Background This scoping systematic review aimed to investigate the existing literature for recommendations, guidelines and standards for research on chronic wound diagnosis, assessment, management and prevention; to identify gaps in this literature; and produce recommendations to support future wound management research.

Methods A scoping systematic literature review was undertaken in 2017–2018, which aligned with PRISMA guidelines and searched academic databases and grey literature published between 2007 and 2017.

Results Eighty-nine documents included recommendations or outcomes on research methods for studies on chronic wound diagnosis, assessment, management and/or prevention; covering the areas of research design, sampling, randomisation and blinding, independent and outcome measures and interventions for research in chronic wounds. Common themes regarding research gaps and flaws were identified.

Conclusion This review identified existing evidence, guidelines, recommendations and standards regarding the conduct of chronic wound research internationally. Recommendations include the need for standardised vocabulary, standardised checklists for wound research, development of core outcome datasets and an agreed and standardised set of economic parameters and methodology for cost-effectiveness. Establishment of a centralised national methodology service for wound research to assist with methodology design would be beneficial.

Venous leg ulcers (VLUs) are a significant complication amongst persons with chronic venous insufficiency (CVI) that frequently follow a cycle of healing and recurrence. Current clinical practice guidelines (CPGs) recommend applying below knee compression to improve VLU healing. Compression could be applied if the Ankle Brachial Pressure Index (ABPI) rules out significant arterial disease, as sufficient peripheral arterial circulation is necessary to ensure safe compression use. We conducted a content analysis of 13 global CPGs on the accuracy of recommendations related to ABPI and compression application. Eight CPGs indicated that compression is recommended when the ABPI is between 0.8 and 1.2 mmHg. However, this review found there is disagreement between 13 global VLU CPGs, with a lack of clarity on whether or not compression is indicated for patients with ABPIs between 0.6 and 0.8 mmHg. Some CPGs recommend reduced compression for treatment of VLUs, while others do not recommend any type of compression at all. This has implications for when it is safe to apply compression, and the inconsistency in evidence indicates that specialist advice may be required at levels beyond the ABPI “safe” range listed above.

Venous leg ulcers (VLUs) are open lesions on the lower leg caused by venous disease, which are associated with high morbidity and pose a challenge to manage effectively (Scottish Intercollegiate Guidelines Network, 2010). Gold standard treatment for VLUs is graduated compression therapy to aid venous return. This paper presents an approach to the challenging management of VLUs that is based on a problem, and subsequent local audit. We use a case study that illustrates a collaborative approach to determine gaps in evidence-based practice (EBP), and a nurse-led initiative in consultation with executive managers and doctors. In our sample, 40% of patients had not consulted a vascular specialist. They did not have a formal diagnosis of leg ulcer aetiology and therefore had not received optimum treatment. Access and cost were main factors impacting on leg ulcer care. Nurses providing evidence-based management of VLUs should ensure collaboration with key stakeholders. This assists in implementing diagnosis of ulcer aetiology for best practice measures. At this local health district, a change in policy to reflect EBP for VLU management in primary health care has been achieved.

What is already known

1. Evidence-based wound practice is an approach to patient care that integrates current information from research and local data, the expertise of clinicians and patient factors.
2. VLUs are a common wound in primary health care that pose significant issues for the patient, caregivers, nurses and specialists.
3. Graduated compression therapy is the ‘gold standard’ treatment for VLUs.

What this manuscript contributes

1. Best practice VLU care in primary health care is impeded by a number of factors, including cost, access to specialist medical consultation and primary health care resources.
2. A collaborative project by primary health care wound specialist nurses, an academic and a summer scholar, with time and expertise to undertake a project to investigate and address a problem, ultimately improved the quality of patient care.
3. A hand-held Doppler should be available to wound specialist nurses in primary health care to aid assessment and management of venous leg ulcers.

Background Surgical patients are at high risk of developing pressure injuries (Pls) due to anaesthesia-induced immobility as well as risk factors such as length of surgery and co-morbidities. Few Australian studies have investigated the incidence of PIs in surgical patients. This prospective cohort study assessed the incidence of post-surgical PIs and identified gaps in pressure injury prevention (PIP) for elective surgical patients.

Methods Consecutive elective surgery patients at an urban tertiary referral hospital were recruited who had an expected length of stay of >48 hours. Baseline PI risk (measured by the Waterlow scale) and PIP strategies implemented at five time points were collected from medical records. Two prospective outcome assessments were conducted at 24 and 48 hours post-operatively. Data were analysed descriptively.

Results One patient out of 150 (incidence rate 0.7) developed an intra-operative Stage 1 PI. Four patients developed skin tears. PIP strategies were applied inconsistently throughout the patient journey, regardless of risk status.

Conclusions While the incidence of surgically acquired PIs in this study was low, ongoing staff education is needed about the importance of consistent skin and risk assessments and of implementing strategies appropriate for level of PI risk.

What is already known:

• PIs are widely considered to be an adverse event of hospitalisation and are largely preventable.
• Surgical patients are at risk of developing a PI primarily due to immobilisation following anaesthesia, length of surgery and co-morbidities.
• There are few studies on PI incidence and prevention strategies used in the post-operative period.

What this manuscript contributes:

Although the incidence of post-surgical PIs among elective surgical patients was low, there are gaps in PIP for this group of patients, including for those deemed at high risk of PI. There is a need for clinicians to improve documentation of risk assessment and strategies implemented to reduce the risk of PIs, throughout the surgical patient journey.

Pressure injuries (PIs) are a significant health issue worldwide, and contribute substantially towards the economic burden in healthcare systems. This is primarily because PIs increase the length of hospital stays; and longer hospital stays also predict PI development. PIs are also used to measure the performance of health staff and facilities in a variety of settings. Inappropriate management of PIs can lead to further complications, necessitating an increase in resources in the hospital for assessment, monitoring and treatment. However, over time, challenges in regard to identifying, assessing and reporting PIs have proven to be problematic for a number of reasons. This paper explains the main challenges to PI assessment, and presents a series of best practice recommendations to rectify these challenges.