UnWRapped
Wound Care UnWRapped is our new weekly podcast dedicated to peeling back the layers of wound care and addressing the questions that too often go unspoken. Each episode explores the evidence, the challenges and the uncomfortable truths behind practice, policy, innovation, education and patient experience.
We bring together a diverse range of voices from across the field (clinicians, researchers, educators, industry leaders, innovators and policy makers) to facilitate honest, insightful and thought- provoking conversations. Guests share their expertise, experiences and perspectives, offering listeners a behind-the-scenes look at the realities of wound care.
Episodes cover a wide spectrum of topics, including patient advocacy, clinical practice, emerging technologies, education and training, economic and policy consideration and more. Our goal is to uncover what’s working, what isn’t, and what needs to change.
UnWRapped
Getting Wound Assessment Right: The Clinical Mistakes Keeping Wounds Open with Kerrie Coleman
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In this episode Hayley Ryan is joined by wound care nurse practitioner Kerrie Coleman to discuss the fundamentals of effective wound management. Drawing on decades of clinical experience, Kerrie shares practical insights into wound assessment, dressing selection, common clinical mistakes, the importance of education and how we can challenge ageism to deliver better patient outcomes.
Whether you're working in aged care, community nursing or acute care, this episode is packed with practical advice you can apply in everyday practice.
Resources Mentioned
Best Practice Guidelines: Wound Management In Diabetic Foot Ulcers
Wound hygiene – Wounds International
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Welcome to Woundcare Unwrapped, the podcast that peels back the layers of wound care to uncover what's working, what isn't, and what needs to change. So let's unwrap it. Kerry Coleman is a nurse practitioner with over 40 years in nursing and more than 30 years specializing in wound care. She helped establish the Skin Integrity Service at the Royal Brisbane and Women's Hospital and now leads all wrapped-up nursing, delivering expert wound care across community and aged care settings. Welcome to this podcast, Kerry.
SPEAKER_00Thank you very much, Haley. Thank you for inviting me.
SPEAKER_01We are very excited, and I'm sure the audience are going to really enjoy what you have to say. So why don't we kick it off, Kerry? 40 years in nursing. Can you tell us a little bit about your time and maybe why you entered into the world of wound care?
SPEAKER_00Um, I started nursing when I was 20, and I'm about to have my birthday tomorrow, which actually makes it 50 years of nursing all together. Um I've always wanted to do nursing. My father didn't want me to do nursing. He said I shouldn't be a handmaiden, and certainly nursing has grown over the years and has become its own specialty. Um I uh did different things up until I had my children. I'd started um my training and that, but I got married at 20. Too much fun. So did my enrolled nursing and in and out of all different varieties of nursing: aged care, palliative, acute care, aged care, wherever I could get it in that point. And then um someone just pulled me aside and they said, Oh, for heaven's sakes, do your registered nurse training. And that's when I went back to university. And it was when I came out of doing my university or cot started off as college training. When I came out of that, um, it was when you had to apply for uh nursing positions uh for trainee, um, for um postgrad traineeships within nursing. And of course, first time ever in history, there was absolutely no nursing. We New South Wales is broke and they were very limited. Anyway, managed to find a spot in Vascular at Port at Prince Henry. Loved it. And I think it's like if you talk to any nurse, you will fall into or eventually find what makes you tick in nursing, what is your bliss? What's just normal and natural? Just you want to go to work. Loved vascular, and that's where I came into the world of wounds. I came into wounds when um hydrocolide was first being released. Alginates first released, hydrogels, first released, and then foams, and so right there at that beginning, um, dragged into that new realm of wound care. Amazing ride it's been.
SPEAKER_01Oh, look, and that's just amazing to hear, Carrie. I mean, 40 or 50 years is just an absolute amazing legacy that you have offered the community, and to go from enrolled nurse to registered nurse to nurse practitioner, it just shows that there is ways forward and well done to you. So I want to ask a couple of questions. You know, you mentioned the sectors you've worked in, so you've worked across public health and now you run your own service. So, what's the biggest difference you see between system-based care and real-world community wound care?
