What did we do?
We investigated the number of people with complex wounds being cared for by NHS community-based services in Greater Manchester, the types of wounds they had and the nature of and variations in their care.
Why was it important?
People with complex wounds are mainly cared for in the community by nurses and podiatrists. Complex wounds are very common but there was previously no robust data regarding the epidemiology, impact, management and cost of complex wounds from Greater Manchester in relation to:
The number of people with complex wounds being cared for by relevant NHS community services and;
The nature of the complex wounds and their care.
How did we do it?
We carried out a survey in collaboration with our participating community NHS provider organisations, using established methods. We collected information about patients with complex wounds who were receiving care from NHS community-based services over a two week period.
This large-scale survey covered eight community services of five NHS trusts delivered in seven clinical commissioning group areas across Greater Manchester. Within each NHS trust, a wide array of community services was involved in the collection of audit data from district nursing and tissue viability, through to children’s community nursing and intermediate care services.
Who did we work with?
What did we find out?
Overall we recorded information about 3,179 people with 5,632 complex wounds and we estimated the prevalence of community-based complex wounds to be 16.4 people per 10,000 people in the population (95% Confidence Interval 15.9 to 17.0). Venous leg ulcers were the most frequent type of complex wound (with a prevalence of 3.2 per 10,000 population), followed by diabetic foot ulcers (2.5 per 10,000), wounds due to trauma (2.2 per 10,000) and pressure ulcers (1.8 per 10,000).
There were significant variations in practice in many aspects of wound care including in the use of antimicrobial wound dressings, whether people with venous leg ulcers had received the recommended assessment of the circulation in their leg and whether they received the recommended compression therapy. Similarly the proportion of people at risk of pressure ulceration who were reported as receiving pressure relief also varied. Overall our conclusion was that there are unwarranted variations in practice including the under-use of evidence-based treatments such as compression for venous leg ulcers and over-use of costly interventions with a limited evidence-base such as antimicrobial dressings.
Christie J, Gray TA, Dumville JC, Cullum NA, 2018, Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care, PLoS One
Gray TA, Dumville JC, Christie J, Cullum NA, 2017, Rapid research and implementation priority setting for wound care uncertainties, PLoS One
Towards evidence-based wound management - Nicky Cullum