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Case Study
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Principles of wound bed preparation using the concept of TIME Alison Johnstone, RN, North Glasgow NHS Trust, Scotland, UK An important aspect of chronic wound management is to establish conditions that will stimulate healing. The principles required have been described in the concept of wound bed preparation and while guidelines are available to clinicians for wound management these are frequently not followed or only place emphasis on specific components of wound care. Using a framework to assess a chronic wound and develop a wound management rationale will help to ensure best practice This case study will report the outcome of quality, cost-effective wound management using the principles of the TIME framework A complex wound was selected in a compromised patient with diabetes who had developed a grade 4-pressure ulcer on the outer aspect of the left heel The ulcer measured 6cm by 5cm and was 4cm at its deepest point. The surface was necrotic and covered with dry eschar with spreading erythema to the peri-ulcer area..The ulcer management plan was prepared within the context of the TIME framework acronym. This allowed application of the principles of wound bed preparation to achieve full healing over an 8-week period Factors considered using the TIME framework:..-Debridement of non-viable Tissue.-Management of infection/Inflammation.-Moisture imbalance.-Wound edge advancement..Over the 8 weeks of treatment, wound healing progressively improved showing healthy granulation tissue formation and evidence of migrating keratinocytes. Ulcer size reduced and progressed to healing despite underlying disease processes Applying the principles of TIME enabled us to provide a systematic approach to the management of this wound. Not only did it supply us with a framework to guide assessment but was also found to be cost-effective in implementation. All clinicians were able to follow the aims within the four components of TIME to achieve quicker healing rate. Dowsett C, Ayello E. Time principles of chronic wound bed preparation and treatment. Br J Nurs. 2004;13(15):S16Ð23 Falanga V. Classifications for wound bed preparation and stimulation of chronic wounds. Wound Rep Regen. 2000;8:347Ð352 Moore K. Moist wound healing: achieving a balance. Wounds UK. 2005;1(suppl 2):1Ð36.. |
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