Two Echidnae Wound Care Podcast with Monika and Donna

Everyone (hopefully most clinicians) undertake wound images and measurements. Don’t get us wrong, these are important. But from our prickly position, they aren’t as robust in our clinical practice as many would like to think.In this episode Monika and Donna provide an experience informed conversation on the common issues with digital photography and unpack the reasons why these affect quality practice and decision making for patients with wounds.Episode 9 is jam packed with practical pearls for all clinicians to take and use no matter what their experience or setting. This episode is valuable for:novice to experienced healthcare professionalsnurse, doctors and all clinicians involved in wound caremanagers focused on quality of care and practice improvementTimestamps00:00 Introduction00:49 Wound measurement and photography as a component of wound documentation02:40 Argggh rulers04:51 Photos as important medico-legal documentation05:10 Ban the Ruler!07:37 If you really feel compelled to use rulers09:15 Controversies and lack of standardisation in wound measurement12:43 Is your photo a true and accurate record?13:53 Photography tips14:33 Wound chart v photos16:05 Flash v natural light16.35 Doing a retrospective on your photography17:23 When it is important to use a flash18:27 How to make wound measurement more consistent19:36 Best time to measure and take a photo21:06 How often should wounds be measured?22:03 Do the world a favour22:50 Context of wound measurement and questions that should be answered24:16 Circumferential wounds and shout out to managers29:06 Measuring depth29:51 Probing wounds31:16 Measuring pressure injuries within an interdisciplinary team33:00 Wound measurement and photography in Chronic Oedema34:12 Wound Hygiene consensus resource34:35 Do you measure the height of hypergranulation?35:19 Don’t just look at the numbers37:52 Photographing pitting test38:20 The value of clinicians undertaking a lymphoedema course accredited by the Australasian Lymphology AssociationResources mentioned:Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, Vega de Ceniga M, Weir D, Wolcott R. International consensus document. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: Wound Hygiene. J Wound Care 2020; 29(Suppl 3b):S1–28 https://convatec.showpad.com/share/NlEvPxvvOe4SF5SzTaRnKAustralasian Lymphology Association - Accredited Training Courses https://www.lymphoedema.org.au/education-&-resources/lymphoedema-training-courses/If you enjoyed this episode please like, subscribe, leave a comment or share with your colleagues.Connect with us at:Email consultants@advancingwoundcare.com.auTikTok https://www.tiktok.com/@twoechidnaeConnect with Donna's resources and sign up for the Woundy Wisdom's newsletter at a...

We are back continuing on the prickly conversations, this time about unhealable wounds. How is the ability to heal determined, and how do clinicians’ factor in a wounded persons goals and priorities, sometimes when there’s conflict with health care recommendations? We discuss if palliative wounds are the same as an unhealable wound and a range of ethical considerations when caring for people with these wounds. These wound types need to be discussed more, we hope you find the content relevant and stimulating for your clinical practice.Timestamps: 00:00 Introduction00:37 A big thank you to our audience for connecting0:37 A big thank you to our audience for connecting02:53 Love the feedback03:20 How do the different professions and expertise determine what is unhealable04:24 When an unhealable is in fact healable05:24 How is a wound determined as unhealable06:14 It’s not always about the healability but quality of life and symptom management07:29 When a person is given evidence-based comprehensive information wounds can be healable07:42 Once fully informed, despite being potentially healable, people may have different goals and priorities08:27 Wrong information risks wrong decisions08:35 Lack of knowledge and skills defaulting to unhealability and a “palliative” wound08:54 What is a “palliative” wound12:26 The unethical systemic barriers that result in unhealable wounds 13:16 Is a wound “palliative” when someone is transitioning to end-of-life care14:23 Dying a dignified death without a wound14:54 Medical professionals more likely to label a wound as unhealable16:06 Lack of evidence-based wound diagnostics resulting in a wound being assessed as unhealable16:17 Many wounds need to be biopsied16:49 Everything is called a venous leg ulcer due to lack of diagnostics17:29 Skin failure and the Kennedy Terminal Ulcer. Trombley-Brennan Terminal Tissue Injury18:14 Barriers to identifying and documenting Kennedy Terminal Ulcer versus skin failure versus pressure injury at end-of-life19:41 An evidence-based approach to determining if a pressure injury on the foot is unhealable21:38 Questions to ask to assess if a wound is unhealable22:44 Why are wound consultants not needed when a wound is unhealable?22:52 Conversations around healability, capacity and dignity of risk24:35 Healing not always an endpoint especially when linked to unrealistic claims26:36 Healing plan vs maintenance vs palliation plan28:42 The role of hygiene and mobility in the unhealable wound28:54 Impacts of intersectionality and labelling a wound as non-healable32:23 Clinical callout regarding unhealable wounds33:15 Agency and the unhealable and healable wound35:09 Well-being and wounds39:04 Ethics of labelling a wound “unhealable” and moral injuryResources mentioned:Kennedy Terminal Ulcer (KTU) and Trombley-Brennan Terminal Tissue Injury (TB-TTI) https://www.caresearch.com.au/Health-Professionals/Nurses/Clinical-Care/Symptom-Management/Skin-Failure-and-Pressure-InjuriesInternational Consensus Optimising Wellbeing in people living with a wound

