Detailed Comparison of Evidence-Based Wound Care Management Policies

This essay provides a comprehensive comparison of two wound care management policies: the "Wound Management Policy" by Rotherham Doncaster and South Humber NHS, and the "Wound: Wound assessment and Management" by South Eastern Sydney Local Health District. The analysis highlights similarities in wound assessment procedures but emphasizes the NHS policy's more rigorous approach, which includes detailed information on wound cleansing, antibiotic applications, colonization control, and patient education. The essay discusses the importance of holistic wound assessment, nutritional considerations, and the influence of factors like smoking and obesity on wound healing. It also explores the use of TIME assessment tools and various dressing techniques. The differences between the policies are attributed to factors such as funding, healthcare services and publication dates. The essay concludes that the NHS policy is more comprehensive and evidence-based, offering a more thorough approach to wound management.

Running head: EVIDENCE BASED NURSING RESEARCH
Wound Management
Name of the Student
Name of the University
Author Note

1EVIDENCE BASED NURSING RESEARCH
Introduction
The skin is the largest organ of the human body that makes up around 16% of the body
weight. It has several functions, related to immunity, regulation of temperature regulation,
production of vitamins and sensation. A disruption of the normal structure and function of the
skin results in wound formation (Dargaville et al. 2012). This essay will elaborate on two
different procedures or policies for wound care management. The first one is ‘Wound
Management Policy” by the Rotherham Doncaster and South Humber, NHS. The other policy
that will be discussed in the essay is the “Wound: Wound assessment and Management” by
South Eastern Sydney Local Health District. These policies and procedures refer to the
techniques that need to be followed for assessing and managing the incidence of several kinds of
wounds. Wound healing can be defined as a complex process that involves natural response for
restoration of injured tissues. It occurs due to interplay of interactions between a series of cellular
events, which reconstruct and restore the injured tissues of the skin. This paper will further
illustrate the similarities and differences between the abovementioned policies and will shed light
on the more rigorous policy, based on evidences.
Similarities and Differences between two policies
Wound care management encompasses a series of techniques and interventions that are
followed by healthcare professionals in order to prevent the wound from getting severe.
Therefore, a prior assessment of the wound that involves collection of patient information,
observing the wound, surveying the patient and identifying relevant data from the patient’s
medical history is essential (Pilen et al. 2012). Both the wound management policies, the NHS

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(2012) and the South Eastern Sydney Local Health District (SESLHD) (2015) provide adequate
information on wound assessment.
The methods associated with evaluation of the wounds and re-assessment are mentioned
in both the policies. Wound evaluation and re-assessment are imperative to its management as
they involve documentation of the wound, which in turn helps the nursing staff to review
previous wound status and the history of its management (Dreifke, Jayasuriya and Jayasuriya
2015). This directly influences improvement patterns and reduces chances of wound
deterioration. Although, SESLHD provides a concise explanation on the different methods that
need to be adopted for wound healing and also contains adequate information on the
pharmaceutical interventions, it does not contain any information on the use of antibiotics. On
the other hand, the NHS policy contains a detailed account of the topical and systemic anti-
microbial solutions and antibiotics that should be applied in case of acute or chronic infections
(Daeschlein 2013).
In addition, both the policies present information regarding the audit and documentation
of any wounds as a part of the assessment procedure. However, the information present in the
SESLHD policy is quite limited and only focuses on plan for wound assessment and
management (S0056 form number), CHIME wound care templates, transfer documentation and
discharge plans. On the other hand, the policy formulated by the NHS presents a plethora of
content on written document related to assessment screening. The policy also ensures showing
compliance to the audit requirements. The NHS illustrates the different techniques of wound
cleansing in order to cause minimal trauma or pain to the patient while removing gross
contamination. It suggests that wound cleansing should be properly followed for the removal of
excess exudates, remnants of old dressings, slough and necrotic tissue, promoting patient

