We have touched on Wound Aetiology previously, however in this episode we dive deeper into how wound types interface with mechanism of injury and dilemas faced when there are multiple causes - what actually is a mixed wound?. We canvass all the major hard to heal wound types including incontinence associated dermatitis, pressure injury, skin tears, moisture lesions, chronic oedema, venous, arterial and more. How does this all relate to management of these wounds? We're sure our discussions in this episode will raise a few clinical conundrums and questions for you. Indeed, you may start to see more of these in your own practice and become more aware of these prickly challenges. The simple isn't always so simple.

Timestamps:

00:00 Introduction

01:12 Mechanism of injury versus aetiology

02:30 The value of clinical audit and quality indicators

03:20 Misdiagnosis of Incontinence-Associated Dermatitis (IAD)

03:56 Intertriginous dermatitis misdiagnosed as IAD

05:29 The challenges of addressing gaps in clinical guidelines

06:03 Be confident to be unconfident

06:20 What is the mechanism of injury for skin loss in IAD?

07:21 When experts conclude that the simple ain’t that simple

08:45 When clinicians are approached by academics to fit a square peg into a round hole

10:36 Tips for researchers undertaking research in venous leg ulcers

11:52 When wound education is siloed and does not replicate clinical reality

13:35 Making clinical hunches and not always on the first visit/assessment and that’s OK

13:50 Current wound documentation does not support multiple aetiologies and impediments to healing

14:00 Challenge of teaching clinical realities to students when they are taught in siloes

14:33 Figuring out what is the predominant aetiology

14:50 How do we define and teach simple versus complex wound

15:13 Mixed aetiologies presenting above and below the groin

15:56 Prioritising which aetiology to treat / manage

16:57 Post operative wound dehiscence and lymphoedema

17:48 Capacity building in lymphoedema

19:27 The need for clinicians working in Hospital in the Home to understand lymphoedema

19:43 The challenge of diagnosing inflammatory conditions such as IAD and intertriginous dermatitis of the pelvic girdle

20:30 Influence of climate on dressing performance and skin injuries

21:00 Mixed aetiologies of the pelvic girdle

22:20 Is IAD avoidable and how easy is it to categorise, manage and report

24:00 Continue reevaluating aetiology

24:12 It is OK change or add to aetiology if clinical rationale can be provided

24:57 Call it what it is. A vascular assessment includes arteries, veins and lymphatics, not just the arteries

25:21 Venous disease plus a wound on the same leg does not necessarily mean the wound is of venous aetiology

26:57 Mechanism of injury v aetiology v impediments to healing. Simple v complex

28:40 Opportunities to improve accuracy of wound data reporting and quality improvement

30:27 When is a stage 1 Pressure Injury of the foot, a “Diabetic Foot Ulcer”

Resources mentioned:

• GlobIAD Incontinence Associated Dermatitis - Tools https://www.skintghent.be/en/onderzoek/tools/2/incontinence-associated-dermatitis-iad
• Australian Aged Care Quality and Safety Commission - Incontinence associated dermatitis and pressure injury https://www.agedcarequality.gov.au/news-publications/clinical-alerts/incontinence-associated-dermatitis-and-pressure-injury

If...

Wound Education, the subject everyone wants, from novice to expert, but where so many barriers exist to getting it just right. In this episode we burrow down into a recent Australian publication discussing recommendations for undergraduate wound education. This is another prickly concept our listeners will have dealt with and have opinions on, no matter what your discipline, experience level or clinical setting. So let's know what your thoughts are because we will talk more in future episodes about the status of wound education.

Timestamps:

00:00 Intro

00:34 Wound education for novice clinicians

01:34 Novices desperate for education

03:35 The needs of wound management education for medical staff

05:15 The assumption that everyone in the healthcare workforce has basic wound care knowledge

06:45 Critiquing research on wound education

09:32 How is the term wound expert defined

10:36 Academic wound education models versus clinical realities and the needs of clinicians

11:10 Irony of clinicians requesting advanced wound education when the basics are not understood

12:08 Fragmented, illogical, or misrepresented content

14:02 Polysemy in healthcare

14:32 What is a simple wound?

