CLINICAL MANAGEMENT ROLE IN IRELAND

Clinical Management Role in Ireland

Clinical Management Role in Ireland

Introduction

The costs associated with wound care are considerable and a lack of standardised education approaches and policies compound this cost and contribute to increased morbidity and mortality of patients (Harding and Boyce, 1998). In Ireland, there are currently no standardised policies or strategies for the provision of wound care. The UK and many European countries, by contrast, have wound management guidelines and standards in place, which serve to guide professionals and enhance patient care practices (Gottrup et al, 2001; RCN, 2001). Wounds and the many associated problems have challenged health care providers for centuries and today, despite the wealth of knowledge available, neither the incidence or prevalence of wounds is reducing (Harding and Boyce, 1998; O' Brien et al, 2000; Kaltenthaler, 2001; European Pressure Ulcer Advisory Panel, 2002). Furthermore, a lack of interdisciplinary models of wound care provision has led to sporadic developments in the field and an inadequate evidence base for practice (Lindholm et al, 1999). In recognition of the dearth of information on the provision of wound management in Ireland, a survey to investigate the key aspects related to current practices was undertaken. This paper reports on the first ever survey conducted in Ireland and the results provide significant insights into policy formulation, decision-making, and the use of resources in the management of wounds in the Irish health care setting.

The scope of the problem

Pressure ulcers

Pressure ulcers are a significant health care burden. European figures suggest that approximately 18% of hospital patients have a pressure ulcer (European Pressure Ulcer Advisory Panel, 2002). One Irish study identified that 12.5% of patients in acute care are affected, with the greatest number of ulcers occurring in the elderly (Moore and Pitman, 2000). The statistics on the incidence of pressure ulcers estimate a range from 2.2-66% in the UK, and 0-65.6% in the USA and Canada (Kaltenthaler, 2001). These figures are influenced by the location and condition of the patient group, for example, hospital vs Community setting, General hospital patients vs those with fractured neck of femur (Richardson and Meyer, 1981; Versluysen, 1986; Hanson et al, 1993; Bridel et al, 1996).

Chronic Leg ulceration

Chronic leg ulceration is a common and debilitating condition, with venous disease being the most frequent aetiological factor (Harding and Boyce, 1998). Studies have suggested that the prevalence of chronic venous disease is between 0.18% and 1.9% (Callum et al, 1985; Cornwall et al, 1986; Baker et al, 1991; Lees and Lambert, 1992; Nelzen et al, 1996), although the accuracy of this figure varies from study to study depending on the inclusion criteria used (e.g. age restrictions, ulcer location), as well as the source of identification: community, hospital or self-referral (Moore, 2002). One regional study conducted in Ireland noted that 12 out of every 10,000 people have a leg ulcer at any given time (O'Brien et al, 2000). The prevalence of leg ulcers was found to increase in the older population (103 in every 10,000 aged 70 years and above); ...