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comfort, and facilitating correct wound bed assessment. However, the SESLHD only mentions
that intensive cleansing of the wound is necessary to prevent further infection. In addition, the
ways by which heavy colonization can interfere with the stages of wound healing are illustrated
in the NHS policy. It further explains about critical colonization, wound swabbing and exudate
control. However, the SESLHD fails to provide adequate data on this topic.
The NHS policy also proposes to provide education and expert professional advice on the
control and prevention of infection to patients, carers, multi-disciplinary groups, and other
healthcare professionals. It aims to educate on wound management, leg ulcer management and
prevention and management of pressure ulcer. It also provides education on the footwear that
need to be put on to prevent diabetic foot ulcers and formulates training programs that addresses
comprehensive dressing selection and wound management (Bakker and Schaper 2012). The
SESLHD policy also proposes providing timely and continuous education and training to the
nursing staff would work towards minimising complications, and makes it mandatory for all
clinical staff to attend the annual Wound Care Management programs. Therefore, it can be
deduced that both policies exert equal importance on the training and education of healthcare
staff. In addition, the NHS policy states that holistic wound assessment should be accurate,
precise and patient-centred. This will help in ensuring that the carers as well as the concerned
patients are well acquainted with the potential complications that can arise during wound
management. However, no information on holistic assessment or comprehensive treatment plan
that meets the needs of the client is present in the SESLHD policy.

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Evidence Based Discussion
Wound healing is an extremely complex procedure and requires a cascade of specific
biochemical and molecular events that help in promoting and enhancing the integrity of the
tissues. This cascade also helps in restoring tissue functions (Gantwerker and Hom 2012). While
comparing the aforementioned two polices regarding wound management programs, it was found
that the policy proposed by the NHS is more rigorous than the one proposed by the SESLHD.
This is due to the fact that the former policy contains exhaustive information on the different
procedures of wound management, education and training in the field, dressing, antibiotic
applications, colonization, wound cleansing and exudates control.
The NHS policy focused a great deal on the different aspects of wound assessment. It
states that it is essential to thoroughly assess all wound types prior to establishing the
management needs and selecting appropriate dressings for the wound. Further, it mentions that
holistic wound assessment should be able to detect presence of health complications, general
factors that can cause a delay in the healing process such as, dietary patterns, chronic infection,
diabetes and concomitant medications like steroids. It also takes into account the type, location
and dimensions of the wound. It focuses on considering the presence of foreign body in the
wound region and also emphasizes on the wound history. These factors can play a major role in
either accelerating or delaying the wound healing process. Evidences suggest that prior and
detailed information on patient history is imperative while designing any wound management
program as it helps the carers to determine any underlying factors that might contribute to risks
or adverse outcomes in the patient. Therefore, a detailed medical record of the concerned patient
is essential.

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Additionally, the NHS policy states that an adequate supply of macronutrients and
micronutrient is required to facilitate the wound healing process. The patient should also be
adequately hydrated. This is due to the fact that any kind of nutritional deficiency reduces the
tensile strength of the new tissues that are being generated and increase the risks of infection and
formation of fragile scar tissues (Chow and Barbul 2014). This interferes with the wound healing
process. An increase in nutritional requirements in a patient with wound further increases the
chances of malnutrition. The policy further states that the underlying circulation and blood
supply should be considered while designing debridement options (Kolluru, Bir and Kevil 2012).
The association between smoking and wound healing is also established by the policy. Smoking
acts as a major risk factor and results in several health complications, such as, vasoconstriction
and hypoxia, increased atherosclerosis, and reduced synthesis of collagen (Sørensen 2012).
Obesity also plays an important role in increasing the risk of infection and wound
dehiscence due reduction in wound perfusion (Pence and Woods 2014). The risks of infection
can get further enhanced with old age that results in weakening of inflammatory responses.
Psychosocial issues also contribute to wound healing process (Broadbent and Koschwanez
2012). Therefore, the policy by NHS not only emphasized on the well known physical factors, it
also elaborated on the different environmental and psychological factors, which play a role in
wound healing and patient recovery.
Furthermore, the policy focuses on the principles of TIME wound assessment tool for
selecting dressings. TIME assessment refers to Tissue, Inflammation or Infection, Moisture and
Edges. It helps in providing comfort to the patients (Leaper et al. 2012). This acronym was
developed by International Advisory board. However, no mention of this assessment tool is
found in the SESLHD policy. Moreover, the size, shape, colour, infection, exudates and pain of a

