Page 47 - RPA May 2020

who’d been stabbed,” she said. “This isn’t something uncommon,
because many people would prefer
a pharmacist to treat their wounds, compared with waiting in a hospital for hours on end.”
She says the focus should be on identifying primary issues, such as whether the wound is new or old and what support is required, from stitches to triage.
“It’s all about having the conversation and looking at an issue from many angles, which should be the approach taken with every topic encountered in a pharmacy,” Ms Mahoney said.
“Most pharmacies have a consulting room of some description where
they can see to wounds and provide treatments from blood pressure [checks] to vaccinations, so that’s business
as usual.”
Holistic approach best for wound care
This first entails learning about the patient’s history.
“A wound must always be viewed
in the context of the patient, ie, what
is the patient’s age and gender,
what are the patient’s illnesses and comorbidities, is the patient taking medication, what is their diet like, have they lost weight in recent times, how are their hydration levels, how robust are they?” Mr Bain said.
“Once a comprehensive and holistic assessment has been executed, the pharmacist should zero in on the wound and ascertain what is the cause of the wound, how long it has been present, where on the body it is, whether it’s just the outer tissue layer or all layers that are impacted, whether some tissue needs
to be removed, whether contamination or infection has taken place, whether the wound is bleeding, whether a bone or tendon is involved, and whether specialist support is required.”
As an example, certain infections, such as mycobacterium ulcerans, occur only in certain geographical locations, and this is where knowledge, experience
and skill come in handy, says Mr Bain. Also important to note, he adds, is a
patient’s socio-economic status in terms of what they can afford, and where they can buy dressings if they require them, as well as whether family members or
a community nurse will be involved in their care.
“This makes it clear how big a pharmacist and pharmacy assistant need to think to see the wound in the context of the whole person and, at times, their family,” Mr Bain said.
“In fact, wound care is an incorrect term. We never care for a wound, but we care for someone who has sustained a wound, and a holistic assessment provides a healthcare practitioner with a guide as to whether a wound is likely to get better or not.
“Generally, a wound can be termed chronic or complex if it hasn’t healed after four weeks. The wounds of healthy people who are well hydrated and nourished will heal for the most part far more quickly than those of sick people.”
The integumentary system
The biggest mistake when it comes to health professionals and wound care is looking at the skin as though it is
a separate entity that can somehow recover and look after itself, says
Mr Bain.
He points out that the skin, being
part of the integumentary system, is influenced by all the other systems
in the body, such as the respiratory system, cardiovascular system, endocrine system and the like, which all interface with each other.
“This means that when a healthcare professional treats a wound, they should be guided as to how balanced the interfacing systems are and how well they’re working together,” Mr Bain said.
“This approach extends to wounds that are not responding to treatment, in that the situation will not be redressed through application of a different dressing. Dressings don’t, in fact, heal wounds, but provide an environment where wounds can heal themselves.
In context, the dressing becomes a tool to help heal the wound.”
Mr Bain advised questions a pharmacist or pharmacy assistant should ask include: “What does the tool do; does it get rid of dead tissue in the wound; does it get rid of microbes; does it help reduce pain?”
He adds that there is no optimal
HEALTH WOUND CARE 45 dressing for a patient who has sustained
a wound, with the situation akin to the construction of a house, which never comes about through the use of just a hammer, but an array of tools for specific functions.
No broad brush strokes
Another pitfall to avoid is the assumption that any wound is simple or straightforward in terms of its treatment, says Mr Bain.
For example, he adds, someone experiences a simple skin tear at home, yet a subsequent tetanus infection sustained during the wound event sees them in intensive care three days later.
However, in such a case, Mr Bain says that if a proper assessment had taken place, a healthcare professional would have realised that the patient had not received a tetanus injection recently, which could have avoided a three-week hospital stay.
This extends to the cleaning and debridement of wounds, he says, which are always specific to an individual and should not even be considered before a holistic assessment is made.
“Once an assessment has been done, a pharmacist or pharmacy assistant has to determine how to clean, debride and dress a wound,” Mr Bain said.
“The right dressing is one that
meets clinical goals, along with the patient’s goals also being taken into consideration. This could mean that the most appropriate dressing isn’t one that gets the wound closed, but rather one that reduces pain and swelling, dependent on the circumstances.”
Swelling in both legs could be
an indicator that a patient has a systemic health issue, Mr Bain says, adding that the pharmacist’s base assessment would identify those who must be referred early to a GP or medical specialist.
“This, once again, makes the significance of a holistic assessment clear,” he said.
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“In the same way, he says
a graze on a 12-year-old’s
knee and a wound in a
similar location on the body
of a 72-year-old should not
be treated in the same way.”
“According to Mr Bain, when
a patient presents with a
wound, a pharmacist or
pharmacy assistant should
ideally follow a holistic
approach.”
RETAIL PHARMAACY ASSISTANTS • MAR 2020