Page 48 - RPA May 2020

46 HEALTH WOUND CARE
FROM PAGE 45
How to deal with a bleeding wound
If a wound is bleeding, a pharmacist or pharmacy assistant should determine such factors as whether the bleeding is due to the type and depth of the injury, or what part of the anatomy has been affected, Mr Bain says.
He adds that among other factors to establish is whether the patient is taking a blood thinner, such
as aspirin, warfarin or novel oral anticoagulant medication.
Many older people are taking warfarin, levels of which could be too high, causing wounds to bleed, Mr Bain says, while substances and medications such as fish oil, turmeric and steroids could cause prolonged wound bleeding.
“Infections can also cause bleeding, so here too, we see that nothing is necessarily straightforward or simple,” he said.
Self-management
As to whether pharmacists and pharmacy assistants should promote self-management, Mr Bain says this should be specific to the situation
– some people may be capable of self-care, while others, especially the elderly, may not.
He points out that a large proportion
of people aged 65 and over must manage to the best of their ability, living at home, often with dementia and/or various other types of cognitive impairment.
He advises pharmacists to keep records of the age and sex of patients and measurable information about their wounds.
“The size of wounds, the type of tissue and the presence of limb swelling should be measured at first assessment and weekly, because one of the most important things a pharmacist or pharmacy assistant can do is collect measurable wound data over time,” Mr Bain said.
“Once pharmacies collect this kind of data, they’ll be able to ascertain what sort of medications, dressings and compression items they require in general.”
Array of treatment products
One of the greatest problems with wound care is the vast choice of products offered as treatment, including a plethora of dressings, says Mr Bain, adding that, to exacerbate matters, people often believe that when a wound doesn’t heal, the cause is an incorrect dressing.
“This makes it hard to make a decision as to what to use and when to use it,” he said. “As per usual, dressings and
other products have to be considered in the context of who the person is and the outcome desired.
“If dressings are seen as tools for specific actions for wounds at specific times, then all that is required is for a pharmacist to ask what they need to do for a wound at that point in time and what dressing can do that job.
“It also comes down to things like the patient’s socio-economic status, what dressings are available, the patient’s choice, the level of comfort that the dressing provides, and
the like.”
Antibiotics for wounds
Most wounds don’t require the use
of antibiotics, says Mr Bain, yet if
these medications are shown to be appropriate based on a tissue sample (wound swab) they should be used for the shortest amount of time possible to gain their desired clinical effect.
He adds that a big problem is
the use of antibiotics without the knowledge of what may be growing in the wound. Such a scenario has resulted in many people becoming resistant to antibiotics.
“One thing that we haven’t been taught to do well is to take a good tissue sample, which should generally be done before a course in antibiotics is commenced,” he said.
RETAIL PHARMACY ASSISTANTS • MAR 2020