Highlights of 10th Anniversary EPUAP Meeting - Abstracts from the Smith & Nephew Symposium

Smith & Nephew Symposium

Negative Pressure Wound Therapy - Defining its Role in Pressure Ulcer Management

John Radcliffe Hospital, Oxford
Thursday 30th August 2007
An official Satellite Symposium at the European Pressure Ulcer Advisory Panel, 2007
Sponsored by Wound Management, Smith & Nephew Medical Ltd

Introduction

The incidence of pressure ulcers is a major source of morbidity and escalating healthcare costs for many countries in Europe, not to mention the rest of the world. In 1999-2000 the cost of pressure ulcer care in the UK was between £1.4-£2.1 billion; this was broadly equal to total NHS expenditure on mental illness, or the total cost of community health services¹. Education regarding effective prevention and appropriate treatment is therefore crucial.

Over the past few years we have seen a growth in technologies that have their place in providing an effective clinical solution to complex wounds and pressure ulcers. One of these is Negative Pressure Wound Therapy and after several years of clinical usage we now have a very good opportunity to review its role as part of the journey of care in pressure ulcer management.

In this symposium John Posnett will begin by looking closely at the some of the real costs behind pressure ulcer treatment. Wound care costs can be hidden within other diagnostic categories; this is certainly true of pressure ulcers, taking for example the rehabilitation costs for patients with compromised mobility.

Clinicians have an increasing need to be aware of cost effectiveness while trying to initiate the best care possible within their communities. TIME provides a framework and educational model for treating complex wounds. Lynne Watret will discuss this within the context of negative pressure wound therapy; where it should start, where it should stop, and where it might sit within any overall care plan for our patients.

Finally, David Gray will discuss his experience with VISTA™, a simple, gentle and cost effective device for negative pressure wound therapy that Smith & Nephew has recently added to its portfolio. David will conclude by offering some suggestions as to where it fits among the clinician's therapeutic options for pressure ulcer management now and in the future.

We believe that a review and discussion on the role of negative pressure wound therapy for pressure ulcer treatment is very timely, and hope that you will agree by joining our symposium and more importantly joining in the discussions that will follow our presentations.

Bennett G, Dealey C, Posnett J (2004) The cost of pressure ulcers in the UK. Age & Ageing, 33: 23-235

Pressure ulcers and complex wounds - the real cost issues

Professor John Posnett: Director of Health Economics,
Smith & Nephew Wound Management

Chronic wounds represent a significant burden in the UK - to patients and to the healthcare system. There are around 200,000 individuals in the UK at any time with a chronic wound - many more new wounds develop annually. The cost to the NHS of caring for these patients is conservatively estimated at £2.3bn to £3.1bn per year (at 2005/06 prices), around 3% of total estimated 2005/06 outturn expenditure on health (£89.4bn).

With appropriate diagnosis and treatment choice this cost can be reduced, but it is important to focus on the real drivers of cost. Around 50% of the cost of wound care arises from the relatively small proportion of patients whose wounds fail to heal normally - either because of infection or because of surgical failure. A new technology can impact positively on costs overall even if its acquisition cost is higher than conventional alternatives - by shortening healing time, reducing the rate of hospitalisation or reducing the incidence of complications.

This session will summarise the costs of wound care in the UK and highlight the main determinants of cost.

Negative Pressure Wound Therapy within a Care Pathway for Pressure Ulcers

Lynne Watret: Clinical Nurse Specialist, Tissue Viability,
Greater Glasgow Primary Healthcare Trust

Pressure ulcers tend to develop in the most vulnerable group of patients. The addition of a pressure ulcer to pr-existing debilitating conditions is therefore devastating to the patient and family alike. These are complex wounds and if they are to progress to healing then the treatment plan must complement all attempts to retain or optimise the functional ability of the patient. This is only achievable through education of all clinicians involved in wound care and in encouraging shared values by those providing care, so as to achieve the best outcome for the patient as well as to ensure overall cost containment.

There is also a requirement to provide a balance between paternalistic control by health care professionals and patient empowerment. The patient and family must be whenever possible active participants in their own care, and the clinician always has to take this closely into account when formulating the treatment plan.

Wound Bed Preparation identifies the barriers to healing. It provides a model which can be understood by all clinicians while responding to the needs of the individual, and provides a rationale for care planning regardless of the care setting. The TIME framework of Wound Bed Preparation can be used for all wound types, including pressure ulcers, as it assists in demonstrating goals for management without dictating specific treatments. Clinical judgement is still required and relies on a clinician who not only can carry appropriate wound and patient assessment but can also rationalise the choice of treatments based on best practice.

Negative Pressure Wound Therapy has for some years been an appropriate treatment choice for pressure ulcers. However, now is time to consider its context within the range of potential treatments available, so as to ensure that it fits into the care plan that needs to be devised for each patient. It is especially important to understand how it can be integrated with other treatments, both prior to and following its use. I will argue that the TIME principles of wound bed preparation provide an excellent context within which to examine the overall principles around treatment choice for patients with pressure ulcers, and may provide the right context for Negative Pressure Wound Therapy.

New Aspects of Negative Pressure Wound Therapy in Clinical Management

David Gray: Clinical Director, Wounds UK and Clinical Nurse Specialist,
Grampian Acute Health Services, Aberdeen, Scotland

Over the last 12 months the Department of Tissue Viability in Aberdeen, Scotland, UK has been utilising a form of Negative Pressure Wound Therapy new to the United Kingdom- the VISTA System [Smith and Nephew, Hull, UK] with interesting results. My presentation will explore the issues faced in terms of practical challenges of adapting a new system to the UK health service and also the practice development challenges encountered.

To date 25 completed case reports have been conducted with other patients using the subsystem for a short period. The wound types studied have been grade 3-4 pressure ulcers of the heel and sacrum as well as dehisced surgical abdomens.

Our experiences to date have allowed us to develop the dressing technique required for each of these unique anatomical locations. We have also identified a number of research questions which we feel may add to the knowledge regarding Topical Negative Pressure.

This presentation will offer an insight in to our experiences of the last twelve months including issues of safety, staff and patient acceptability and economic impact. All 25 completed case reports will be discussed.

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