TIME for an update - what’s new ? The new TIME Clinical Decision Support tool.

Join us twice a month for our insightful podcasts with leading expert guests, who will look at the latest 'hot topics' in wound care to update and inspire you.

Join this expert panel who will discuss the latest developments in the TIME framework and how the new  Clinical decision support tool (CDST) can help to reduce practice variation and improve clinical outcomes.

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00:00:02

SPEAKER:
Welcome to Smith & Nephew's Closer To Zero podcast. Bi-monthly podcast with leading experts in wound care hosted by Smith & Nephew. Helping health care professionals in reducing the human and economic costs of wounds.

00:00:15

RUTH:
Hello, I'm Ruth Timmins from Smith & Nephew and it's my pleasure to welcome you to our Time for an Update - What's New? podcast. We have an expert panel who will be discussing the new TIME clinical decision support tool. We're so very privileged today to have with us Professor Keryln Carville, Terry Swanson and Wendy White. Professor Keryln Carville is Professor of Primary healthcare and Community nursing with the Silver Chain Group and Curtin University in Western Australia. She has extensive clinical experience and is committed to research and education within the domains of wound and ostomy care. Keryln chairs the Pan Pacific Pressure Injury Alliance and is the current chair of the International Wound Infection Institute Evidence Committee. She participated in the development of the Infection Consensus Document in 2008 and 2016. We also have Terry Swanson with us, who is a Nurse Practitioner in wound management based in Victoria. She has a passion for wound management and how to improve care. Even after 30 years, she hasn't lost her commitment or energy for sharing best practice in practical and accessible ways. Terry has served as the Chair of the International Wound Infection Institute and is the current Vice Chair. She chaired the development and publication of the 2016 Consensus Document update on wound infection and was also part of the Global Wound Biofilm expert panel. And of course, Wendy White who's with us today, is a credentialed wound clinician and qualified educator with over 30 years of wound and skincare-specific clinical expertise from a wide range of settings and in private practice. So thank you to all of you today for joining us.

00:01:58

WENDY:
It's really great to be here and in fact it's wonderful to have both Keryln and Terry on with us today. You know, these two individuals are considered not only leaders and experts but I think the word that comes to mind for me is trailblazers, not only nationally but internationally. But I think really, it's very, you're both recognised for that commitment to the development and support of others in their wound management journey. And I think that that's a really important background as we begin to look at the expansion of the document and tool today. You know wound bed preparation and the supporting TIME acronym, is now nearly two decades old and the three of us were old enough to remember wound care pre-wound bed preparation principles and, and we know now that these are principles that are never going away and of course the foundation on that form foundation of clinical practice moving forward. We know it was originally designed to help support health care professionals to remove those local barriers of the open wound in the context of diagnosis and the person preference and factors. It was all about trying to bring science into practice to promote this endogenous healing. But, you know, Keryln and Terry, you were also actively involved in relation to the International Wound Infection Institute review in your publication in 2012.Extending the TIME concept, what have we learnt in the past ten years? (1) And you were able to find the changes in our knowledge and technologies that had occurred and you came to the conclusion with that expert group, that wound bed preparation and TIME was here to stay. And now subsequently there have been more expert meetings in 2018, subsequent publications in the Journal of Wound Care in 2019(2) looking at this expansion of the tool, the CDST which we're going to look at today through TIME, an update to the tool to address the current clinical challenges in wound care. And you know, you've both been involved in an evaluation process of this and also actively involved in a brand new World Union Wound Healing Society consensus document, supporting this process that has been published in 2020. (3) You know I can think of no better two people to chat about this framework and this expansion. And I'm really looking forward to having this chat with you today. You know Keryln, you know, what is the importance to you of maybe understanding this background, and looking at this history and why there was this need to expand the concept of TIME as a tool.

