Gary Bain: Running an outpatient wound clinic in NSW, Australia

My name is Gary Bain. I work just north of Sydney in Australia. I've been doing wound management now for 27 years and running my own outpatient wound clinic for the last 25 years. So we see all forms of wound care because being in a large 600 bed hospital environment, we do see acute wounds as well as chronic and complex wounds. One of the biggest challenges currently we're facing in Australia with our wound management is a big subsection of our society which actually don't get much support in regards to seeing health practitioners and getting guidance with the management of their wounds. So this means that either patients or their carers are having to do a lot of the work themselves with their wounds which become complex and problematic. We often actually aren't even aware of them until something has gone disastrously wrong and then they may attend an emergency department or finally manage to see a GP. So a lot of these people are doing their own wound care themselves. We know from an Australian census that there's nearly three million people who are active carers and some of them will be doing wound care but we believe there's many more patients themselves without any form of support who are doing their own wound management and we need to find innovative ways of reaching them because what we tend to have is we have people with cultural reasons for probably not wanting to go and see a GP or engaging with a health practitioner. We have a large asylum community now who are very insular, very secluded within their own ranks and so we're facing these issues of non-inclusion of people with difficult wounds and we've learned that most often the primary place of contact is in fact their pharmacist. So that sometimes is our best and only option is to say how can we reach people who've got wound problems and is the pharmacist the best point of contact? And then one of the problems we have there which we need to address is how can somebody come in who's got their own wound, go into a pharmacy, say what do I now need which is appropriate for my wound this time, who can I talk to, what products do I buy, how do I use them, how do I pay for them, when can I get them delivered, can somebody give me some guidance? And there is our big problem but also a great opportunity. Karen Innes Walker and in fact our evaluation team who comes from the Innovation Centre, they decided to say how can we look at addressing some of these issues and in particular looking at a mentoring program which we could put in place within general practice and also within the community nurse setting by way of saying here is somebody with senior experience, they've got qualifications and experience with wounds. They can act as your guide, they can help you with the questions and difficulties you've got with the patients they're currently caring for. They can show them principles of best practice and along with that perhaps a guide and show them innovation within their own care delivery. And in so doing that they've come up with excellent outcomes after such a short period of time. And they can show that they can save cost, they can improve patient well-being, they can get more wounds healed, they can improve patients' experiences with pain, so we are showing that a good mentoring program can certainly help within the health practitioner realm and their relationship with their patients. The mentors when they are engaged within a general practice or a practice setting, most often they are there as a part time or a one day per week arrangement, but again it will suit what goes on within a locality as to where somebody lives and what accessibility a mentor might have for those with whom they've signed up for, but generally speaking you'd we'd be looking at one or two days per week. In Australia, wound care is very much a nursing-led activity. And there are folks who are interested in coming on board from the medical community. They will be driven by some GPs. There's also a reasonable number of plastics and vascular men who have some interest as well. But their numbers are small and it is largely a nursing domain. One of our issues we have is that now that nursing training has changed in recent decades and we're going more to a degree and university base. Our nurses are perhaps not being as skilled in wound management as they once were and if the nurses are the ones who are leading the field and assisting our medical community who themselves are not well trained in wound management we have created some issues for ourselves as we move forward with our current training and the perhaps lack of definitive wound management as part of that training experience. The diabetic foot in Australia We are seeing better working relationships between podiatrists and nursing staff and GPs. There are some centres of excellence where they are working together well as a team. However, there are not enough podiatrists for our population being spread as broadly as it is to have these centres of excellence in all of the areas you need them. So still by and large most people with diabetic foot wounds would be seen by their GP and the practice nurse and the weight of that burden still really is within their realm. you