Skerritt Louise, Gooney Martin, Sheahan Linda
Health Service Executive, Dublin South and Wicklow, Nursing and Health Care, School of Health Sciences, South East Technological University, Waterford City, Ireland.
Nursing and Health Care, School of Health Sciences, South East Technological University, Waterford City, Ireland.
J Wound Care. 2025 Jan 2;34(1):74-87. doi: 10.12968/jowc.2024.0108.
Wound management can be costly and challenging to the health services' scarce resources. Information regarding the number of wounds in a community care setting and their associated aetiology will provide nurses and nurse managers with an insight into the specific needs of these clients with wounds and highlight areas where care or services can be improved or further developed. This research aimed to establish the prevalence and aetiology of wounds, the current delivery of wound care, wound documentation and referral pathways in an Irish community care setting.
A retrospective chart review was carried out on all clients in the community care area who received wound care from the Public Health Nursing Service over a specified one-year period.
A total of 331 individuals were identified as having wounds, and nearly half presented with more than one wound, equating to 632 wounds in total (point prevalence (PP)=0.46%). A total of 56% (n=186; PP=0.14%) had leg ulcers (LUs), 18% (n=58; PP=0.04%) had pressure ulcers (PUs), 15% (n=49; PP=0.04%) had developed a diabetic foot ulcer (DFUs) and a further 11% (n=38; PP=0.03%) had wounds of other aetiologies. The mean duration of wounds was 11.37 months. Comorbidities were present in 99% (n=327) of clients with wounds, with cardiovascular disease observed in 87% (n=288) of clients and diabetes in 45% (n=148). Nursing wound-related concerns resulted in 52% (n=171) of clients receiving antibiotics, with 71% (n=121) being prescribed more than one dose. As many as 61% (n=104) of clients prescribed antibiotics did not have completed documentation to demonstrate a suspected wound infection. It was established that 16% of the Public Health Nursing Service's active caseload was made up of clients with wounds and the management of these wounds accounted for 65% of nursing time, equating to 28 full-time community nurses.
This study has identified that people with chronic (hard-to-heal) wounds often present with more than one chronic disease, which may negatively influence the wound's healing trajectory, lengthening its duration. The criteria for onward referral for suspected wound infections have been examined and resulted in large numbers of poorly documented wound assessments, leading to a high reliance on the use of oral antibiotics as commonplace for the management of hard-to-heal wounds. Hard-to-heal wounds, such as lower LUs, PUs and DFUs, are either caused or significantly affected by the presence of underlying comorbidities. Therefore, aligning the prevention and management of these burdensome wounds with National Clinical Programmes will deliver efficient, cost-effective, holistic quality care to clients in Irish community healthcare settings.
伤口管理对卫生服务部门稀缺的资源而言成本高昂且颇具挑战性。有关社区护理环境中伤口数量及其相关病因的信息，将使护士和护士长深入了解这些伤口患者的具体需求，并突出护理或服务可改进或进一步发展的领域。本研究旨在确定爱尔兰社区护理环境中伤口的患病率和病因、当前伤口护理的提供情况、伤口记录以及转诊途径。
对社区护理区域内在特定一年期间接受公共卫生护理服务伤口护理的所有患者进行回顾性病历审查。
共确定331人有伤口，近半数患者有多处伤口，总计632处伤口（点患病率（PP）=0.46%）。共有56%（n = 186；PP = 0.14%）有腿部溃疡（LU），18%（n = 58；PP = 0.04%）有压疮（PU），15%（n = 49；PP = 0.04%）发生了糖尿病足溃疡（DFU），另有11%（n = 38；PP = 0.03%）有其他病因的伤口。伤口的平均持续时间为11.37个月。99%（n = 327）的伤口患者存在合并症，87%（n = 288）的患者有心血管疾病，45%（n = 148）的患者有糖尿病。与伤口护理相关的护理问题导致52%（n = 171）的患者接受了抗生素治疗，71%（n = 121）的患者被开具了不止一剂抗生素。多达61%（n = 104）接受抗生素治疗的患者没有完整的记录来证明存在疑似伤口感染。已确定公共卫生护理服务的活跃病例中有16%由伤口患者组成，这些伤口的管理占护理时间的65%，相当于28名全职社区护士的工作量。
本研究已确定患有慢性（难愈合）伤口的患者通常患有不止一种慢性疾病，这可能对伤口的愈合轨迹产生负面影响，延长其持续时间。已对疑似伤口感染的进一步转诊标准进行了审查，结果发现大量伤口评估记录不佳，导致在管理难愈合伤口时高度依赖口服抗生素。难愈合伤口，如下肢腿部溃疡、压疮和糖尿病足溃疡，要么由潜在合并症引起，要么受到其显著影响。因此，将这些负担沉重的伤口的预防和管理与国家临床计划相结合，将为爱尔兰社区医疗环境中的患者提供高效、具有成本效益的整体优质护理。
