I joined the district nurse to visit a patient in the community to carry out wound dressing. The patient had a diabetic foot ulcer wound. I had visited the patient with the district nurse on three different occasions and have observed the district nurse carry out wound dressing on him. On this occasion, which was my fourth visit to the patient, I performed the wound dressing procedure under the supervision of the district nurse. On my previous visits, the wounds were being dressed in urgo clean acting as the base cover, advazorb, k-soft and k-lite. The nurse reviewed the dressing and recommended a new dressing called medihoney to be used as base cover instead of urgoclean. The nurse made me understand that using medihoney as a base dressing helps to lift the slough and kill infection. It helps with rapid wound healing as it draws moisture out of the wound area thus dehydrating bacteria. The wound had a foul odour and was exudating at a medium level.
Before the start of care, I respected the patient’s autonomy by gaining consent. I understand the importance of avoiding complications with wounds, so I embedded good infection prevention and control practices to minimise the patient’s risk of infection. I washed my hands and wore my PPE as per policy. Even though, care was provided in patient’s home, I maintained patient’s privacy and dignity by letting them choose which part of their home they would like the procedure to be carried out. I equipped myself by reading more on patient’s wound care before the procedure in order to preserve patient’s safety. I ensured a person-centred approach by using verbal and non-verbal communication, so patient felt involved in his care. With the support of the district nurse, I prepared all equipment and dressings needed for his wound. Using an aseptic non-touch technique, I removed the old dressing with a non-sterile glove and assessed the wound. I assessed the wound and identified four areas on the foot with ulceration with extensive maceration of the surrounding tissue. All four areas had medium levels of exudate with the presence of slough which was yellowish in colour. I took a measurement of the width, length and depth of the wounds to help identify if wound was healing and to monitor if the new dressing was effective.
I cleaned the wound with gauze soaked in water and gently dried it and its surrounding skin. I asked patient if he felt any pain and he confirmed being in pain only when the wound is being dressed. I redressed wound with medihoney placing it on the wound surface and ensured the dressing was in contact with the wound bed. Advazorb non-adherent foam dressing was applied on top of the medihoney due to its absorbent nature. The use of medihoney will increase wound exudate and as such a good absorbent dressing must be used. Advazorb non adherent foam dressing rapidly absorbs and retains fluid in the dressing. I secured all in place by using a yellow line and wrapped the whole foot with the K-soft bandage to assist with healing as they are very soft and comfortable and helps redistribute pressure for ultimate comfort. Lastly, I applied the K-lite bandage which acted as a base for compression and used the yellow line to securely hold the dressing.
What did you do well?
I ensured a person-centred care by communicating with patient through the procedure. Patient felt involved as he communicated his concerns about how the wound is healing. I had the opportunity to apply knowledge I have acquired regarding wound care. Wound was assessed and pictures taken, and I noticed there was no odour so could tell the medihoney was being effective. I identified some dark tissues on the wound bed trying to fall off which I understand signifies healing. Performing this wound care procedure enhanced my aseptic non-touch technique skills and helped build my confidence. The experience has helped me gain knowledge about tissue viability, wound healing and helped me familiarise myself with the types of wound dressings used
What would you have done differently?
Upon seeing the wound, I did not know how to describe what exactly was happening to it. I could tell it was healing as it looked better than before. The wound was heavily sloughy. I intend to gain a broad knowledge and understanding in wound care management. I intend to communicate more clearly next time so my patient understand me better. The patient had other health conditions, example, insulin dependent diabetes, which impacted on the wounds and we discussed the importance of maintaining safe blood glucose levels to promote healing. The patient was independent with his insulin so I gave advice for a healthy diet.
Improving safety and quality of care
I undertook relevant risk assessments (e.g. falls, skin integrity, mental capacity) that may be required and demonstrated an understanding of the difference between risk aversion and risk management. On other visits, I carried out skin integrity assessments and I am aware of other risk assessments and their importance. I utilised a range of communication skills to effectively engage with the person receiving care, their family/carers and members of the multidisciplinary team in the provision and evaluation of care. I was able to give a hand over to the rest of the team for this patient. I communicated well with the patient and I understand I could have contacted the TVNs for advice.