Treat the whole of the patient, not the hole in the patient

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What’s the biggest mistake pharmacists make when it comes to wound care? Angelo Pricolo talks to Geoff Sussman

Wound Awareness Week runs from 17 – 23 August 2020. The objective of the 2020 Wound Awareness campaign is to spread awareness of what wounds are, who is at risk and what someone should do if they have a wound that won’t heal.

Wounds are estimated to cost the health system $3 billion dollars every year and nearly half a million Australians suffer from chronic wounds every day. These are staggering numbers and show the effect on a vast proportion of the population.

People with chronic diseases, such as diabetes or are over 65 are more at risk. These patients are also over represented in the pharmacy. Clearly this illustrates an opportunity for pharmacists to be more involved in treatment as these patients are also frequent visitors to the pharmacy.

“The pharmacist is in a unique position as a primary health professional to deal with simple wound problems as part of their daily practice,” says Associate Professor Geoff Sussman OAM.

“The critical issues are the need to know your own boundaries and when you need to refer the patient on to a wound specialist for attention.

“In wound care the pharmacist is the product expert on wound pharmaceuticals in the same way as they are with drugs. They should know the most appropriate product to use in a given situation.

“Wound management is a clinical skill which will demonstrate to your customers your ability as a Health Professional.”

Dressings are rarely discounted, even by the big chains or the discounter pharmacies. They are essential items that people place real importance on and are required for optimal healing. Failure to correctly treat wounds is more likely to create complications like infection, scarring or just discomfort.

Pharmacists are uniquely positioned because of access to a wide range of dressings, an understanding of the healing process and often a vision of the medication being taken right there on their dispense computer. All these have an impact on healing time or indeed whether healing takes place at all.

A review of medication can reveal drugs that may impair wound healing. This is not always apparent to the patient and can include corticosteroids, immunosuppressant drugs, antineoplastics, anticoagulants and anti-prostaglandins.  Other times medication can assist wound healing.

Diseases that can diminish circulation and perfusion especially to the extremities can interfere with the normal delivery of cell nutrients and the constituents of the immune response. This can impair the body’s ability to transport leukocytes and macrophages, which delays wound healing. Medication that can help reverse this can be the difference between healing and further suffering.

The nutritional status of a patient is also very important. It can be assessed and then addressed with supplements if necessary. This is essential for wound healing and begins with an assessment of the person’s appearance and an estimate of caloric intake.

If we are presented with a venous ulcer then compression is an important part of treatment. It is essential the correct compression is used, the method of application is explained and ongoing support is available to ensure compliance.

Pharmacists are often a little timid when it comes to recommending compression. Class I compression is usually very safe (unless arterial problems are severe) and is the same level used to protect against DVTs.

Wounds Australia is an important organisation to join, with benefits that include weekly email blasts, a hard copy magazine and website that provides useful information. The website also provides details of endorsed educational programs.

The Wounds Australia website also provides the names and location of Wounds Australia Credentialed Wound Professionals and most states have wound clinics.  If the issues is foot related there are many high-risk Podiatry clinics too.

“If a pharmacist is truly interested they must undertake training. There are a number of courses including the Monash University Post Granulate Wound Care course,” says Geoff Sussman.

He insists the biggest mistake pharmacists make is in not stocking an appropriate range of modern dressings. Added to this… “Just selling products without the appropriate counseling. “

“There will, I am sure, be major outcomes from both the Royal Commission on Ageing and the MBS review of chronic wounds. I gave evidence to the Royal Commission and was involved with presentations to the MBS wounds committee. I believe the final report will have a major impact on pharmacy.”

Associate Professor Geoff Sussman is the Immediate Past Chairman of Wounds Australia Board and has been a powerful advocate for the position of pharmacists in the wound care space for many years. So many students and pharmacists have been enriched with his guidance and he again plans to be involved at APP next year.

As more pharmacies continue to include consult rooms for vaccinations, the opportunity presents to utilize the room further. Offering a wound dressing service is the perfect fit. It just takes a leap of faith and the appropriate training that build on the basic skills that are already there.

Angelo Pricolo is an addiction medicine pharmacist and former National Councillor of the Pharmacy Guild of Australia.

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