We have touched on Wound Aetiology previously, however in this episode we dive deeper into how wound types interface with mechanism of injury and dilemas faced when there are multiple causes - what actually is a mixed wound?. We canvass all the major hard to heal wound types including incontinence associated dermatitis, pressure injury, skin tears, moisture lesions, chronic oedema, venous, arterial and more. How does this all relate to management of these wounds? We're sure our discussions in this episode will raise a few clinical conundrums and questions for you. Indeed, you may start to see more of these in your own practice and become more aware of these prickly challenges. The simple isn't always so simple. Timestamps: 00:00 Introduction01:12 Mechanism of injury versus aetiology02:30 The value of clinical audit and quality indicators03:20 Misdiagnosis of Incontinence-Associated Dermatitis (IAD)03:56 Intertriginous dermatitis misdiagnosed as IAD05:29 The challenges of addressing gaps in clinical guidelines 06:03 Be confident to be unconfident06:20 What is the mechanism of injury for skin loss in IAD?07:21 When experts conclude that the simple ain’t that simple08:45  When clinicians are approached by academics to fit a square peg into a round hole   10:36 Tips for researchers undertaking research in venous leg ulcers11:52 When wound education is siloed and does not replicate clinical reality 13:35 Making clinical hunches and not always on the first visit/assessment and that’s OK13:50 Current wound documentation does not support multiple aetiologies and impediments to healing14:00 Challenge of teaching clinical realities to students when they are taught in siloes14:33 Figuring out what is the predominant aetiology14:50 How do we define and teach simple versus complex wound15:13 Mixed aetiologies presenting above and below the groin15:56 Prioritising which aetiology to treat / manage16:57 Post operative wound dehiscence and lymphoedema17:48 Capacity building in lymphoedema19:27 The need for clinicians working in Hospital in the Home to understand lymphoedema19:43 The challenge of diagnosing inflammatory conditions such as IAD and intertriginous dermatitis of the pelvic girdle20:30 Influence of climate on dressing performance and skin injuries21:00 Mixed aetiologies of the pelvic girdle22:20 Is IAD avoidable and how easy is it to categorise, manage and report24:00 Continue reevaluating aetiology24:12 It is OK change or add to aetiology if clinical rationale can be provided 24:57 Call it what it is. A vascular assessment includes arteries, veins and lymphatics, not just the arteries25:21 Venous disease plus a wound on the same leg does not necessarily mean the wound is of venous aetiology26:57 Mechanism of injury v aetiology v impediments to healing. Simple v complex28:40 Opportunities to improve accuracy of wound data reporting and quality improvement 30:27 When is a stage 1 Pressure Injury of the foot, a “Diabetic Foot Ulcer”Resources mentioned:GlobIAD Incontinence Associated Dermatitis - Tools https://www.skintghent.be/en/onderzoek/tools/2/incontinence-associated-dermatitis-iadAustralian Aged Care Quality and Safety Commission - Incontinence associated dermatitis and pressure injury https://www.agedcarequality.gov.au/news-publications/clinical-alerts/incontinence-associated-dermatitis-and-pressure-injuryIf...

Wound Education, the subject everyone wants, from novice to expert, but where so many barriers exist to getting it just right. In this episode we burrow down into a recent Australian publication discussing recommendations for undergraduate wound education. This is another prickly concept our listeners will have dealt with and have opinions on, no matter what your discipline, experience level or clinical setting. So let's know what your thoughts are because we will talk more in future episodes about the status of wound education. Timestamps: 00:00 Intro 00:34 Wound education for novice clinicians01:34 Novices desperate for education03:35 The needs of wound management education for medical staff05:15 The assumption that everyone in the healthcare workforce has basic wound care knowledge06:45 Critiquing research on wound education09:32 How is the term wound expert defined10:36 Academic wound education models versus clinical realities and the needs of clinicians 11:10 Irony of clinicians requesting advanced wound education when the basics are not understood12:08 Fragmented, illogical, or misrepresented content14:02 Polysemy in healthcare14:32 What is a simple wound?14:44 What is a wound?15:34 Challenges of developing clinically realistic educational wound frameworks 15:47 A tiny wound17:15 Sterile versus clean technique. Really really?17:39 Coveting and naval gazing 19:35 Translating academic wound educational models into clinical practice20:42 When “new” evidence is based on superseded guidelines 21:59 Clinically relevant undergraduate education22:26 What about foundational content for consistent safe practice23:04 What’s on the wall of your treatment room that can guide you23:31 When foundational content is advanced in clinical reality24:44 Recommended foundational content 26:54 Need for real-world research28:10 Opportunities for nurse coaching/mentorship29:10 Are wound management standards and expectations too high?30:35 When non wound “experts” talk on expert wound topics31:31 Profiling what wound management experts do33:06 Read the antibiofilm and International Wound Infection documents for clinical pearlsResources mentioned:The Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019 are published on the MAGICapp allowing for ‘point of care’ use where the guidelines can be viewed on any tablet, phone or computer (updated multiple times a year).Haesler E. and Carville K. (2023). Australian Standards for Wound Prevention and Management. Australian Health Research Alliance, Wounds Australia and WA Health Translation Network.

Compression, the topic everyone has experience with, an opinion on, and something to learn - including us. This will be the first episode of many on compression because there is so much to unwrap. We would love to hear your feedback on this one as we touch on so many points. Timestamps: 00:00 Introduction01:00 How lymphoedema training has informed our practice as wound consultants02:11 Looking wholistically at hard-to-heal wounds through a lymphoedema lens02:33 Clearing oedema in proximal body parts first before moving oedema in the legs03:10 Assessing oedema03:32 The problem of less research and experience in non-cancer related chronic oedema than cancer-related04:14 Location and distribution of fibrotic tissue composition05:05 Lymphoedema wound nurses the outliers06:42 Where are the compression companies at wound management events?07:55 Wound clinicians without lymphoedema training do not understand compression prescription in chronic oedema08:09 Prioritising lymphatic function and compression over wound hygiene, including debridement10:12 Reluctance of some allied health professionals to apply lower limb compression in the presence of wounding 11:22 Practice gaps in wounds and compression prescription12:54 Motivation to understand more about lymphoedema13:51 Myth of venous oedema being different to lymphoedema14:00 More on reluctance to treat chronic oedema when wounds present14:48 Lymphoedema escalation pathway15:11 Becoming a lymphoedema mentor15:43 Self-care in lymphoedema16:18 The gaps in staging lymphoedema16:40 Inadequate compression prescription, application and troubleshooting leading to bad patient experiences and money down the drain17:36 What do we mean by the term “tolerating” compression?21:34 Using the term” they don’t tolerate” compression when it is the healthcare system that is intolerable22:09 The S.T.R.I.D.E. document to guide compression selection  23:11 Practical considerations when using S.T.R.I.D.E. principles25:36 Round versus flat knit garments27:31 Wound lymphoedema clinicians have two computers of formulary open simultaneously 28:52 More on round versus flat knit30:47 Muffin-topping a red flag that compression needs to be applied into the thigh or higher32:19 The Australasian Lymphology Association resources and courses 32:56 When nurses speak the same language around wounds and chronic oedema34:38 Prioritise leg hygiene, understanding chronic oedema before debridement and dressings36:38 The influence of industry on the science, education and clinical practice of wound managementResources mentioned:STRIDE document https://lymphoedemaeducation.com.au/wp-content/uploads/2019/07/S.T.R.I.D.E.-Professional-Guide-to-Compression-Garment-Selection-for-the-Lower-Extremity.pdf (if you’re curious what STRIDE stands for, it’s Shape, Textile Type, Refill, Issues, Dosage, aEtiology)Australasian Lymphology Association https://www.lymphoedema.org.au/If you enjoyed this episode please like, subscribe, leave a comment or share with your colleagues.Connect with us at: Email twoechidnae@gmail.com TikTok https://www.tiktok.com/@twoechidnaeConnect with Donna's resources and sign up for the Woundy Wisdom's newsletter at https://goodwoundcare.carrd.co/Disclaimer: The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow...

Join Mon and Don as we burrow into our journey's to wound consultancy. We hope you learn a little more about what has shaped us as individual wound clinicians, as we share some of our defining professional experiences as nurses.Timestamps: 00:00 Get to know us00:56 Mon’s journey02:38 High value education and training02:38 Benefits of lymphoedema education and training in wound management03:09 How the podcast started 03:59  Alternative pathways to wound consultancy07:20 The complexities of wound management across the sectors09:52 Don’s journey10:33 The fundamentals of wound care10:45 Advanced practice in the community setting, going back to basics and helicoptering12:25 High value, low-cost benefits of washing legs14:36 Takes time to save time15:25 Advantages and opportunities in community nursing and wound management17:01 The value of the helicopter view in wound consultancy17:22 Workplace culture as a barrier to best practice wound care18:30 More benefits of lymphoedema education and training in wound management19:19 Trauma-informed and weight-neutral care19:58 Can’t get to the wound unless you go through the head20:24 Wound management is not about the dressing and it’s not even about wound care20:59 I should be a psych nurse with skills in chronic disease23:00 Changing the language of wound consultancy24:08 Recommended PhD topics for hard-to-heal wounds25:19 The trauma stories of wounding25:29 Misunderstanding the term non-concordant26:23 Wound care is not always about looking at the wound28:44 The importance of networking and future episode topicsIf you enjoyed this episode please like, subscribe, leave a comment or share with your colleagues.Connect with us at: Email twoechidnae@gmail.com TikTok https://www.tiktok.com/@twoechidnaeConnect with Donna's resources and sign up for the Woundy Wisdom's newsletter at https://goodwoundcare.carrd.co/Disclaimer: The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures. Please consult your own healthcare provider for individual wound advice.