SPEAKER_00Huge. I have been on the biggest learning curve for the last three years. I was extremely naive. You would think at my age I would be more aware of potentially the different world I was going into, was not prepared. Um, I was a protected species. I worked for 30 years in a large acute facility with anything I needed. Um, certainly not staffing, I would like, but I had um I had services around me. If I needed bloods done, x-rays done, if I needed a biopsy, if I needed to deprive, it was there. I opened up my cupboard, everything I needed was there. Um, my pharmacy cupboard, it was there. So it was um one of those things that um you get into this level of compliant uh complacency that you don't realize what it's like in the real world. And when you're in the real world, then suddenly I don't have that covered, I don't have that pharmacy um behind me. Um certainly more freedom as an MP than what I had in public care. So what I could prescribe or what I could order, whether I could do referrals, very, very restrictive. In community, totally different world. But then I had to work with what they had. Um and community and aged care worlds apart as well. So I've had to learn a lot about rules and regulations and then work with what they've got. And this is where I think all my years of experience in nursing, I've been able to go back to a lot of well, what would I have done 20 years ago? How would I have managed this if I didn't have all these fancy dressings? Oh well, we would have done this, so it's been very helpful, but big difference.
SPEAKER_01Really good reflection. So let me ask some perky questions now, Carrie. Um, what are clinicians getting wrong most often when it comes to wound assessment, in your opinion?
SPEAKER_00Oh man, where do I start? You know, I I went in all guns blazing. I was going to create new systems, we were going to get new cut care pathways in place, get the education rolling, and um, we were going to look at, you know, how we could improve the lot for the residents. Um, this was in aged care where I actually very first started, and um and within the year I realized that we were struggling. Um you had people who were keen, who wanted to learn, but then the turnover is huge. So I could spend six months on training and getting people to to actually want to do wound care, and then I turn around and they were gone. So, in that period of time, what I found is that they're not prepared for wound care, is that it all goes back to our training, and that is where a lot of the issues remain. So, for a lot of these nurses, they come directly from their training into aged care now. There's no uh little time out in a hospital or somewhere like that, they're all directly coming from uh our university training and they're coming in under skilled. They're taught assessment, but they're not taught it in uh in enough depth. And they're also taught about scope of practice that scares them. So when you start talking about assessment, they go straight back and say, but is this my scope of practice? Is it am I covered to do this? So that's the ones that we are training in Australia, but then let's look at the ones that are coming from all the other countries, all these other beautiful, wonderfully experienced, educated nurses who English is their second, third, fourth, fifth language. And they're coming in and their level of education is actually quite different to what the Australian level of education has been, and their work care that is in their homeland is very, very different as well. And it's very standardized to more natural therapies or very basic therapies. So, and again, that lack of having been trained how to do that assessment, they their their main issue with doing that assessment is actually for some of them is wanting to do the assessment. That they feel that there is a benefit in doing a wound assessment. Some just get in there, have a look, put a dressing on, write it down, that's the end of it. Others want to see the story and want to see if they can make a difference. Um and I think it there is that gap that's in there between the ones who want to make a difference and the ones who don't. So assessment is is a very sensitive topic for them. Often the junior RNs, it's mainly the enrolled nurses in some aged care facilities doing health care as well. So we've got to keep that in mind. Um, but the RNs are the leaders. Um, they will then put it on to the clinical nurses, so the senior clinical nurses. Now they're not time poor, in fact, of that they spend a lot of time with the patient, but they're time poor because they're behind a desk. They're behind their computers, they're putting together all the assessments, they're keeping all the documentation up to date. That meets all the regulations, that meets their funding requirements. And so they may have the skills or the experience to assist with or to expand on that assessment for the junior nurses, but it's getting their two timing schedules to meet.
