Guest Editorial: Wound Care ‚Äì The Evidence, the Education, and the Outcomes
How many wound care clinicians have been frustrated by antiquated wound care practices and the reluctance of healthcare professionals to change? Reflecting on less-than-ideal professional practices presents a dilemma that requires a plan for action. Effective educational strategies need to be combined with practice initiatives to change healthcare provider behavior and improve patient outcomes.
To effect this plan, clinicians must journey into the realm of evidence-based medicine to combine what is known about the wound care evidence base with the educational evidence base. Best practices for the treatment of wounds were systematized in the preparing the wound bed model, first published in the November 2000 Ostomy and Wound Management. These practices have been updated for this issue. The witticism, "Before treating the hole in the patient, we must treat the whole patient," is the cornerstone of the best practice approach. Clinicians must be constantly reminded that addressing the cause and patient-centered concerns is the key to wound care success.
For example, instead of randomly switching from one dressing to another, wound care experts need to assess tissue debridement, infection/inflammation, and moisture balance (TIM). The edge effect (TIME) should be considered when all the components of the wound have been corrected and healing is not progressing at an acceptable rate. This additional component (the edge effect) adds support to the clinician's toolbox for appropriate timing of newer active treatments.
Adjunctive therapies such as biological agents, skin grafts, and vacuum-assisted closure then can be considered. The successful use of the VAC is dependent on adequate wound bed preparation, appropriate client/wound selection, and education. The article on the VAC examines expert opinion on the role of vacuum-assisted closure for the treatment of chronic wounds and the evidence base for its use.
Clinical education is the backbone of practice-based learning. Current educational strategies may be somewhat ineffective. Continuing education should evolve into continuous professional development - instead of the teacher, lecturer, or facilitator simply deciding what should be taught, clinicians should ask questions based on everyday practice and actively search for answers beyond the passive learning of the classroom setting. The article on evidence-based medicine gives the reader the tools to begin the educational journey. Think of your last clinical dilemma and put the method to the test. Reflect on the last time you taught others - can you make the educational experience "active," allowing participants to practice skills, encourage follow-up, and design strategies to bring new knowledge to practice? Effective educational activities also should be linked to patient care outcomes such as wound healing or prevalence rates. Was the knowledge integrated into practice? Were more wounds healed in a shorter time? Was quality of life improved for patients?
The evolving art and science of integrating or transferring new knowledge/evidence base into practice has been labeled knowledge translation. Healthcare systems have finite budgets and resources, and cost effectiveness becomes an issue. An elaborate cost effectiveness model for the use of becaplermin in diabetic neurotropic foot ulcer treatment has been presented in this issue. The model is robust and the cost effectiveness of other treatments for this type of ulcer can be compared. This model provides a mechanism for wound care accountability within systems (benchmarking).
The Guest Editors and authors challenge readers to develop their own continuous professional development program. Healthcare providers need to transfer what they learn on their journey to acquire new knowledge into their healthcare protocols and systems to improve the lives of their patients.