wound debridement (CSWD) in Canada, prior to the release of the Canadian Association for Enterostomal Therapy Evidence-Based Recommendations for Conservative Sharp Wound Debridement.

DESIGN

Data collection was based on a nonrandomized, nonexperimental study design and reported using descriptive statistics.

METHODS

Invitations for health care professionals to participate in a CSWD scan were sent to 4315 people via e-mail through the membership lists of 2 Canadian voluntary professional wound care associations. Skip logic screened out respondents who had no experience in CSWD (n = 57). The total number of professionals who participated was 487. A 26-question electronic scan addressed demographics, education, policy, practice, and risk/quality issues related to CSWD. A comment section was included for some questions.

SUBJECTS AND SETTING

A selected subsample of 397 nurses was chosen from the original total of 487 respondents. Nonnurse respondents were excluded due to the low total number of participants in each of these other professional categories.

RESULTS

Nurses perform CSWD in all types of care settings in Canada from outpost nursing stations to hospital wards, homes, and long-term care facilities. The wound education preparation reported varied. The most frequently reported formal wound care education was a 2-day course (59%; n = 220), followed by an enterostomal therapy course (42%; n = 155) and the International Interdisciplinary Wound Care Course (26%; n = 98), with overlapping preparation evident. Eleven percent of respondents (n = 47) reported having taken no formal wound course, and 7% (n = 27) taught themselves to perform CSWD. Twenty-eight percent of nurses (n = 112) were unclear about whether CSWD was within their scope of practice or replied that it was not, and 69% (n = 273) did not know if there was provincial legislation that restricted their practice of CSWD. Forty-eight percent of nurses (n = 181) reported that their institutions do not have policies on CSWD, and 9% (n = 35) did not know. Adverse events associated with CSWD were reported by 196 respondents, with minor bleeding reported most frequently (98% n = 192) by those who answered the question.

CONCLUSIONS

The education, policy, practice, and risk management of nurses practicing CSWD could benefit from development and dissemination of a set of National Standards and Competencies for this high-risk wound intervention.

Canadian Association for Enterostomal Therapy evidence-based recommendations for conservative sharp wound debridement: an executive summary

The Canadian Association for Enterostomal Therapy Conservative sharp wound debridement evidence-based recommendations are a result of the decision and commitment to advance clinical nursing practice to improve the provision of care to patients via development of an open source guide. The recommendations were developed by a volunteer group of ET nurses who work in clinical practice, policy development, consultation, and education in wound care. The document was developed over the course of 2 years (2009-2011); it is a distillation of existing literature, guidelines, and expert opinion. The development and dissemination of the recommendations were sponsored by the Canadian Association for Enterostomal Therapy. These recommendations should be considered in the context of the organization or care setting as well as available resources and supports. Resources and supports take the form of access to emergency care, physicians and allied health care professionals, education, administrative support, funding, supplies, equipment, and policy. The recommendations should also be applied with consideration of the evolving evidence that will further define practices in Conservative Sharp Wound Debridement. Refer to the supplemental digital content associated with this article at (supplemental digital content 1, http://links.lww.com/JWOCN/A16) for the complete document.

The necessity of wound debridement

Wound debridement has evolved over the centuries and is now recognized as a major component of wound bed preparation. Debridement involves the removal of nonviable tissue and is essential to promote healing and reduce the risk of local infection (Fairbairn, Grier, Hunter, & Preece, 2002). In addition, maintenance debridement of the obvious necrotic tissue and excessive bioburden is essential before a wound can proceed to healing.

Clinical competence in sharp debridement: an innovative course

A quick and effective way of promoting wound healing is to carry out sharp debridement where indicated, but this procedure carries a high level of clinical risk. Minimizing risk is an essential feature of clinical governance. A new course in wound debridement was developed at King's College, London in response to local NHS trust demand which required assessment of competence for this high-risk procedure. This innovative development crossed traditional boundaries, and required high collaboration between education and practice.

TIME principles of chronic wound bed preparation and treatment

Managing chronic wounds has progressed from merely assessing the wound to understanding the underlying cellular abnormalities and associated clinical problems. The concept of wound bed preparation offers a systematic approach to removing barriers to healing such as tissue (non-viable), infection/inflammation, moisture (imbalance) and edge (non-advancing or undermining). The principles of wound bed preparation as outlined in the tissue, infection, moisture, edge (TIME) table are explained in this article, with examples and recommended treatment interventions. The TIME table is recommended for use at the bedside when assessing patients with wounds.

Debridement: ethical, legal and practical considerations

Deciding which product or technique to use in order to effect debridement involves more than a simple dressing choice. Patient preference, degree of risk, environmental factors, resources and possible contra indications/cautions must be taken into account before proceeding. The option of conservative sharp debridement is a valuable tool and is potentially of great benefit to many patients. Despite this it may be underused in primary care due to the perception that it is a high risk procedure.