SPEAKER_01I think there's a oh, it absolutely makes sense, Kerry. You you've raised some very valid points. I mean, even in the hospital setting, we can bounce off our colleagues. Uh, we've got doctors if we need to, we've got allied health if we need to, but in an aged care sense, you might be the sole RN or just a few RNs. Um, I think bringing up compliance is absolutely crucial. Have we got aged care wrong when we're seeing these highly experienced leaders in aged care now strapped to doing administrative tasks instead of being out there and delivering that wound care practice that they actually know well? Instead, they're directing, and that's not necessarily supervisory directory. That's giving suggestions and and um that person that could even be a new grad, as you mentioned, outdoing it on their own. So some very valid points. Do you think we're actually overcomplicating wound care for some degree?
SPEAKER_00Oh, absolutely, and I think um I think there's a lot of places that they get their information from, um, and most of it's company driven. So um they'll have been um companies who come that are supplying the consumables to their organization and they'll run education sessions for them 20 minutes, and and a lot of that time it is very basic. It doesn't really give examples, it's not led by uh by uh a person who's actually physically doing wounds or involved in making those assessments, um, and then it's by dinners or by day education, where they do get a lot thrown at them, and so they come away very confused. So, and then depending on who's been, if you have had an experienced nurse in there that has had some say in setting up their cupboard or what dressings that they should be having in there, so sometimes they can actually end up with um quite a variety of dressings that all do the same thing. So they don't know what they should be doing, they don't know um whether you know they should use something to absorb or something to donate. But what they don't know and what nobody pushes is clean the wound. It's the basic.
SPEAKER_01Absolutely basic, Carrie. As we always say in our world, in our very niche world, is clean it like you mean it. Um we know that it's so important. I mean, confusion is so relevant, what you just brought up. You know, the amount of aged care nurses and community nurses that have said to me over the years, oh no, I've actually done a course in wound care. And when you actually dig into that, oh, you know, this industry partner provided this training, they came and did a little workshop that was an hour. That doesn't cut it. Now we need our industry partners. I'm not certainly saying we don't, we do, but there's a time and place, and if we're confusing the sector, we're not helping. So let me ask, what's one clinical practice you see regularly that makes you think this needs to stop?
SPEAKER_00Oh, woven, woven pad dressings. Oh Lord save me. If we could take the one thing off their shelf and uh never to be seen again would be a woven pad uh dress, island dressing.
SPEAKER_01Yeah, so maybe explain that a little bit to our audience that don't know what a woven dressing is.
SPEAKER_00So the old we often know them as um prima poles, if we'll see. So they're um uh like a big band-aid, they use woven tape with this as adhesive and has a non-adhesive pad in the middle. And you'll often see them used after post uh post-operative for little fixes, and they're not designed to be on any sort of fragile skin, and they're certainly not designed for skin tears or for leg ulcers or for pressure injuries. They should only be used for short, nasty, dirty little cut it out. Here's a suture, let's protect it for 48 hours and then you can take the thing off. So, but they are the life bread dressing in aged care.
SPEAKER_01Yeah, and probably because it's cheap, so it's accessible. Um, but we know in our industry it does not help. I always say keep it in the first aid kit because that's where it belongs.
SPEAKER_00That's exactly right.
SPEAKER_01So, um, from your experience as well, Carrie, what are the most commonly missed or underlying causes of non-healing wounds? Why why are we still seeing wounds that are one year old, 15 years old? Like it's beyond us. Why are we still seeing that? What's being missed?