00:05:02

KERYLN:
Wendy, thank you, thank you for the opportunity. It's really a very interesting question you raised and I was just thinking about it listening to you speak. The term wound bed preparation was largely accredited, its first use, I think, to Vincent Falanga, some, some years back. But the concept has been around a long time and I think if you, and it was Winston Churchill who said that the further you look back, the further you can look forwards. And so, just reflecting on the history of wound healing, as we know it began as an art. If I was to choose one time in history other than the last two to three decades when there's been so much science generated about wound healing. The next introduction, if you like, will be the introduction of the scientific era in wound healing I would have to accredit to the second half of the 1800s. And that's when people like Pasteur, who introduced the world to organisms and Lister who introduced the world to antiseptics, and Semmelweis who taught us the importance of hand washing. This really I think, was the genesis of wound bed preparation. All of a sudden there was science behind the art. And of importance it was, it, it, it enabled those that were managing whatever the clinical problems in this instance wound management that there was a time where you had to stop and assess and then had to think about what was the best evidence for management. And really nothing much else happens if you look at the way we manage wounds up until almost 100 years later, when we had the 1980s, 1990s. And up until that time, and even in the 80s and 90s, the wound dressing was seen to be the panacea, I think. And if it didn't work, you put another one on. And it was at that point we have to say well what happened that challenged us as clinicians? We had, I think increased expectations, largely as a result of the growing Dr Google, so our, our not only, our patients had a higher expectation on their wound healing outcomes, but we as clinicians also started to be challenged. And it was also aligned with that as has been the case for the last two decades, three decades, increased cost in wound management. And we have so little actual data on that. And, and you know that's the next challenge for the next decade. Certainly is that we can start to construct what is the true cost of wound healing. But in 2003 when that group came together, with Greg Schultz and Elizabeth Ayello and Gary Sibbald and others, they for the first time gave a structured approach to looking at wounds as either acute or chronic, and if they're chronic, then what should underpin their assessment. (4) And so, that initial TIME concept gave a say step by step approach to assessment. Very simple but very directed and thus as a result of that, it guided our interventions and hopefully improved our outcomes. You mentioned too that in 2012-13 when the wound healing…so the Wound Infection Institute did the review to see whether it was still relevant. Was the TIME concept still relevant? And yes, it was. In fact more so, it was expanded because at this point we started to appreciate that we had new technologies such as negative pressure wound therapy, we had increased science which was wonderful, and it started to encourage us to think more broadly.(1)  There is the wound but the wound is on the person. And I think if we again look at what's happened since that era up until today, and certainly 2019 when the new updated wound decision tool came to be, again it, it still had the underpinning principles of good assessment, preparing the wound for good healing outcomes, putting the person, as Socrates and Nightingale would say, in the best position for nature to act, and to guide those decisions in a structured way. But underpinning that structured approach, again are the principles of good assessment and the principles of evidence for decision making. And I think you know if ever there was a time, if there was a time that we , - that's a play on words - but if ever there was a time to implement TIME, it's now. Because again we have, you know, huge expectations. We have increased wounds and yet we, you know, we... we want to get the best outcomes for those we care for. So I think the time is right for TIME, if I can play with words.

00:09:44

WENDY:
Yes it certainly is. And what it what and what a great way to sort of maybe now introduce you, Terry too, with the historical background and the fact that you got together and you met with world leaders in 2018 which then led to further publications, and this concept of expanding TIME as a clinical decision support tool and then were also actively involved in the next step, the evaluation. Can you tell us a little bit more about that, the meeting process and how that led to your evaluation process and what you found.