14:44 What is a wound?

15:34 Challenges of developing clinically realistic educational wound frameworks

15:47 A tiny wound

17:15 Sterile versus clean technique. Really really?

17:39 Coveting and naval gazing

19:35 Translating academic wound educational models into clinical practice

20:42 When “new” evidence is based on superseded guidelines

21:59 Clinically relevant undergraduate education

22:26 What about foundational content for consistent safe practice

23:04 What’s on the wall of your treatment room that can guide you

23:31 When foundational content is advanced in clinical reality

24:44 Recommended foundational content

26:54 Need for real-world research

28:10 Opportunities for nurse coaching/mentorship

29:10 Are wound management standards and expectations too high?

30:35 When non wound “experts” talk on expert wound topics

31:31 Profiling what wound management experts do

33:06 Read the antibiofilm and International Wound Infection documents for clinical pearls

Resources mentioned:

• The Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019 are published on the MAGICapp allowing for ‘point of care’ use where the guidelines can be viewed on any tablet, phone or computer (updated multiple times a year).
• Haesler E. and Carville K. (2023). Australian Standards for Wound Prevention and Management. Australian Health Research Alliance, Wounds Australia and WA Health Translation Network.

Compression, the topic everyone has experience with, an opinion on, and something to learn - including us. This will be the first episode of many on compression because there is so much to unwrap. We would love to hear your feedback on this one as we touch on so many points.

Timestamps:

00:00 Introduction

01:00 How lymphoedema training has informed our practice as wound consultants

02:11 Looking wholistically at hard-to-heal wounds through a lymphoedema lens

02:33 Clearing oedema in proximal body parts first before moving oedema in the legs

03:10 Assessing oedema

03:32 The problem of less research and experience in non-cancer related chronic oedema than cancer-related

04:14 Location and distribution of fibrotic tissue composition

05:05 Lymphoedema wound nurses the outliers

06:42 Where are the compression companies at wound management events?

07:55 Wound clinicians without lymphoedema training do not understand compression prescription in chronic oedema

08:09 Prioritising lymphatic function and compression over wound hygiene, including debridement

10:12 Reluctance of some allied health professionals to apply lower limb compression in the presence of wounding

11:22 Practice gaps in wounds and compression prescription

12:54 Motivation to understand more about lymphoedema

13:51 Myth of venous oedema being different to lymphoedema

14:00 More on reluctance to treat chronic oedema when wounds present

14:48 Lymphoedema escalation pathway

15:11 Becoming a lymphoedema mentor

15:43 Self-care in lymphoedema

16:18 The gaps in staging lymphoedema

16:40 Inadequate compression prescription, application and troubleshooting leading to bad patient experiences and money down the drain

17:36 What do we mean by the term “tolerating” compression?

21:34 Using the term” they don’t tolerate” compression when it is the healthcare system that is intolerable

22:09 The S.T.R.I.D.E. document to guide compression selection

23:11 Practical considerations when using S.T.R.I.D.E. principles

25:36 Round versus flat knit garments

27:31 Wound lymphoedema clinicians have two computers of formulary open simultaneously

28:52 More on round versus flat knit

30:47 Muffin-topping a red flag that compression needs to be applied into the thigh or higher

32:19 The Australasian Lymphology Association resources and courses

32:56 When nurses speak the same language around wounds and chronic oedema

34:38 Prioritise leg hygiene, understanding chronic oedema before debridement and dressings

36:38 The influence of industry on the science, education and clinical practice of wound management

Resources mentioned:

• STRIDE document https://lymphoedemaeducation.com.au/wp-content/uploads/2019/07/S.T.R.I.D.E.-Professional-Guide-to-Compression-Garment-Selection-for-the-Lower-Extremity.pdf (if you’re curious what STRIDE stands for, it’s Shape, Textile Type, Refill, Issues, Dosage, aEtiology)
• Australasian Lymphology Association https://www.lymphoedema.org.au/

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Disclaimer:

The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow...