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Wound care conference: Tissue Viability Society

The Tissue Viability Society held its annual conference in April this year in Telford. The theme this year was “Collaboration, evidence and innovation for practice” and the programme sought to explore ways in which all aspects of tissue viability care could contribute to better clinical decision-making.

Professor Andrea Nelson from Leeds University opened the conference with a presentation that argued for the need to incorporate multiple and complementary sources of information into decision-making. She highlighted the need for research to inform good decision-making, but argued that no single type of study design is inherently better or worse than any other: the issue is around whether an appropriate design has been used to answer a particular question.

Dr Patricia Grocott, a nurse from King's College, London, presented a convincing argument for the need for innovation for difficult clinical situations. Her talk focused on the challenges of providing adequate wound care for patients with epidermolysis bullosa (an unusual condition where the skin blisters and wounds in response to touch) and fungating wounds. 

The standard dressing products available on prescription rarely meet the needs of such patients and new approaches are needed. Dr Grocott described collaborative work with which she is involved, bringing together the skills of patients, nurses, clinical academics, designers from the fashion industry and dressing manufacturers to explore new approaches to meeting the needs of these patients.  

Dr Zena Moore, a nurse who is currently employed as a lecturer at the Royal College of Surgeons in Ireland, discussed the role of repositioning in preventing pressure damage. She emphasised the uncertainty around the effectiveness of the routine use of risk assessment tools for assessing risk but emphasised that risk assessment is only of any benefit if it leads to appropriate action.

She noted that although age, nutritional status, incontinence and general health status are all recognised as risk factors for pressure damage, they are only really significant if these factors contribute towards immobility. Again, immobility is significant in that it leads to pressure when patients cannot relieve the pressure themselves. She, therefore, argued that unrelieved pressure is the risk factor that requires most emphasis when providing care.

Dr Anthony Omerod from the University of Aberdeen spoke about pyoderma gangrenosum, a relatively unusual skin condition that easy to miss and consequently mistreat. He outlined the scanty existing evidence to guide practice but drew attention to a new multi-site trial (the STOP GAP trial) which is seeking to discover more about treatment of this painful and disfiguring condition.  

On the subject of leg ulcers, a key issue for community nurses, Gill Sykes (a podiatrist from Calderdale and Hudderfield NHS Foundation Trust) and Alison Hopkins (a Tissue Viability Nurse from Tower Hamlets PCT) focused on the link between poor gait and venous disease. They argued convincingly that nurses need to pay more attention to how patients walk since the calf pump mechanism plays a key role in promoting venous return and thus promoting healing for patients with venous hypertension and venous disease. 

The essential role of the podiatrist was highlighted around addressing footwear issues to prevent pressure damage and to encourage good gait. Alison also argued that while compression remains a vital part of healing venous leg ulcer (and surgery and pharmaceuticals may have a role to play) insufficient attention has been paid to the musculoskeletal system in venous leg ulcer care. Focusing on physical exercise is likely to improve the pump mechanisms of the lower leg and promote healing.

The poster exhibition contained an interesting variety of initiatives. Several posters focused on collaborative work in the community between the NHS and the private sector. One poster described the implementation and monitoring of a wound management competency framework delivered by tissue viability nurses to nursing homes within their localities while another proposed that the NHS should support private nursing homes towards implementing a static led mattress, pressure relieving approach.

Another poster described their integrated complex wound care team which combined the skills of the tissue viability team, the podiatry wound care service and the lower limb service to provide a co-ordinated approach to managing complex wounds. Two posters considered the need for root cause analysis for investigating the incidence of pressure damage and explored ways in which this might be implemented.   

The conference was supported by a wide-ranging exhibition offering information about dressings, emollients, pressure relieving equipment, compression hosiery and bandaging, ongoing clinical trials and tissue viability organisations.

Tissue Viability Society