00:10:26

TERRY:
Thanks Wendy. Yeah. So the journey did start in 2018 and this was to find or redevelop the tool to practical applications for the clinician and then four groups volunteered to do practical evaluation. So real life evaluation. And so there were actually four publications based on the clinical experience and then there was Blackburn et al (5)  which was part five that evaluated all the studies and the survey to give the reader an overall picture. And our group in Warrnambool, Victoria was truly a real life experience. So, two practice nurses volunteered to do the research. They were generalists and first TIME researchers. So we met them through expressions of interest and I gave them their responsibilities and obligations that they had to do five patients to enrol and then they had to document on them every week for four weeks. And their experience with this was quite enlightening. What they learned or the insights that I got from their documentation, was they learned that assessment and proactive management at the beginning of the journey, was more important or had a renewed awareness. So, they actually...one patient example, is they triaged this patient, they didn't expect him to heal so they were quite aggressive in their wound bed preparation and their topical application and the team approach, and this patient healed within two weeks. Another insight was they weren't aware of skin tear classification. So they improved their knowledge deficit. They stated that the TIME CDST provided them with increased confidence and knowledge regarding exudates, how to describe and record and adjust their dressing regimes accordingly. They improved and had greater confidence with tissue identification and signs and symptoms of infection. They found it easy to use, but maybe it's the age group similar to age reminds myself, but they said the tool could be slightly larger.(6)  So there's actually two versions of the TIME CDST. So what is a product-specific version and a non-product specific? And the reason is some health care professionals only understand the dressing by its commercial name. They don't understand the categories. So it gives the user the ability to use their preference. And the tool provides you with the TIME, the assessment for TIME tissue, what the outcome for that area is and strategies to achieve that. For the infection and inflammation, again a clinical outcome and ways to manage or do that. With moisture management, again in each one of these giving you the how to do and the clinical outcome and then with E, understanding that the attachment and that those edges need to be clean and moist. So for this and the other projects, it gave us great insight into practical application. These nurses didn't even have a camera in the facility. So they initially took them by their mobile phones. And you would think that in 2020, everybody has a structured assessment tool or a structured way that that assessment is done of the patient, the wound and the patient's environment. But that's not the case, Wendy. And so, this tool which will be free to download, for people who don't have that structured documentation or to use as a teaching tool, or a memory aid for those who currently are trying to educate others. So it's a simple one page prompt document that you can alter to your local environment.

00:15:42

WENDY:
Terry, I just love the way that you talked about the...It sounded like sort of enjoyment of introducing this process and these tools to the non-specialist and watching their journey. And that, that thing where they talked about just wanting to go back and relook at policy again. Their internal policy that this sort of challenged the way that they did things, but they were open to that. It just sounded like a wonderful opportunity together. You know, a lot has come out of this and from the perspective of you both, what do you think are the benefits of following a sort of a structured systematic approach you know, from novice to expert? Because this expansion of the tool, now incorporates A, for assessing the person and their well-being, B, bringing in the multidisciplinary team etc, C, controlling those factors, D, deciding your treatment and your short term goals and your diagnosis etc. and then E that evaluation and this sort of cyclic approach that you are able to introduce a non-specialist or generalist too. So I'll just pose the question again. What do you think is the benefits of following a structure or a systematic approach from novice to expert?

00:17:10

KERYLN:
I think Terry summarised it really well from her experience and I had a similar experience. I had five registered nurses, who each did a case study (7). And they were community practitioners, and I put out an expression of interest for registered nurses within our organisation who had, had graduated one to three years previously. Because looking at Benner's model, you know, that journey we all make from novice to expert, some nurses make it very quickly and some nurses may take a longer period of time. And within our organisation we have a lot of education around wound management. So I was trying to get a spread looking at if you like, first year out versus third year out. And interestingly enough, again we found the same things that Terry did. We found an acknowledgement that, from the nurses, that their knowledge had increased. But most importantly, that their assessment skills had advanced. At the same time, they recorded the usual documentation which is all electronic on Concare Mobile. And that does prompt a structured approach for a recording. So I wasn't so, expecting to see the structure of the assessment so significant. But what I did find, which was encouraging, was their assessment skills and the knowledge that underpinned that assessment, they all stated had improved. And particularly like Terry, in regard to signs and symptoms of infection. So I think, yes it was proved to be a very valuable teaching tool for guiding practice and most importantly for prompting when other interventions needed to be implemented. And I think you know that the fact that they can go back, so even though they had the documentation for the CDST, they could go back again and keep referring to that one pager, keeping it simple and ensuring they're on the right track. So we were quite pleased with the outcome. And you know I have to tell you, I had to do, after we finished this process, I had to do some education for some medical students, and decided I'd use it and use the CDST in that forum. And it was particularly valuable there because they had, had no previous or very, very little previous education or exposure to wounds. And yet they were able to pick it up immediately. I was so impressed. So I think it has a relevance not just for nurses but also for other health disciplines at different levels in their journey.

