INFECTION PREVENTION & WOUNDCARE
or they don’t send referrals for people who really do need help.
“At the primary care level, doctors and nurses on the ward, or in the community, are the ‘primary caring person’ at that point in the chain; they need to make their assessment quickly, and intervene correct- ly, in order for wound healing,” he said.
Kingsley emphasises the importance of es- calating to the right people in order to get assistance: “If they need to escalate it to a specialist nurse for some further help, or a tissue viability nurse, or a specialist doctor like a dermatologist, or a vascular surgeon, escalating for further help, it’s about how quickly can you do that, and how do you set the criteria for that.
“The tendency in the NHS is to be, in many cases I think, defensive. They tend to send too much, and this has the knock-on effect that we don’t get the opportunity to teach people properly, because we’re just caught up in dealing with stuff we shouldn’t be dealing with. Or sometimes, people don’t send us the patients that really do need our attention. So the escalation referral pro- cess is one of the biggest challenges. If we get that bit right, put a little bit more into education, people will then get more of the right things done sooner.
“Our biggest challenge in wound care is getting seen by the right person at the right time, and getting quick, rapid and effective therapy. Far too many wounds are left to become chronic before they’re referred.
“From a wound infection point of view, the longer the wound is open, the increased risk there will be that a wound infection might result. It’s just laws of probability, there’s more chance for stuff to go wrong, and for organisms to take an opportunity.”
It requires more than education, Kingsley states. People who can distinguish between what they can handle and what needs fur- ther attention are the key to wound infec- tion prevention. He said: “Education is cru- cial, but that’s only one aspect of it. I can’t teach all of the people all of the time to do the right thing.
“Being a good generalist doctor or a good generalist nurse is perhaps one of the hard- est jobs of all. It’s absolutely a crucial job; we need really good generalists who know what they know, and who know when to appropriately pass on for further help. Having a good general nurse or a good general doctor is really crucial to getting the patient through the system to the right person at the right time.”
Kingsley operates on the 80-20 principle, which assumes that anybody working within the chain should be able to deal effectively with 80% of the cases they are presented with, and it is only 20% that are more complicated and require further help.
“They’ve seen it before, they’ve got a care pathway in mind, they’ve got experience, they deal with it quickly and effectively and everything goes well. The other 20% of the time, it’s diffi cult, it’s complicated, and they need help. So the system needs to say, when you’re in that 20%, this is where you get help, and this is how you get help rapidly.
“That for us is the challenge. Whatever system you’ve got, whether it’s emailing in a photograph, whether it’s a written refer- ral, or a telephone referral system, it’s got to help people to understand that actu- ally ‘this one requires referral, because this one’s complicated’.
of experience. So use them for local experi- ence, whether it’s on the ward or in the lo- cal community, to get the answers rapidly for the patient and get on with the job. If having tried to escalate within a team no- one’s really sure, escalate outside the team, and very commonly a tissue viability nurse is a good place to go and do a bit of triage.”
Kingsley suggests this could include a phone call or sending a photograph to check a particular wound. This allows staff with the right expertise to either issue in- structions for further care or to organise a time to see the patient directly.
“That whole system is really our biggest challenge; it doesn’t just relate to wound care, it could be true also of infection con- trol advice, it could be true for stoma ad- vice or any of the other sorts of things that we have specialist nurses or specialist de- partments for.”
The Infection Prevention Conference in September included Kingsley as a speaker, and he emphasises how conferences like this can benefi t individual trusts and spe- cialists within the fi eld.
Speaking to NHE just before the confer- ence, he said: “Members of my team will go along in order to pick up what’s new.
“We’re looking for new guidance, innova- tive practice from our peers, perhaps to look at products in the show that accom- panies it, and we might go with a specifi c thought in mind. For example, we might have an issue where we think, actually, we’re not happy with what we do currently, and we need to fi nd out what there is in the fi eld of skin antiseptics. So you might go and have a particular thing in mind or you might just generally go around and browse and see what is new.”
“It’s something about that very clear, crisp process that says, if you know what you’re doing and there’s a good and solid care path- way, please get on with it. If you’re stuck and if it’s complicated, the number one escala- tion point is to your immediate teams.
“A staff nurse might go to the district nurse and ask for advice. If the senior, more ex- perienced people in that team can’t help, then refer on to the next point in the chain, which might be a tissue viability nurse.”
Kingsley maintains that it is not necessar- ily an issue of seniority: “It might just be you’ve got a particular nurse, or someone that’s got a real interest in wound care on the team, and they’ve got a good amount
He concluded: “It is a very good way of keeping your fi nger on the pulse, so that, sometimes when a problem crops up in the next twelve months you think, wait a min- ute, I’ve seen an innovative design of a toi- let, then you’ve got an idea that you can go and search for one. That’s always valuable. But we’re certainly looking for things like guidelines and good tips of the trade, from this specialist conference, designed for that level within the overall team.”
Andrew Kingsley FOR MORE INFORMATION
Visit
www.northdevonhealth.nhs.uk/ infection-control
national health executive Sep/Oct 11 | 53
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