SPEAKER_00Um, I literally just before uh coming on here this afternoon, uh, was on site to see a man who's had uh leg ulcer, which has been deteriorating since he join uh went into the facility, wasn't improving before it either. And um it's just getting worse and worse. And when I looked at it today, um no compression and he needs compression, and that's yet another topic to look at. Um, but he's got dry, dry skin, um, and he's got this area that's around his lower gaiter, almost circumferential of this red raw skin. So I take the dressing off, and and it was a chulgra with a non-adherent pad, so like a Telford-style double-sided non-adherent pad, which stick like crazy, and um, and then some combine on top of that, and then blue line, uh bandage, and then blue line. And when I take it off or soaked it off, and I spoke to the nurse doing it, he had been sent to the hospital yesterday because they were worried about it being infected because when they do the dressing it bleeds. Okay, well what do you do on the dressing? Oh we just wash it down and we just put a non ad a non adherent pad on. And I said, So nothing else, no. So the had no understanding of venous disease or lower limb, no understanding of actually the dressing that they're using is inflaming the situation. That the reason that when they took it off yesterday when the sun was there and it caused a lot of bleeding because it was stuck and it was the trauma of taking it off that made it bleed, and actually it's inflammatory, not infection, and we just need to manage this wound, right? So they're unable to see and understand lower leg pathology. Sometimes they're good and they'll say it feels cool, so something's not working, but more often than not, the bandages are just around the gator area, causing constriction. So lower legs is very, very poorly done, um, and the only dressing they seem to know is a tool or something like inodine, so you know that it's very limited. Pressure injuries. I was asked today to look at a pressure injury to confirm that it was a pressure injury, and it was, and it clearly was. So there's still a lot of confusion out there between well, what actually is a pressure injury, and you would think that in 2026, with everything that's around, all the training these people get, the the um the that they've got to meet all their federal um things, status things, and that education should be part of it. They still don't get pressure injuries, and they said, but it's a skin tear gone bad. And I said, Well, no, it definitely is pressure, or it's IAD, and it could be IAD and pressure, so they're still not really looking or trying to understand possibly what that wound is caused by. So they're the two worst I see. It's pressure injuries, legos.
SPEAKER_01Yeah, some good points, Carrie. And so not only are we hearing um and seeing in practice a lack of educational knowledge around wound care, but we're not even getting the etiologies right at all times. Now, in fairness to those new generalist clinicians, it really stems back to how are we providing that education, that training, and then assisting them to apply it to practice? And I think that's one of the key drivers that often gets missed. Um, what's your approach when a wound is not progressing? How how quickly should you recommend that that wound is escalated and referred on? I mean, one great thing that came out of the um aged care standards that changed uh in November last year is they're now required to refer on. So wound specialty is a need and it's good to see that actually embedded. Uh what's your thoughts there?
SPEAKER_00It's all about the timing. Um, often I uh I now go to my sites every three to four weeks on a regular basis, and I'll have these. And occasionally they'll throw this patient in, they'll say, Oh, we forgot, we've been forgetting to get you to review this. And when you look at the Lego, and you think, Oh Lord, how how long? Well, and um, and so for me, then I'm directly on to um the GP. So the pathway through the aged care is quite a convoluted pathway. So um even if I go directly through the family, we involve the family, I still have to do my pathway through the GP because they're deemed to be that you know key person in their care. Um trying to get hold of that GP is sometimes tricky, and then getting that GP to agree that further um specialty review is required and what that specialty should look like. Um, and often I have to get the family to intercede and back up what I'm saying to try and get that path away along the line. More often than not, by the time I see a wound and I think, oh glory be, we've got to do something about this wound, and now the nursing staff have identified that this wound is not healing. So a really common one is skin cancers. So you BCCs, your SECs. On arms, ears, faces, backs. And they'll say, it's a non-healing wound. We've had everything on it. It's not getting any better. I'll review it and I'll say, Well, that's a skin cancer. We need to look at uh biopsy, we need to move this along. Um, often some of the GPs have their own MPs, the generalized MP. So that is my first port of call is to them and say, Um, you'll need to send out referrals to to uh a dermatology or somewhere, plastics, wherever. Um, or I am happy to do so. No, no, no, we will. But those the nursing staff have probably for months been trying to escalate that wound. And and it sits in that pot with the GP for quite a long while. And often when you get to talk to the GP, they go, Well, at their age, they'll probably die before this kills them. And I said, if only that was true, it's not. And um, and so there is this I actually it's one of the things that just breaks my heart so much in aged care is this blindness that seems to be there from our medical uh partners of uh skin cancers and um not responding to that care. Or even when you send them to a dermatologist, it gets identified. The dermatologist will turn around and say, uh, we'll just watch it. You know.