00:19:51

TERRY:
I would agree with that Keryln, that any health care practitioner and whether you identify as a specialist or generalist, whether you're a novice or expert, this tool gives you the ability to teach or implement or to guide practice. What it did for our group, was it helped them identify knowledge gaps. Also when they enrolled patients in, they had to have the diagnosis. So when you talked about the A through E, Wendy, that's part of the broader picture of the document. And in a webinar that I'm conducting on 16th of September called Time is Tissue - get a good start with a clinical decision support tool, I talk about that A through E in some detail. But because they enrol these patients, they had a patient who didn't have a diagnosis and they'd been treating him for six weeks. So when they looked at the tool and they said, " We have to start with the diagnosis". And so they brought in the multi D team, and got a diagnosis and then implemented it according to the target therapy for that diagnosis and then they re-evaluated it. So it was just a perfect example of the whole tool, the A through E. It's like alphabet soup when you're talking about this but then that TIME CDST. But it really does support standardisation of practice. And then these clinicians and I think for other, the other projects did too, to help identify infection. And we know that we have to be the wound detectives. And if we can capture, identify and manage the early signs of infection, we have the opportunity to maybe save a limb or maybe save a life. But it's through that structured assessment and then that evaluation, and decreasing the tolerance for non-progression, and certainly no tolerance for deterioration.

00:22:18

WENDY:
So it's been, it's been so interesting listening to this experience and how this  expanded tool changed some of the way that practices were occurring and you were just talking then about a non-tolerance of deterioration and this monitoring. You know, I know both of you feel very strongly about not only the importance of evaluation and the way that we document and communicate that, but this escalation or this trigger for referral or a need for assistance. How do you feel that this expanded tool could help in that way?

00:23:00

KERYLN:
I actually think assessment underpins everything. And if things aren't going according to plan and I smiled to myself when Terry used the term 'wound detective', because I use it all the time, we're collecting evidence. That's what assessment is. Evidence to determine why wound is going according to plan or why it's not. And you know, the important thing and particularly speaking as a community practitioner, knowing when to escalate. By escalate, when to refer or when to call in the troops, so to speak. When does a person require more comprehensive or diagnostic investigations? And so that process of escalation should be something that for many novices I think, they're, they're a bit unsure of their own skills and is this, you know a good thing to do, or people think, oh no, they have jumped the gun. It is important and I think a structured approach such as the CDST does do, is if they've worked their way through that and things aren't going according to plan, it gives them the confidence to say OK, I've done what I should have done, and it's not improving or there is some other area of concern, now I need to refer on. So escalation is critical. Knowing when to escalate, is a...is a big challenge for a lot of people, and I think the tool gives confidence that they have performed their assessment and their initial care planning according to the evidence and now there's a time to move on. And I think that that is, gives confidence to the outcomes for the person that we're caring for.

00:24:43

TERRY:
I agree Keryln, and the document that's going to be launched at the World Union Wound Healing Society virtually in September, this document will be available. And that's a 27 page document. And it has a picture library to help with identification of tissue types and infection. So it's an expanded version, it has the one page tool in there as well. But it gives you the background as to the rationale, how to implement, what some of the barriers are. So the whole consensus document really is an essential tool for those who are teaching, to give that background and then the tool for the everyday user about how you can implement that into your practice and overcome some of those barriers.(3)

00:25:39

WENDY:
Yes  it's very empowering, isn't it, to have something, like you've said, that is so, so simple yet evidence-based, to guide all of us no matter where we are in our journey. You know, one of the challenges sometimes out there can be a lack of consistency of care can’t it? It can be within an environment or it might be when we're involved with others that are delivering care. Do you think something like this, if this was used more broadly, do you think this could help with consistency of care?

00:26:20

TERRY:
That is certainly one of the main aims of the document is to decrease that variation in practice through a systematic, evidence-based approach. And certainly with the review, the four projects, that was consistent outcome.

00:26:37

KERYLN:
I think the other thing it does do is standardise language across the disciplines, you know, and that's a good thing for improving therapeutic communication.

00:26:46

WENDY:
Agree. I was really interested by reading within the document there was this statement, the use of TIME every time and this concept of not just using it when we're anticipating a challenge, but for all wounds. Do you both agree with that, that this is just applicable for acute wounds as it may, that are...or that of a more delayed healing wound? What do you think around that?

00:27:17

KERYLN:
Well see, chronic wounds all start out as acute wounds. I think we forget that sometimes. You know they just don't turn up on our doorstep 30 days or whatever false parameter people used to say it's chronic or it's not. So how good would it be if we stop acute wounds becoming chronic? And I think you know the relevance for a decision tool, begins with wounding and, and it's not limited to chronic wounds at all. And I, initially that was my one concern with it back in 2003. I thought this is relevant for all wounds. So the goal should be we stop acute wounds becoming chronic. And so the sooner we implement best practice in the form of assessment and clinical decision making, then we might take a step closer to that goal.

00:28:04

TERRY:
And the terminology is changing, isn't it, Keryln and Wendy, that we're moving away from designated timelines and that any wound that is not progressing, becomes delayed or a hard to heal wound. And then it need...you need to invest in that wound to alter that deterioration or that delay and then playing detective again and finding out why. And if we can get people to do more proactive management for say elective surgery and manage that incision site, then we would have less wounds out in the community. And Keryln, your group did a study about how many of the wounds, chronic wounds, initially were surgical ones.

00:29:01

KERYLN:
Yes, and just looking at our data at any given time, if I just look back what Silver Chain nurses managed last financial year, primarily in Western Australia, there were 40,000 wounds on more than 18,000 individuals. And if, if you look at the breakdown of those wounds, 50% are acute, if we use the traditional understanding of acute being surgical or trauma-related, and in there I would include skin tears, and 50% are chronic if we use the traditional understanding being, leg ulcers, pressure injuries, tumours etc. So when, you know, when, what I'm trying to say is we're not out there all just managing chronic wounds. We're out there managing wounds. And they all wear different hats subject to that individual's healing journey. And the intervention, if it can be targeted, can be evidence based and can be structured at the beginning of that wounding episode, then we will hopefully prevent many of those wounds that we're traditionally thought of because it's a pressure injury, it's a chronic wound. You know we don't...it was...bless him, Professor Hunt back in 1977, he said, "What we need is a good definition of acute and chronic wounds." I think we're still looking for it. I mean there's been definition from the 80s, which said you know, "The acute wound is that wound goes through an orderly and timely healing process, with sustained anatomical integrity and the chronic wound doesn't because of intrinsic or extrinsic factors that impair the person's healing journey. So is that enough or is that too broad? Or maybe we should add to that broad statement and say, the wound is not healing as it should do so, but why not? And, and that's where the principles of the CDST are so important. If it guides our thinking in ways that we're not going through that normal healing trajectory as anticipated.

00:31:09

TERRY:
I agree Keryln. Why not? Why is this wound not healing?

00:31:15

WENDY:
Agreed, agreed and very much because of both your history, both of you and your active involvement in the International Wound Infection Institute, and this link now we know of overwhelm and ultimately chronic inflammation and biofilm. The intimate knowledge that you have on this scenario as well and, and its involvement in transition to chronicity or slow to heal or failure to heal. You know, I think what I got from both of you is that you really feel that this tool can help people understand in a broader sense but also in a local sense what they're looking at and the significance of that. And I heard you mentioned before Terry, about those clinical signs of infection and how there is reference to the consent... the practice document in 2016 from the International Wound Infection Institute (8). You know we, we've had a really lovely discussion today, and, and I'm wondering if you would each have maybe three take home messages, three things that you just really want to make sure that we remember out of this time that we've had together today. Would you like to go first Keryln?

