TIMES MODEL of Wound Bed Preparation

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TIMES MODEL of wound bed preparation

Supported by Activa, L&R www.activahealthcare.co.uk Wounds UK THE TIMES TABLE: REMOVING THE BARRIERS TO WOUND HEALING

Tissue, non-viable Infection, inflammation Moisture Edge of wound: non- Surrounding skin or deficient or biofilm imbalance advancing, undermining

NPUAP

The overall appearance of the wound Wounds contain bacteria, which may Exudate is a normal part of wound Lack of new, healthy tissue at the The wound management strategy may bed indicates the ‘health’ of the tissue proliferate and cause infection — healing, and drying out can impede the wound edges, or the presence of rolled effect the surrounding skin — within the wound bed. delaying healing, and increasing pain, healing process. edges, indicate wound healing is not the condition of which can, in turn, affect exudate and malodour. progressing normally. the wound healing process. Devitalised tissue provides an ideal High levels of moisture (often environment for microbial growth and, Even where infection is not apparent, containing harmful proteases) can Key actions: Key actions:Figure 1: before in most cases, should be removed to healing may also be impeded by the break down new wound tissue and » Mechanically debride (e.g. » Address the causes of skin issues expedite healing. presence of biofilm. macerate periwound skin. Debrisoft) encrusted exudate » Manage hyperkeratosis/dry skin/ at wound edges to remove local eczema/oedema/skin damage Key actions: Key actions: Key actions: barriers to healing » Mechanically debride hyperkeratosis » Mechanical debridement (e.g. » Mechanically disrupt biofilm (e.g. » Dry wound: Mechanically debride » Assess why the edge is not (e.g. using Debrisoft)3 Debrisoft®) is recommended1 by using Debrisoft) to break it up to remove loose dry skin; then progressing — consider biofilm » Protect the skin from further » Use a moisture-donating dressing and allow antimicrobials to work hydrate with a moisture-donating management (see I) or referral for damage in line with best practice (e.g. ActiFormCool®) to soften » After disruption, use an dressing (e.g. ActiFormCool) biopsy and local formulary guidelines remaining devitalised tissue (if antimicrobial dressing » High exudate levels: Mechanically » Protect delicate edge tissue » Encourage self-care needed) between dressing changes (e.g. Suprasorb® X+PHMB) debride to reduce the body’s (e.g. dressing with Lomatuell® Pro) for 2 weeks, then review automatic response to produce moisture; then select an absorbent dressing that retains exudate effectively (e.g. Flivasorb®)

Mechanical debridement using Debrisoft was highlighted as rapid, safe, easy-to-use and virtually pain-free2 ASSESS, DRESS, COMPRESS

The Best Practice Statement: Holistic management of venous leg ulceration reiterates that initial assessment of leg ulceration should include:4

General assessment Leg assessment Wound/skin assessment

■ Medical and ■ Vascular ■ Aetiology of family history assessment wound ■ Lifestyle (including Doppler) ■ Presentation of ■ Psychosocial ■ Limb factors (e.g. the wound and status shape/oedema) surrounding skin

Time for TIMES » The Best Practice Statement panel revised the TIME framework, a structured, holistic approach to wound bed assessment and preparation, and updated it to TIMES. Incorporating ‘S’ into the framework recognises the importance of also assessing and managing the surrounding skin Assess Debrisoft aids wound assessment and preparation by removing barriers to healing enabling improved visibility and healthier wound bed and skin even after one treatment. (see Figures 1 & 2) Dress After Debrisofting™, the correct dressing should provide an optimum environment to continue healing Compress For venous leg ulceration, compression therapy is the gold standard in holistic care Figure 1: before Figure 2: after THE DEBRISOFT® DIFFERENCE

Unique mode of action of Debrisoft and Debrisoft Lolly » Quickly lifts debris (including slough, exudate and biofilm) and binds it within the fibres » Removes barriers to healing without damaging new, viable tissue » Leaves area clear and promotes development of healthy tissue

Debrisoft supports wound bed preparation5 T I M E S reported reported no reported reported reported reduction local signs of reduction in improved improvement in slough infection excess granulation when address- exudate tissue quality ing a skin condition 89.4% 83.1% 77% 88.9% 97.6%

References 1. Strohal et al, 2013. 2. European Wound Management Association, 2012. 3. Wounds UK, 2012. 4. Wounds UK, 2016. 5. Feedback from 1,994 clinicians who took part in The Debrisoft Difference Challenge for up to 2 weeks; 64.7% of wounds in the study were static. 64.4% of wounds were leg ulcers.