Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key principles of assessing a chronic wound in primary care include:
- Comprehensive wound assessment: Document the size, depth, position, and severity of the wound using a standardised classification system where applicable, such as SINBAD or the University of Texas classification for diabetic foot ulcers. Avoid using outdated systems like the Wagner classification NICE NG19.
- Risk and skin assessment: Assess and document risk factors for poor healing or complications, including mobility, sensation, nutritional status, and comorbidities such as diabetes or peripheral arterial disease NICE CG179.
- Infection assessment: Look for signs of infection such as redness, heat, swelling, pain, and systemic signs like fever. If infection is suspected, consider appropriate antibiotic treatment based on likely organisms and local resistance patterns NICE NG125.
- Use of appropriate dressings: Select interactive dressings that promote a moist wound environment and avoid inappropriate materials like Eusol, gauze, or mercuric antiseptics NICE NG125. Seek advice from tissue viability specialists when needed.
- Debridement considerations: Ensure debridement is performed by trained professionals, especially in diabetic foot ulcers, and avoid enzymatic or inappropriate debridement methods in surgical wounds NICE NG125,NICE NG19.
- Documentation and monitoring: Record wound measurements, depth, presence of undermining, and use validated tools for categorisation (e.g., NPUAP-EPUAP for pressure ulcers) to guide management and monitor progress NICE CG179.
- Patient-centred approach: Consider patient preferences, provide tailored information about wound care, prevention, and management, and involve multidisciplinary teams as appropriate NICE NG19,NICE CG179.