Clinical tips: wound care

health worker bandaging an elbow

Pharmacists can do a lot to help wounds heal well, writes Karalyn Huxhagen

The practice of wound care in pharmacy can be relatively simple, or the pharmacy may choose to expand their role to provide advanced dressings and products. Some pharmacies provide a service where they will change dressings and provide expertise in management of the patient’s wound.

The Australian Pharmaceutical Formulary and Handbook, APF 24 2018 contains an excellent reference section on wound management. The PSA bookshop also sells a book Wound Care in Practice an everyday guide to wound management for health care professionals, published by the PSA in 2013.

Both of these references provide material to assist pharmacists performing roles from basic to advanced wound care.

To practice wound care the pharmacist must also have good knowledge on maintenance of skin integrity, reduction of inflammation and management of infection. Wound care is not all about applying dressings and antiseptics. Wound repair also requires adequate nutrition with advanced nutrition techniques being used for serious wound infections. For some wounds appropriate first aid techniques will also be needed e.g. the need for cleansing and antibiotic prophylaxis following human and animal bites.

In my lifetime we have moved from leaving wounds to dry out and form a scar to a process called moist wound healing. Moist wound healing does not mean wet wound healing as this can lead to maceration.

There are four phases to of wound healing:

  • Haemostasis
  • Inflammation
  • Proliferation
  • Maturation

Management techniques may change as the wound moves through the various stages. For example in the haemostasis phase a seaweed dressing may be utilised. Once the wound has reached proliferation stage a hydrogel may be used to enhance the proliferation of skin cells.

During the maturation stage it is important to remind patients that even though the surface of the wound may appear healed that it can take quite a long time for the inner components of the skin to repair and regain strength. It is not uncommon for a patient to present for assistance as their wound bed has collapsed and the wound edges have come apart. This is often seen in large patients where the wound is large and not well supported.

For a wound to heal properly with minimal damage and scarring there are several factors to be considered.

  • Systemic factors that pertain to the patient e.g. general health, comorbidities, nutritional status
  • Local factors – debris in the wound, blood supply, stressors on the wound
  • Wound bed preparation has to be performed appropriately and revisited at every dressing change
  • Appropriate cleansing techniques
  • Appropriate dressings
    • Inert dressings
    • Interactive dressings
    • Bioactive dressings
    • Scar reduction dressings
    • Charcoal dressings
  • The possible need for advanced techniques such as:
    • Grafts
    • Growth factors
    • Tissue –engineered products
    • Hyperbaric treatment

The use of bandages and specialised garments to apply compression can be important for some wounds.

To support the wound in its long healing phase the patient may need to utilise the services of an occupational therapist, exercise physiologist or sport scientist to develop a specific garment or support to help the wounded area regain its full capacity and strength. For example following a severe cut to three fingers when opening an ampoule to draw up a chemotherapy agent a fellow pharmacist required an elaborate set of wires and screws in her hand and wrist to enable her partially severed fingers retain their ability to move while the tissue and tendons repaired.

While the various manufacturers of wound care products will provide in-service and on line training on their various products I commend to you the chapter in the APF on wound management. It is comprehensive and extensive and provides excellent background knowledge for pharmacists and the pharmacy staff providing a wound care service.

Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group.

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