SPEAKER_01So I I I feel your frustration actually, and I'm gonna dig a little bit deeper on this one because we all see it. And let's name it, let's pull the elephant out of the room. It's ageism. Yes. You know, it's not only just our cancerous wounds that we hear are non-healing, but it's some wounds that are taking a long time. You'll often hear clinicians talking about nurses and doctors and other members of the healthcare team say, it will never heal. I've heard families say, it will never heal. At what point do we change the ageism status quo? You know, I've had patients 92 years old go and have a successful operation to get some good blood flow in their lower legs and get back onto healing at 92. So we have to stop doing that. What's your thoughts there?
SPEAKER_00Totally agree. Do you know? Um, quite a while ago you presented on a challenging patient with a pressure injury um uh up north, and and it was all everyone that was the too hard basket. We can't do this, it's just too hard. They won't do this, they won't, they don't want to do that. Um, and you forged a way through and you are successful in achieving resolution for that person. Aged care is very much um along that lines, it is about um somehow we have to look at how do we make these people responsible and not go um they're aged, they're old, we we we can't do anything to help for them, but get the families to be on site, not all families will, not all families have the financial capability either, but to take them in privately. Now I have found every uh person and family that I've gone through for the residents that I really worried about, um, they're on board, they take them in privately, they've all gotten their surgery, they all get the skin cancer cut out, grass put on, um, you know, stents put in, um, even hyperbaric. So, you know, it it is something that um we need to think about. They they say that obesity is the last standing, you know, thing that you know we can all have a go at people for, but actually I think ageism is out there because it's the one thing that we do if you look at all the jokes that come up, all the memes, but it comes up for old people. And me being on that end of it now, um, it is starting to worry me. And it's something I think that we need to take back into our training, and we need the um the acute sector to start seeing that um people with um on the the older side are are just as likely to have a good response for treatment and should at least have an initial go at it, and then let's move on. But you've then got the constraints of the acute sector, public acute sector, especially in Queensland, where you've got bed blocks. A lot of our aged care are sitting still in acute sectors. Now, just before I retired, we had a patient that was um blocked in um in our stars, in our rehab sector, couldn't get them out into uh a permanent aged care bed, and they just kept like a bit like the mouse on the wheel going around and around. But while they were in, they had no one um diagnosed um skin cancers that were on the planning list for plastics to do, but because they were an inpatient, they kept having their surgery or their outpatient appointment put off because they were inpatients. There was no ability to fast track that surgery from a rehab point of view and get them back onto into that acute care without actually discharging them, putting them in the outpatient, getting a surgical booking and bringing them back in. So I think that the system is built with um a lot of breaks set into it so that it can be controlled from a management point of view that does not benefit the everyday person. And in reality, is this isn't just for the elder person, the older person, this is happening for much younger people as well. So I think that what we what we all have to do, and anyone who's listening to this or watching this, is you have to be that person that pushes for your patient. That you say, actually, no, that's not good enough. No, and you need to, if that GP is not playing the game, you put it on their list every week.
SPEAKER_01Well said, Carrie. We always talk about being an advocate for the patient. Um, we've got some way to go when it comes to ageism. Um, you know, I'll never forget this patient I had only last year, actually. He was certainly deteriorating, he didn't have long, he was on the end-of-life pathway, had all of his faculties, and he wanted to continue the physiotherapy of his lower legs because he had lower leg wounds, and that just meant some basic contractual um movements with the physio once a week, and it was put to him that he didn't need to worry about that now, it's it's um not really needed, it's not gonna heal. And I remember sitting in that room and hearing this patient turn around and say, and this was his exact words, and it stayed with me true to this day. I know I'm dying, and I'd like to try until that day comes. And I just thought we need to be that change agent, we need to be that person to advocate for our patients. So let me go back then to around product selection, and we've spoken a little bit about some things that we see. How often do you actually see in practice inappropriate product selection?
