Development of the Wound Resource Education Nurse (WREN) programme
Managing wounds costs an estimated £5.3 billion a year in the UK. Poor wound care knowledge and a lack of access to specialist practitioners contribute to this expense. A project—the Wound Resource Education Nurse (WREN) programme—was developed to support patient-centred care, effective nursing outcomes and staff satisfaction in relation to wound care.
The competency-based WREN programme is open to health professionals, healthcare assistants and tissue viability link nurses who are enthusiastic and willing to develop their tissue viability knowledge and skills. Sessions are delivered on a monthly basis and comprise a mix of didactic teaching, practical sessions and case-based scenarios. Learning is assessed through quizzes and practical assessments at the end of each session and at course completion.
Two years after it started, 60 WRENs in an acute trust have completed the programme or are attending sessions. The programme has been rolled out to a mental health trust and district nursing services over 12–18 months, and has been attended by doctors, physiotherapists and other practitioners.
The WREN programme has largely been successful, with the mental health trust showing the greatest improvement in practice and care. In all organisations, staff have developed competence and confidence in wound management, facilitating timely, appropriate care and realising cost savings. Although the programme was initially aimed at staff in nursing roles, other professionals have embraced it, so the trusts have a variety of competent practitioners.
Clinicians in the NHS are continually being challenged to provide high-quality care to patients despite decreasing resources (Health Foundation and Foundation Trust Network, 2014). The ageing population has led in an increase in people with long-term conditions, which are the primary cause of death and disability worldwide (Currie, 2013). One such condition is leg ulceration; according to Guest et al (2015), leg ulcers are the most commonly treated wounds in the UK, and are estimated to affect up to 1.5% of the population. Leg ulcers are painful, susceptible to infection and negatively affect quality of life and mobility (Green et al, 2014).
The annual cost of managing wounds within the NHS is estimated to be £5.3 billion (Guest et al, 2015). This cost may result in part from ineffective clinical practice such as inappropriate treatment and inaccurate diagnoses, which increase time to healing and the risk of infection or other complications (Han and Ceilley, 2017). Therefore, practitioners need to be knowledgeable about wound healing, assessment, diagnosis and care planning using clinically appropriate and cost-effective dressings (Stephen-Haynes and Greenwood, 2014; Browning, 2017).
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