Objective:

• Optimising ability to heal.
• Psychosocial Support.

Considerations for shared care:

• Ensure the patient is happy to share the care, sleep is an important part of a patients wellbeing.
• Are they able to get into bed or sleeping in a chair?

Red Flags:

• If the patient is unsure or anxious about sharing the care.
• Pain on climbing stairs, wound leaking too much will soil bedding, wound too odorous to share bed with partner.

How to overcome those Red Flags:

• Spend some time educating and discussing concerns, it may be that shared care is an option later and not right now.
• Review analgesia, OT referral to assess equipment, appropriate absorbent dressing and timely dressing changes.
• Odour absorbing dressings (is it due to infection)

Objective

• Optimising ability to heal.
• Risk factor performing shared care task.

Considerations for shared care:

• Will the task affect their breathing?
• Is there something we can ask them to do that will optimise their respiratory function to increase oxygenation for wound healing?

Red flags

• Lower limb wounds where patients are sleeping in chairs.
• COAD can have a negative effect on healing.
• Consider a patient’s mobility if concerns regarding breathing.

How to overcome those Red Flags:

• Education about the importance of going to bed at night.
• Referral or discussion with respiratory specialist team to support and help optimise.

Objective

• Risk factor performing shared care task.
• Optimising ability to heal.

Considerations for shared care:

• Is the patient independent with his/her mobility?
• Mobilisation for patients with a lower limb wound can support the circulatory system and improve the ability to heal. Patients unable to mobilise can perform simple foot and ankle exercises to help.

Red flags

• Will performing shared care put them at risk of a fall?

How to overcome those Red Flags:

• Patients unable to mobilise or at increased risk of falls can perform simple foot and ankle exercises to help the circulation.
• Consider a carer / family member to perform task if falls are a risk.

Objective

• Risk factor performing shared care task.
• Psychosocial Support.

Considerations for shared care:

• Can the patient communicate their needs, understand instructions? And will they be able to obtain help when required?

Red flags

• Patient with speech impairment or cognitive impairment that could result in problems not being highlighted.

How to overcome those Red Flags:

• What support network does the patient have?
• Is there a family member or carer who may be willing to take on this responsibility?

Objective

• Optimising ability to heal.

Considerations for shared care:

• Consider the patient’s diet and their hydration, is there any changes your patient can make?
• Does your patient drink enough?
• Consider if the wound is having an impact on appetite or ability to eat.

Red flags

• The risk of putting extra stress on your patient from a financial perspective, increase in food shopping bills, ability to prepare and cook the new diet.
• If the patient drinks more, have they got the ability to get to the toilet?

How to overcome those Red Flags:

• Consider a referral to a dietician.
• Are there any supplements that could be prescribed to support a clinical outcome of wound healing?
• Consider the location of the toilet, can things be moved to make getting to the toilet easier? Or would a commode or urinary device be more suitable / safer for the patient?

Objective

• Psychosocial Support.

Considerations for shared care:

• Consider the type of dressing / bandaging, is it in line with the patient’s needs?
• Where is the wound and is it having any effects on intimacy?
• The effect the wound may have on body image and relationships.

Red flags

• Does the patient prefer the dressing to be well hidden? Does the dressing impede intimacy and affect their relationships?
• Leaking wound, odour, needing to rely more on partner for help with personal hygiene or wound care.

How to overcome those Red Flags:

• Has the patient discussed their wound with partner / family? With support, could this help to make wound / dressing more acceptable?
• Discuss patient’s concerns and address or seek advice and counselling.

Objective

• Optimising ability to heal.
• Risk factor performing shared care task.
• Psychosocial Support.

Considerations for shared care:

• Does the dressing impede work or play?
• Clinic appointments means potentially taking time off work, maybe relying on someone to take them.
• Is the wound stopping them swimming or going to the gym or attending their usual clubs?

Red flags

• Does the wound prevent working and social interaction?

How to overcome those Red Flags:

• Can a discussion with work take place to discuss the wound and an area be provided for dressing changes?
• Discuss what social activities can be achieved whilst the wound heals

Objective

• Optimising ability to heal.

Considerations for shared care:

• Does excess moisture effect adherence of dressing?

Red flags

• Dressing is difficult to adhere to skin due to excess moisture.

How to overcome those Red Flags:

• Can underlying issue be treated or can products be used to dry area prior to application or to assist adherence?
• Education for the patient on how to achieve a good seal with the dressing selection chosen.

Objective

• Optimising ability to heal.
• Psychosocial Support.

Considerations for shared care:

• Can your patient take on the responsibility to wash the affected area e.g. lower limb prior to dressing changes?

Red flags

• If the patient is unable to reach affected area, it may create a risk of falls.

How to overcome those Red Flags:

• Is there a carer or family member that could support?

Objective

• Risk factor performing shared care task.

Considerations for shared care:

• Do their home surroundings enable them to complete clean and safe dressing changes?
• Are they physically able to perform the task safely?

Red flags

• Is the dressing going to increase risk of falls or be a trip hazard?

How to overcome those Red Flags:

• Is there an alternative type product that could be used that will improve the patient’s independence.

Objective

• Risk factor performing shared care task.
• Psychosocial Support.

Considerations for shared care:

• Does incontinence effect application of dressing product?
• Ability to apply dressing due to reach and position?
• Is the patient taking regular analgesia?

Red flags

• Patient may not feel comfortable asking family / carer to support.
• Embarrassment in relation to incontinence.
• Will the analgesia cause the risk of constipation?

How to overcome those Red Flags:

• Talk to the patient about the challenges being faced, offer support and solutions.
• Offer support in relation to incontinence understand the issues and align any care plans so it incorporates elimination.
• Could a carer be involved?
• Ensure the patient has the most appropriate analgesia and bowel management regime.

Objective

• Optimising ability to heal.
• Psychosocial Support.

Considerations for shared care:

• Does patient have known mental health problems that may put them at risk from performing shared care?
• Does the patient understand their diagnosis in relation to there wound?
• Is the patient concerned about dying or is the wound management palliative?

Red flags

• Could the dressing be used to cause harm?
• Patient may be frightened and not fully understanding of their condition

How to overcome those Red Flags:

• Is there an alternative dressing that reduces the risk?
• Consider referral to other service providers for support e.g. mental health teams.
• Ensure clear communication is achieved, so that the patient can freely ask questions and feel comfortable about any concerns or worries they may have.