SPEAKER_00Every day. So today, just Justin, today, I saw one wound that was wet that they were using um a gel on, making it wetter, and then I went to the next person and they had um um a gelling fiber on their wounds that had been on there for three days, and it was dry as a chip. And you know, um so they there is this thing that they all get dressings that they like, so you'll find that there's two, three dressings that they will use constantly because um they know them or they've had some success with them before. But it goes back to that very first question of do they do their assessment? And because they don't really ever uh it's it's more often than not the the resident's not getting a diagnosis, so we don't know what the atiology is, and so they're just going by what it looks like, and so often it might start off wet, that's why they chose the jelly fiber, but then it's moved on. But they don't understand that that assessment is at each dressing change, and you just don't keep going on. So often there is that confusion, when do I wet it, when do I dry it, or when do I actually do nothing? You know, there are some times where you we're all solved the dream of moist wound healing. But are there is that the appropriate thing for every single wound every single time? Comes back to that assessment again. So um they do like it, but then I go to other facilities that have absolutely nothing. So I've got two facilities, same company, right, same group that uh that own them. Um one have almost nothing. A chilgra, some non-adherent, some some combine. Maybe if I'm really lucky, I'll find a paste bandage, um, or a bit of gel or something. But and then I go to the one five minutes down the road, around the corner, literally, um, and uh they've all stocked. They'll have their silicon foams, they'll have their gelling fibers, they'll have um superabsorbent dressings, they will have you know um some antimicrobial style dressings. So, same organization, literally down the road five minutes, but it's run by different facility managers. So, how that budget is run or how what they keep on their shelves is often coming down to what the cost of running that facility is, and how um if that facility manager is trying to curtail costs and come in on budget, so then the first thing they cut are the worn consumables because they're not allowed to cut the the uh continence aids, so they've got to supply X amount. Well, mind you, they do reduce, so they don't get enough in their little packs. Um, but um, but the the very first thing that they can put a um are slowdown on are those consumables. So with that movement that I talked about before, they're a transitory lot. Um I went around on rounds today with a girl that you know I had seen up the coast, so she's now down at Strathpoint, so you know um they they go from one facility, one site to another site that all has different consumables, different level of consumables. And so I think that they get quite confused by it. Then of course, whoever is their provider, whoever their distributor is, will come in and give education based on what they want them to buy.
SPEAKER_01And look, um, I I don't even think we can isolate that to aged care. I see it in community, I've seen it in hospitals. It's kind of widespread. The first thing to go is the dressing products. You know, one of the things that we are always trying to really focus on is that cost first quality. I mean, yes, you can put the cheaper dressing on today, but how much longer are you going to extend that wound for? Which in effect costs you more money. But getting that across sometimes to the higher level governance teams, procurement teams, and the real decision makers is quite a challenge, you know. Well, if you could speak to someone in a governance team today, or someone in power in any of the sectors about stopping dressings when they need it most, what's some advice you'd give?
SPEAKER_00Oh man. Well, I've been down this road. So working for 30 years at the Royal Brisbane, there wasn't a day go by where um budget time's coming around. And so it was always we've got to try and look at how we're gonna consolidate our consumables. It's always addressing consumables. So I've had many a time I've had to sit down and say, you know, yes, things can be can be changed. Yes, we need to be more proactive, yes, but what it takes is looking at what what is actually happening, doing those analyses, seeing what our gaps are, seeing what our bad behaviours are. So um this came up very in that first year when I started in um aged care, and I sat down with them and I said, You've got some very expensive dressings, and you've got some very cheap dressings. They tend to all use the cheaper dressings, and I said, So I've been and I gave a case study. So I'm you know me, Haley, I'm uh the the power of a story. There is nothing um more uh emotive and moving than putting up a really good case study, and um, and I have delivered quite a few over my years working in in public health to try and get across to the bean counters the importance of what we do. Not that I made don't think I made a lot of difference, but this day I was able to meet with the board of the group that I was with, and I had shown them a where they'd been choosing uh a simple dressing, the adhesive, non-woven but the primapore to call it anything, on this wound, and the wound wasn't the dressing wasn't being changed daily, it was getting he was having a daily shower, so it was getting wet, they were drying it, getting wet, drying it, and by the end of a couple of weeks they're still there, it was fluffy, it was grey, the edges were curling, and so we had taken photos of this dressing, the timeline, this dressing, did a journey, and uh and then we took it off, and what was underneath that dressing was absolutely appalling, just dreadful, and you could you could see that that's what it was going to look like, and when we sort of showed that case study to them, and I said, So if you want them to reduce using a more appropriate style but more costly dressing to use something that shouldn't be used, basically, in any facility. So what you've got now is a wound that is going to take a lot longer to heal. It's gonna cost you a lot more to heal. In fact, if we had at this period of time put on the more appropriate dressing, it would be resolved now. I said, But where the rub comes is the education and getting them to know how to use that expensive, the more costlier dressing, not expensive, because that's not a good term. Um, but the dressing that has the the higher price tag on it, how to actually use that appropriately and not use it like a band-aid, so that you get that full length of time. But you know what? It all comes back down to assessment. So, how to do that, but it was really good because I was able to, in that facility, get those dressings off the shelf.
