Exploring and understanding challenges in clinical practice: appropriate dressing wear time

Objective: Dressings are an imperative aspect of wound management, yet dressing associated complications can delay healing progression, causing unnecessary distress to the patient. Evidence suggests that optimal dressing choice and avoidance of unnecessary dressing changes are essential to enable undisturbed healing and minimise the ingress of harmful microorganisms to the wound site. However, frequent removal of dressings is still evident in practice, resulting in a negative patient experience and delayed healing. This study aimed to understand the experiences, key factors and current practices that determine foam dressing wear time in patients living with a wound in the community setting. Methods:The study was based on a mixed-methods design. A retrospective audit was undertaken to establish reasons for renewal of foam dressings on patients with acute/chronic wounds. Semi-structured qualitative interviews were also conducted with registered tissue viability nurses (n=12) working in the community setting. Results: The majority of wounds identified in the audit were treated with the same product family throughout the data collection period. Reasons for changing dressings were related to the need to inspect the wound or because of adherence to care plans, rather than being associated specifically with dressing performance. Practicalities, ritualistic practice and time pressures and demands were also key factors influencing a dressing change. Conclusion: Fundamental changes in staff attitudes and beliefs about dressing wear time are essential to optimising dressing performance and increasing patient quality of care. Enabling flexible community services that are reflective of the needs of the service are central to changing practice and increasing dressing wear time in the community setting.