Managing wound at home

1. WOUND
& DOMICILIARY CARE :
AN INTEGRATED SERVICE
Dr Wan Zuraini Bt Mahrawi, MD, GCFM
MSc in Wound Healing & Tissue Repair (Cardiff, UK)

2. I N F O G R A P H I C
YOU COULD ALSO PRE-ACCESS THIS PRESENTATION ON
SLIDESHARE.NET
KEYWORDS: Wan Zuraini, Domi wound care, home wound
care

3. OUTLINE – DOMICILIARY CARE SERVICE
Intro DCS
The Team
What We Do?
Wound Care within DCS

4. CONCLUSION
Documentation
LimitationBest Practice
OUTLINE – DOMICILIARY CARE SERVICE

5. INTRODUCTION OF DCS
DOMICILIARY CARE SERVICE
Perkhidmatan Perawatan Domisiliari (PPD)
adalah satu perkhidmatan perawatan holistik
yang diberikan kepada kes stabil yang
terlantar dan memerlukan kesinambungan
penjagaan serta perawatan selepas discaj dari
hospital atau rujukan dari klinik kesihatan.
Melibatkan penjaga & pesakit terlantar

6. DCS
OBJECTIVES
Guidance Continuation
of treatment
Improving QOL Carer involvement

7. D O M I T E A M

8. Family Medicine Specialist
/ Medical Officer (Leader)
Responsible to guide and decide any medical issues
related to the patient and the carer. As manager to
reject and accept cases based on given criteria
DOMICILIARY TEAM
Compulsory at each visit
Compulsory at each visit
As pro re nata – pharmacist,
OT, PT, Social officer,
dietician
Medical Assistant
Staff Nurse
Allied Health
DOMICILIARY CARE SERVICE – THE TEAM

9. DOMICILIARY CARE SERVICE
WHAT WE DO? Focusing on these three aspects of clinical and administrative
management of:
Catheter change, bedside test,
emotional support, prevention
care bundle
Nursing Care
Short term & long term
management imposing medical,
physical & psychosocial part
Community based rehab
Family and patient support for
end of life care
Palliative

10. WOUND & DCS : AN INTEGRATED SERVICE
HOME CARE
WOUND CARE

11. WOUND & DCS : AN INTEGRATED SERVICE
HOME CARE
WOUND CARE
Def: the care that is provided by health care professionals
and families to patients with wounds living at home
Best practice
Recommended device, product, materials
Wound Documentation
Limitation

12. Best Practice of HCWC
Minimum
recommendations
for Health Care
Professionals’
knowledge and skill
01
Recommendations
for products,
devices and
materials for wound
prevention and
wound management
02
EWMA Document HCWC 2014

13. 1. Minimum recommendations for
Health Care Professionals’ knowledge
and skill
A. Level of knowledge
 Assess complex wounds and wound healing
 Implement wound management based on best
practice and evidence
 Select best available wound care products in the
context of holistic care
 Support patient’s independence and participation in
decision making
 Educate patient and informal carers in self-care and
wound prevention
 Document wound healing, symptoms and treatment
of wounds as well as patients’ and informal carers’
concordance with care
 Ensure the continuity of care in all
circumstances/conditions
 Integrate multi-professional knowledge for the patient
care by using consultation and ehealth
Minimum recommendations for
Health Care Professionals’ knowledge
and skill

14. 1. Minimum recommendations for
Health Care Professionals’ knowledge
and skill
B. Competencies
 Be able to attend the patient and/or the environment
of the patient during the different phases of their
illness
 Provide education for patients and their informal
carers within their social environment
 Coordinate the management of the wounds regarding
the prophylactic and therapeutic principles
 Engage in continuous professional development to
maintain knowledge and skills
Minimum recommendations for
Health Care Professionals’ knowledge
and skill

15. Key features for
selection of
products, devices
and materials for
wound prevention
and wound
management
 Use safe products (with
minimal collateral effects)
 Use simple to use
products (to reduce risk
and anxiety from the
informal career or the
patient)
 Use disposable products
when possible (to reduce
risk of transmission of
infections from home to
Home)
 Use products that reduce
pain (to reduce risk and
anxiety from the patient
and the informal career)
 Use products that have a
wide range of application
Recommendations for products, devices and
materials for wound prevention and wound
management

16. Cont’ - Key features for products, devices and
materials for wound prevention and wound
management
Wound
dressings can
be
effectively
used through
extended
parts of the
healing
continuum
Wound
dressings
should not
stick to the
wound bed,
and should
eliminate or
minimize
need for
wound bed
cleaning
Wound
products are
easy to use
and access,
especially if
patient or
informal
carer takes
part in
wound
management
Wound
products
enable the
lowest
overall cost,
including the
cost of home
care services
and patient
costs
Wound
product are
eco-friendly

17. What should be in your bags?
1. Recommended products for HCWC
PRODUCTCATEGORIES
1. Wound prevention – lotions for
thin and flat epidermis, loss of skin
elasticity
Lotion for thin and flat epidermis,
loos of ski elasticity
2. Wound bed preparation
Antimicrobial strategy
1. Cleansing agent
Moisture control
Debridement
3. Dressings
Absorbent dressings, antimicrobial
dressings, foams, gels,
hydrocolloids, polymeric membrane
dressing, periwound management
4. Fixation Bandages and tapes

18. 2.Recommended devices for HCWC
For wound prevention
• Pressure redistribution mattresses
• Cushions
• Total offload device
• Garments
• Therapy shoes

19. Pressure ulcer risk assessment scale
(PURAS)
NORTON SCALE (England
1962, 5 parameters) –
physical condition,
mental state, activity,
mobility, incontinence
WATERLOW SCALE
(England 1984, 8
parameters) – BMI, skin
visual, sex, age,
continence, mobility,
appetite, medication
BRADEN SCALE (USA
1987, 6 subscales) –
sensory, perception,
mobility, activity,
nutrition, friction &
shear
GOSNELL SCALE (USA
1973, 5 parameters) –
mental status,
continence, mobility,
activity, nutrition
RAMSTADIUS TOOL
(AUSTRALIA 2000, 2
questions) – skin
integrity, mobility

21. 3.Recommended materials for HCWC
Patient education
materials – leaflets
information on
nutrition, wound
care at home
1
Best practice
evidence – National
and international
guideline
2

22. Wound Documentation
PURAS
Wound
Assessment
Tools

23. Wound Assessment Tools
1. Pressure ulcer Scale for Healing (PUSH)
2. Pressure Sore Status Tools (PSST)
3. Bates-Jensen Wound Assessment Tool (BWAT)
4. Sessing Scale (SS)
5. Sussman Wound Healing Tool (SWHT)
6. Wound Healing Scale (WHS)
7. DESIGN
8. Leg Ulcer Management Tool (LUMT)
9. ASEPSIS
10. Barber Measuring Tool (BMT)
11. Photographic Wound Assessment Tool (PWAT)
12. Triangle of Wound Assessment (TOWA)
13. Wound Chart (Manual Wound Care Malaysia 1st Edition 2014)
Assessment of wound healing: validity, reliability and sensitivity of available instruments, Pillen & Miller
2009

24. Limitation
1. Lack of adherence to clinical guidelines
2. Lack of wound care expertise demand below competencies
3. Finance resources for dressing materials, devices and education
training

25. CONCLUSION
With adequate knowledge and resources, it is mandatory
to perform a synergistic comprehensive wound
assessment and management within Domiciliary Care
Service to ensure holistic care are properly delivered.

26. THANK YOU