SPEAKER_01Sometimes the real stories can bring it to life for people for sure. And I guess the flip side of that is, you know, uh there's nothing worse than hearing that, you know, they they implemented some great costly um silver dressings, and next minute every patient has a silver dressing on. So this is a shout out to our clinical colleagues to think about when do you actually need that antimicrobial dressing and when don't you? Because the next thing that's gonna happen, we know you're not gonna be able to find it in the cupboard because it's locked up in the manager's office because they don't want to keep putting the expense out. And who misses in this case? It's the patient. So you're spot on. All right, so one final um major question I have for you, then, Kerry. You know, we've had a such a great conversation today, but what does good wound care actually look like then in the community setting?
SPEAKER_00Um, simple. You've got to keep it simple. So when I've been working in the community, more often than not, um especially for NDIS, is that they don't have nursing in their package and they get discharged home with a pressure injury or a wound breakdown post-surgery, and it's gonna be yet another six months before their package gets reviewed, or they'll try and move some funds around, but it's not always capable. Um, they're able to do that. So, more often than not, you've got to work with family and um and with the carers. And so, one thing I've learnt in community when I've got to work with family and carers is that if you don't keep it really clear and simple, no sandwiches, none of those things, um, and rationale. So if you do this like this, this is what it should look like, this is what it should happen. Then you put this on, this amount like this, and you've got to be very explicit, very um and give um, and if that it should do this by this time. If it doesn't do this by this time, give me a call. There's a problem. So you've got to give them information, same in aged care. It is about keeping it simple. It all comes down to cleaning your wound hygiene, cleaning of the skin. They're scared to clean the skin, they see that that's outside their scope of practice. I can't peel off that dry skin, it might hurt them or it might make a wound. And I said, No, if it wants to come off, it'll come off. So it's teaching that clean skin is good skin, and that we need to be very aware of that. Um, and so I believe that if we start cleaning our wounds, giving them good cleaning, giving the patient lots of love and making sure that they are fed and hydrated, then and then simplifying looking at that wound, wanting to know if you've got to wet it or dry it, or protect it. And think of it really, really simply. And when you put a plan in place, be very, very uh explicit in what you want that to do and why they're doing it, how they're doing it, and um and what what is the expected result and what isn't an expected result so that they understand because they don't understand. So the one thing I do know that they do brilliantly is follow your notes. They will follow them to a T. Um, but if your notes are ambiguous, so will their care be ambiguous. So the more um the more concise you are in your documentation, um the better the outcome for that patient. But look at what's on their shelf, how can we work around it? I don't go straight to using antimicrobials and often look at how our dressings can actually help us. So knowing that some of our gelling fibers will sequester bacteria. So if we clean the wound really well, keep the patient well fed, use a dressing that's not antimicrobial but does actions to control the bugs that are on the surface of that wound and help diminish building up of biofilms and things like that, then we can then move that wound on. The more complex addressing doesn't necessarily give you a better outcome if your assessment hasn't been done and your cleaning isn't thorough.
