Jacqui Fletcher on Wound Assessment

The workshop was one of a series that we've done across the years at the Leg Club on wound assessment and it's something that's fundamental to providing care for patients with wounds because if you don't get the assessment right then it's unlikely that you will get the actual treatments the dressing choice and the other things around that correct. The aspect we focused on yesterday was measurement. Again it's something that's really under-recognised I think people look at all sorts of things around exudate and odour but they don't really think very much about measurement measurement, so we focused down on how you might do that and what it might mean yesterday. One of the things that was really apparent, and a lot of the clinicians already knew this, is that there are real inconsistencies in what people measure and how they measure. So whether you're looking at linear measurement with a ruler or looking at surface area measurement by using the grids, they get very, very different answers when faced with the same wounds. We looked at simple things like agreeing within your clinical area on definitions. So, for example length could always be head to toe or length could always be the longest measurement. We also discussed the use of the tracing grids which are very visual and putting more information on. So rather than just counting the squares actually putting a pen marker across in the squares and identifying ones that were half squares. So if you've got something that you can actually then lay over the wound again you could see exactly what the previous person had done. And there's an example we used of a pressure ulcer wound that's both undermined and has some further discolouration. And the experience we have is that people either measure the open area, the open area plus the undermining, or the open area plus the discoloured area. And if you've got a tracing grid, you can actually mark all three of those on and put different measurements on them so that people know the full extent of the wound. People do it in one of two ways. They either use a gloved hand and put their fingers in and press upwards towards the surface, which is probably, if the wound's big enough is a kinder way of doing it because you've got a much firmer feel of the sensation. Or they will again use a probe and feel up towards the surface and put a pen mark on the skin and measure from there.