6EVIDENCE BASED NURSING RESEARCH
wound are essential to be determined for preparing an exhaustive care plan. This was followed
by the NHS policy.
Furthermore, evidences suggest that an effective wound care is often associated with
clean dressing techniques that are followed under aseptic conditions (Broussard and Powers
2013). The policy focuses on the use of anti-microbial solutions or dressings for heavy
colonization and also states that all dressings should be adequately designed in order to provide
an optimal environment for wound healing to the patients. It focuses on the use of hydrogels,
alginates, hydrocolloids, foams, Maggot Therapy, and Cadexamer iodine for different wound
types (Metcalf and Bowler 2013). Thus, this policy provides detailed and relevant information on
the wound dressing procedures.
In addition, it provides a clear concept on wound infection and colonization. There is a
need to closely monitor bacterial colonization at the site of wound infection owing to the fact that
colonization delays the wound healing process (Almeida et al. 2014). Therefore, the NHS policy
is more effective in providing an explanation on this matter compared to the SESLHD policy,
which makes no mention of effects of colonization. In addition, the wound infections can be
detected by the process of wound swabbing (Asada et al. 2012). This further helps in developing
various interventions. The NHS policy also contained detailed guidelines on wound swabbing
procedure.
It further recognized the importance of debridement for optimal healing rate.
Debridement is an essential part of wound management and is generally practiced by autolysis,
mechanical, biological, surgical and sharp debridement methods (Doerler et al. 2012). It
promotes wound healing and heals ulcers faster.

7EVIDENCE BASED NURSING RESEARCH
Possible reasons for differences
There are many underlying reasons that contribute to the differences between the two
aforementioned policies. The primary reason could be cultural and ethnic differences between
England and Australia. The NHS policy is from the UK, while, the NSW government has
proposed the SESLHD policy. There exists different healthcare funding in these two nations.
Furthermore, most of the healthcare services by the NHS are free of cost in England. Events that
involve emergency situations or accidents are sent for referrals (Mindell et al. 2012). However,
the entire cost of GP services is not funded in Australia. Moreover, the Australian Government
provides complete subsidy to only state funded hospitals (Lopes, Carter and Street 2015).
Therefore, it can be stated that the funding and healthcare services are better in when compared
to Australia. This might have contributed to the differences in the wound management policies.
Another probable reason of difference lies in the date of formulation. While the NHS policy was
issued on 17 August, 2012, the SESLHD was published in October 2015. The earlier publication
of the former policy provided better chances of improvement and revisions. This can attribute to
its rigorous nature. Thus, if the SESLHD policy gets adequate time, it might work towards
improving the areas that lack sufficient information.
Conclusion
To summarise, this assignment focused on two wound care management policies. One
policy was “Wound Management Policy” by the Rotherham Doncaster and South Humber, NHS
and the other was “Wound: Wound assessment and Management” by South Eastern Sydney
Local Health District. There are several similarities and differences in the information they
contain. The assignment elaborated on some of the easily observable similarities and differences.

8EVIDENCE BASED NURSING RESEARCH
On analyzing the differences, it was found that the policy propose by the NHS was more
rigorous than the other. Evidences from several researches were used to establish the information
presented in the policy.
A thorough evaluation and consideration of the collected evidences led to the conclusion
that the wound management policy by the NHS is of a higher quality as it contains exhaustive
information regarding assessment and management of wounds. To conclude, it can be stated that
differences in culture, ethnicity, and health funding systems might be the possible reasons for the
variations in the policies. Therefore, there is a need to adopt evidence based strategies in order to
manage wounds, which in turn will help in promoting the complex healing process.

9EVIDENCE BASED NURSING RESEARCH
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