Hi All;
I'm looking to develop a wound care service within our rapid access prescribing service. I have been working with older people for last 2 years so have lots of hands-on wound care experience, but not relating specifically to drug users problems. I need to start with what sorts of wounds present to drug services. Fill me in on the gory details! Already had a bloke with a sock stuffed into his ulcer! Any other information / opinion needed too.

Thanks
Mark F

Hi Mark,
well you would be a very useful chap. I would think you could apply most of your good sense approach to older people's ulcers to this field, as many of the longstanding injecters have problems with varicose veins and varicose eczema following recurrent DVTs. Hopefully generally the arterial supply is quite good. Your skill with dopplars would come in handy for assessing all the DVTs. we see lots of cellulitis from missed and broken veins, which may or may not have associated DVT.

I have one chap who now and then rolls his sleeves up to show me how his arms are progressing, displaying rows of infected sores, but in fact they are not injection related. He has a picking habit, and the wounds are a form of self harming. People are often ashamed to show their wounds, and will self care for longer than your older group i imagine.
Sometimes a fair bit of encouragement is needed before people will shamefacedly roll up the trouser leg, and a routine request to display injection sites can feel like an assault on a very private problem which has been hidden carefully away.

Thanks Judith. Thanks for the tip. Shall do some research.

Another point to bear in mind is that sometimes patients are very run down and infections can quickly turn nasty. I had a patient on a ventilator after having septicaemia. There has been a few cases of botulism spread around the country.
I have the help of the practice Nurses and district Nurses when things get too complicated - like four layer bandages. I am an asylum attendent after all
I think another thing is compliance, when ulcers are nearly better sometimes people drift away so I always give plenty of warnings not to do this. Telling a few horror stories I think helps people to realise how these things can go horribly wrong. I also stress that these things won't get better overnight and that they can take months to get better and always to be careful not to bash limbs. Patients often say they just knocked their leg etc. and educating them about damage to veins blood supply helps them understand why they have ulcers and what they need to do to keep themselves safe and healthy.
I'm also a bit of a Delia Smith on the cheap and educate on healthy simple meals that will help wound healing and general wellbeing.

Oh and make sure you tell them not to be a DIY Nurse and keep dirty mitts away from your dressings !

Thanks Simon
The aim of the service is to be able to react quicky to hold the wound until the client can be seen by a District Nurse or Practice Nurse, and to detect conditions that require rapid intervention. We would as a matter of course get people to go to their provider of general medical services asap; my role would be getting people to engage with those services whilst caring for their wounds in the meantime.
I was reading with interest the cases of Botulism mentioned elsewhere on this forum. Good points about bashing legs and our role in education. There's probably mileage in talking to some of my old DN colleagues and making some wound care information leaflets. Keep you posted

Mark - feel free to contact us at the NFA in Leeds. Our nurses have a wonderful array of wound care "products" and achieve some good results even with rough sleepers.

At a recent SCMG meeting one of our NES GPs commented that her practice nurses were spending a considerable amount of time assessing and dressing leg ulcers and while there is a PCT district nurse service within about a mile of the surgery hardly anyone took the advice to go there and kept returning to the practice nurses. I know some specialist drug services host PCT funded nurses and wonder whether we should be going down this route or should we be trying to develop more flexibility in primary care based treatment?

I think you've answered your own question there Pat. People are much more likely to access their GPs surgery (especially if they attend there regularly for treatment) and isn't this the point of being treated in primary care. Practice nurses should be able to deal with wound care for drug users or anyone else. I don't think other patients should be referred elsewhere unless it was really serious. It should go down the same care pathway as all other wound care in my opinion.

This message has been edited. Last edited by: Jim Barnard,

Hi all, we had plans for a dressings clinic and I wrote the protocols and the flow chart etc. We initially planned to provide an assessment of wounds, provide immediate management then refer to the local dressings clinic. They were very supportive and helpful and even suggested the most appropriate dressings etc. Then the plans melted away, not sure why so I now refer directly to them. In the meantime I provide advice and a clean dressing. Sadly, not alot of clients attend the appointments and fall through the net, hence the ulcer, abcess gets worse.

I think the thing with the ulcers of longterm injectors is that they CAN be really serious, as you put it Jim - so it does require a level of expertise, not to mention a huge amount of patience.

To Sally; That'd be good. Sally N @ LAU said you were doing woundcare. I'll give you a ring for a visit if I may.

To Pat & Jim. Had a brief chat to an old school District Nurse, and she said the provision of wound care services at GP surgeries was patchy and variable. Wholeheartedly agree that Surgery based primary care services need integration with the drug services and we need to be working much more closely. District nurses are streched doing home visits. If the client can get to the surgery, they should be having their needs met there. Normalisation and engagement with the primary care services eh? Call me a revolutionary.
Yours Mark F

This message has been edited. Last edited by: Mark Fuller,

one of our nurses in our needle exchange has set up a wound care thing for people using the needle exchange who dont/wont attend their gp's, she has recently won a nursing times award about what she has set up. Her name is marie white and if u want to contact her our telephone number is 01706 702170 and ask for marie. hope this helpful

Mark,
You are right that if patient's can get to surgery they should. I wouldn't say that the District Nurses are more stretched than the practice Nurses.
I would build up a good relationship with the tissue viability Nurses in your area they are great for dopplers and ours will come to the surgery to give advice.

I wouldn't say that either. I don't know any practice nurses. Funny you should mention the TVNs. Just found a big bunch of blurb from them from a course last year.

Another question. What is the situation with holding stock in the clinic. Someone here said there might be issues with the "Medicines Management" people at trust HQ. Bear in mind we'd probably be holding a couple of different sizes of Tielle, everything else would have to be prescribed (as far as I understand things at this point). Thoughts?

I'd get an account with a local Pharmacy to give yourself some stock, a drug comapany advisor may also be able to get you some info. and samples.. Then you can replenish from the prescription for each individual patient.

just watch out a bit for the drug company "advisor" (a.k.a. "salesperson") There's no such thing as a free piece of Tielle.

You may also have local protocols and the TVN's will no doubt give you copies.

do give us a ring Mark, Tracey has local protocols etc and will tell you about stock.

Will do in a couple of days. Assignment deadlines looming @ LAU.
Mark