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which encompasses basic wound conditioning with a focus on cleansing and debridement, but also the promotion of granulation, for example with NPWT. If healthcare professionals were to follow the M.O.I.S.T. concept, the standard of care would improve considerably.
How did the concepts behind the framework develop into what’s being proposed today? The M.O.I.S.T. concept is essentially based on the widely used TIME concept, which was developed back in 2002. However, since some of the modern aspects of wound care aren’t represented by TIME, the M.O.I.S.T. concept was developed by a group of experts as an update. The new areas are represented by the letters O for oxygen and S for supportive strategies, and they take into account innovations and successful therapies that should be included in the complex process of wound treatment if necessary. For oxygen this includes treatments like haemoglobin spray, higher cyclical pressure oxygen and low constant pressure oxygen in a contained chamber. Supportive strategies is the umbrella term for any products applied with an aim to rebalance the wound environment to push it towards a healing trajectory, such as advanced bandages.
Right now, a lot of wound care is nurse-led. Does M.O.I.S.T. encourage the involvement of physicians in the management of wounds?
The treatment of patients with chronic wounds should always be conducted by a multidisciplinary team where possible. But depending on the country, the treatment of patients can be regulated very differently to accommodate for the resources available. With the M.O.I.S.T. concept, it plays a subordinate role in which occupational group carries out the wound treatment. It is more important to consider all relevant aspects in the framework and, if necessary, to integrate them into a treatment concept using the resources available.
Is there a lack of standardisation in wound care, and does M.O.I.S.T. seek to bring more of it to the field?
Practical Patient Care /
www.practical-patient-care.com HEIDI HOLISTIC TREATMENT REASSESS
OUTCOME MEASURES
H: History E: Examination I: Investigations D: Diagnosis I: Implementation
Social factors infl uencing the wound
Behavioural factors Cultural factors Spiritual need Pain management Shared care
Patient-centred care
Yes, exactly! A key point of the M.O.I.S.T. concept is to bring structure to the complex treatment strategies used for patients with chronic wounds. We are currently in the process of rolling out the M.O.I.S.T. concept, which was originally developed in German-speaking countries, worldwide. To do this, it must be adapted to the specific conditions in each country. After that, we are confident that we can show how each respective situation has improved.
How do the HEIDI (History, Examination, Investigation, Diagnosis and Implementation) and M.O.I.S.T. concepts work together to provide better patient care? HEIDI is a very good concept for describing the entire patient treatment process. The M.O.I.S.T. concept focuses exclusively on localised wound treatment. Patients with chronic wounds must be seen and treated in a larger overall context. Thus, the M.O.I.S.T. concept is only one important building block in complex holistic wound treatment.
Have the concepts gained any traction among healthcare professionals or associations? The M.O.I.S.T. concept was developed by experts from the umbrella association of German-speaking wound healing societies WundDACH. It has been the recommendation of the professional societies in Germany (ICW e.V. for example), for more than five years. In recent years, the concept has also been presented internationally to stimulate more and more interest worldwide.
How do you and the other proponents of M.O.I.S.T. plan to take it from an academic concept to the standard of care in hospitals?
First, the concept had not only to be translated from German language, but also adapted to international standards. We have started doing this very successfully in the last two years and presented our progress at numerous conferences. Now, further publications will follow that will focus more on the respective national conditions. In the end, the M.O.I.S.T. concept should not be an academic concept but a tool for everyday clinical practice that can be used anywhere in the world.
Do you see the growing interest in technologies that assist with the diagnosis and treatment of wounds as an important part of increasing the benefits M.O.I.S.T. could have in the clinic?
Innovations for wound care are regularly introduced to the market, and they have the potential to further improve wound treatment. Since it doesn’t include recommendations for any specific products but instead focuses on points of action for treating wounds, the M.O.I.S.T. concept can accommodate new technologies in its treatment pathways. I see a lot of potential for the broader application of M.O.I.S.T. in the clinical field in the near future. ●
www.molnlycke.com 37
Topical treatment of chronic wounds
M: Moisture balance O: Oxygen balance I: Infection control S: Supporting strategies T: Tissue management
Review of timeframe that is wound- patient appropriate
Documentation
Proactivity, not reactivity
Patient-reported outcome measures (PROMs)
Clinical outcomes Economic outcomes
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