The state of wound assessment tools in Singapore: an evaluation study
Variations in wound assessment and documentation remain an issue for clinicians despite efforts to standardise practices using national guidelines such as the Wound Care Assessment Minimum Data Set (WCA-MDS). As little is known about the quality of the wound assessment tools (WATs) used in Singapore, this study aimed to determine whether the existing WATs used meet the WCA-MDS criteria and clinicians' needs.
The study adopted an action evaluation methodology to evaluate seven well-established WATs, such as the Applied Wound Management (AWM) and National Wound Assessment Form (NWAF), and eight locally-designed WATs against the 34-item WCA-MDS criteria. Two clinicians reviewed the WATs using a self-developed audit form between June and July 2020.
The results show that only five WATs met at least 50% of the 34 criteria indicators, with the MEASURE assessment framework achieving the most at 68%, followed by TIME-CDST at 65%, Hospital C WAT at 56%, NWAF at 53%, and AWM form at 50%. The five most common criteria indicators included wound type/classification, date and time of wound, wound size, wound bed tissue type, and exudate information. Most criteria indicators under the ‘patient information’ and ‘specialist's referral’ subdomains were omitted, reflecting the lack of focus on these areas in the local WATs.
Despite advances in WAT development in the literature, the current state of wound assessment and documentation across healthcare institutions remains inconsistent. There is a need to focus on clinician training and establishing a nationally-validated WAT in Singapore.
Wound assessment remains an integral part of wound care as it provides useful parameters for differentiating wounds that are responding to treatment from those that are not.
However, suboptimal assessment, coupled with inconsistent documentation, can prevent timely treatment and result in delayed wound healing, increased risks for infection, and complications (Gillespie et al, 2014). Therefore, it is important for a clinician to perform wound assessment and documentation in an accurate, consistent, and timely manner (Ding et al, 2016).
Presently, the wound assessment and documentation practices remain inconsistent among different clinicians, institutions, and countries (Coleman et al, 2017). Ding et al (2016) conducted an integrative review of nurses' surgical wound assessment and documentation practices and reported inadequate documentation and inconsistent wound practices despite having national clinical guidelines. They cautioned that this could hamper the quality and monitoring of wound healing progression and treatment.
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