SPEAKER_01Hmm. I think all roads lead back to that simplicity, that KISS model that you mentioned. It's about good cleaning, good assessment, education, education, education. If you've been looking for a way to build up your clinical knowledge that actually fits around your work schedule, you're going to like Learn on the Move. It's designed to make learning feel easy again with free, short, online modules or reviewed by local healthcare specialists. You can dive into wound care, dementia, age care, diabetes, lower limb conditions, and plenty more clinical topics, all in your own time. So explore how to learn on the move at learn on the move.org and sign up today. We've actually covered such a vast array of information here today. We do a lovely little segment at the end of all of our podcasts, which we've called Rapid Fire to Unwrap. And it's a true or false uh question to you. I'm going to put a question to you. We have no time to expand on the answer. It's literally from you is it true or is it false? Are we good to go and have a bit of fun? Yes. All right. All wounds should be kept moist.
SPEAKER_00Sorry? Should all wounds be kept moist? No. Yes.
SPEAKER_01If a wound isn't healing, it's usually because of the dressing. True or false? False. Swabbing wounds routinely is best practice. False. Antibiotics are overused in wound care.
SPEAKER_00True.
SPEAKER_01Most clinicians are confident in identifying the wound etiology. False. Compression therapy is underutilized in Australia.
SPEAKER_00True.
SPEAKER_01If a wound looks clean, it's not infected. False. Slough always needs to be removed. False. An early intervention would prevent most chronic wounds.
SPEAKER_00True.
SPEAKER_01Oh, interesting answers there, Carrie. I love them. I have one other little segment that we do throughout our podcasts. Um, and it's really around understanding a little bit more about our world. So clinical confessions is what we've called it. What's something you've seen in practice that's made you think we really need to talk about this?
SPEAKER_00I've seen a lot. Um is it something from a nursing perspective or something from Yeah, from your perspective, really. From your perspective. Yeah, from my perspective. Um the designs of nursing homes, the equipment chosen for nursing homes, um has to improve. Um I've um I see so many injuries from the beds um for a lot of the residents. A lot of their skin tears come actually from their bed and their bedside tables. So that's one thing because I over my years at um Metro North, I've been um heavily involved in equipment and SOAs, you know, um, and looking at what's best equipment and what works and what doesn't work and what is safe. And what I found out in aged care for a lot of some of the facilities, I should say, is that that stringency um look at safety and the equipment and what's best for that uh group of people is not adhered to. And I think that really needs to they don't even check their mattresses on a regular basis to see if they've bottomed out. It's just I, yep, it's my latest. So the bed is for pressure prevention, your bed, your mattress, you've got to be spec. And so, yeah.
SPEAKER_01Yeah, some very valid points. I mean, again, every lead has risen us back to go back to education, education, education. That's where we need to focus our efforts and through assessments. So, look, Kerry, I want to thank you for such uh a wonderful discussion today. Thank you for joining our podcast. Um, and uh look, keep doing what you're doing because we need more of us. There's not enough of wound care specialists out there.
SPEAKER_00There isn't. There isn't. Thank you so much, Haley. It's been really enjoyable. Thank you. I was a little bit nervous.
SPEAKER_01After 50 years, Kerry, you got it in the bag. So thank you again. Now, in this episode, I'm joined by Kerry Coleman, who is an absolutely extraordinarily fantastic nurse practitioner of close to 50 years. We've unpacked so many areas. I hope that you can join us again for next week's podcast. And so let's keep doing what we're doing and unwrap all of those perky questions. Thanks again. Thank you for tuning in to this episode of Wound Care Unwrapped. You can find us on LinkedIn, Facebook, Instagram, and TikTok at wound rescue PTY LTD. A big thank you to our show partners at Learn on the Move. You can find more about them in our show notes. Now, wound care changes when we start to have better conversations. And that's why we believe it's about healing lives and not just wounds. So tune in for next week's episode of Wound Care Unwrapped.