We celebrate reaching 3 episodes with a lot more prickly topics affecting anyone attending woundcare. Join Mon and Don as we burrow into the issues inherent in reaching a wound aetiology - or is that a mechanism of injury? How confident are we? What are the barriers and pitfalls and are we setting unrealistic expectations for the everyday clinician in documentation that informs the care planning?Timestamps: 00:00 Celebrating making the third pancake04:31 Not as simple as just telling someone what to put on the wound10:53 Wound aetiologies and broader issues12:03 Siloing aetiology and treatment13:09 Unrealistic expectations of general and wound care clinicians to determine aetiology17:49 Mechanism of injury vs aetiology, do humans fit into a box?18:56 When wound charts don't support complexity20:13 What is a hard to heal wound20:48 Limitations of wound documentation systems including EMR25:45 Wound education is not a panacea27:43 Health economics and healthcare systems affecting wound outcomes 28:15 Raising awareness and reflections for future episode topics for emerging and more advanced cliniciansIf you enjoyed this episode please like, subscribe, leave a comment or share with your colleagues.Connect with us at: Email twoechidnae@gmail.com TikTok https://www.tiktok.com/@twoechidnaeConnect with Donna's resources and sign up for the Woundy Wisdom's newsletter at https://goodwoundcare.carrd.co/Disclaimer: The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures. Please consult your own healthcare provider for individual wound advice.

Let's continue burrowing down into prickly conversations. Join Mon and Don as we unpack caring for the carers including the array of clinicians (nursing, allied, medical) plus formal and informal carers. Everyone plays a role in determining what happens to the person's wound.Timestamps: 00:00 Caring for clinicians and carers06:56 The community nursing team, does it match the needs of the person with a wound?12:45 The challenges of a depleted workforce and lost skills14:58 When complex skills are required such as debridement and compression, the cons of a risk averse, task-oriented system17:10 When caring for the team sometimes means saying 'no' when foundational interventions aren't being attended. Challenges when clinicians disagree23:58 Puggles (baby echidnas). Clinicians seeking a career in wound management. Using foundational versus advanced treatments26:01 Is puggle-ise a word?. Infantilising concepts in wound management26:52 Reflective practice. Passing on the mantle of knowledge.28:33 Future prickly topicsIf you enjoyed this episode please like, subscribe, leave a comment or share with your colleagues.Connect with us at: Email twoechidnae@gmail.com TikTok https://www.tiktok.com/@twoechidnaeConnect with Donna's resources and sign up for the Woundy Wisdom's newsletter at https://goodwoundcare.carrd.co/Disclaimer: The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures. Please consult your own healthcare provider for individual wound advice.

Are you a clinician interested in wound care? Maybe you're just starting or know a little about hard to heal wounds? Or are you more seasoned in your career? Perhaps you work in the community, aged care, a hospital or a subacute setting.Join Monika and Donna, 2 advanced practice nurses and lymphoedemapractitioners, as we kick off and introduce our wound care podcast. In our first episode, we discuss why we're here and why the name 'TwoEchidnae'. We are so excited to be sharing with other clinicians (not just nurses), ourexperience and frustrations inherent in the discipline of wounds. Humour is essential. We will be burrowing down into some prickly conversations, digging up myths andchewing over real-world evidence. Timestamps: 00:00 Intro 00:40 Who we are 02:22 Why a wound podcast? 07:55 Why the name Two Echidnae? 10:20 Why a wound care nurse is like an Echidna?24:50 What to expect from our podcast If you enjoyed this episode please like, subscribe, leave a comment or share with your colleagues. Connect with us at: Email twoechidnae@gmail.com TikTok https://www.tiktok.com/@twoechidnaeConnect with Donna's resources and sign up for the Woundy Wisdom's newsletter at https://goodwoundcare.carrd.co/Disclaimer: The views expressed in this podcast are our own.This podcast is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures. Please consult your own healthcare provider for individual wound advice.