00:32:41

KERYLN:
Oh!  Yes. A couple of things. One is, nobody owns the wound, but the patient, client or resident. And so, it's not...this immediately makes me think that we're a team or there should be a team approach to how we assess and manage that individual. And it's not a failure if you think we don't know how to do it, or that something isn't going according to plan, or I'm not recognising why this isn't. So I think being mindful of the fact that a team approach is really important. Secondly, assessment as Miss Nightingale said, "The most important thing we teach nurses, is to teach them how to observe." We today would use the word how to assess, and she was right, you know, if you know what is the norm and what is the abnorm, then you're on the right track. So assessment underpins every clinical decision we make. And then the third element that I think that is critical to a good therapeutic outcome is the fact that you want evidence about our practice. And there's a lot being written in the literature, in fact you know it's quite ex...there's been more signs generated in our lifetime than since the beginning of all time. And with that comes a privilege, but it also comes a responsibility I think, that what our interventions when our practices is underpinned by the best evidence. And just as you and I could take the nurses and practitioners that came before us, trust me, those who follow us will do the same thing. And all we can do, hand on heart, is to say we implemented with the best evidence that we had and that time. And I think it's not just because we've always done it that way. We just need to be constantly critiquing our own practice. Is it in line with the best evidence that we have at this time?

00:34:41

WENDY:
Yeah. They are three great messages. Terry, have you got anything that you would like to add to that?

00:34:47

TERRY:
I do. It may be rewording what Keryln said but assessment is the cornerstone of wound care. If you don't have the diagnosis, and understanding of what you're seeing. You really can't target the therapy appropriately. So you need that systematic approach. And this tool is one way to do it. Be proactive from the beginning. And if it's not within your scope of practice to diagnose or change the intervention, or to understand what you're seeing, then refer off. I know that my referral pattern has changed dramatically in the last ten years, that I refer much quicker and more often than I used to and I'm considered an expert. So there's no...it's doing your patient the best outcome, giving them the best outcome by bringing that team in. It's not about ego. And then any time you take the responsibility to do a wound dressing procedure, make sure you take the time and I mean that literally, and using the acronym TIME, to do the wound dressing procedure and the provision of wound care. And we now know that it, whether you're in an informal care, a registered or non-registered person, you can still do therapeutic cleansing and aggressive cleansing with a moistened gauze. And then reporting what you've done and what you see. And if you do that, it provides effective care and not just symptom management.

00:36:42

WENDY:
I've really, really enjoyed this time with you. You know how rare it is sometimes that we get to be in the same room together and to just hear you both speak so passionately and as experts, but in those that are interested in the journey of others, it's been a real pleasure. If I was to just kind of kind of summarise some of the key points for me that I'm taking away from your input is, this ability to explore this expansion of the TIME tool into the clinical decision support tool, it's this ability of keeping it simple, but still being comprehensive and evidence-based. Always pointing to the person. So you, one of you said, we need to invest in the person to work towards their diagnose and give targeted treatment. The next point I had, was I loved it and both of you say the talk and we need to be wound detectives. We are collecting evidence which will then guide our direction which is best for that individual working with them. We need to try to reduce these variations of care and, and, and promote consistency. And finally I think as Keryln said, "If there was ever a time or TIME and this expansion to promote the comprehensive evidence based approach to wound care, no matter where it is on its journey and no matter where that person is, that time is now." I want to thank you both very much. It's been a pleasure.

00:38:26

KERYLN:
I would like to thank you and I'd also like to thank Smith & Nephew for their commitment to the TIME concept and over the years and the fact that we've got to a point where we now really do have something that is going to make a big difference, I think, in delivering evidence-based practice. Thank you.

00:38:43

TERRY:
I agree. Thank you very much for the opportunity.

00:38:46

RUTH:
Well thank you all and thank you to our listeners for joining us today. And thank you to our special guests. Be sure to tune in for our next podcast.

00:38:57

SPEAKER:
The use of the TIME Clinical Decision Support Tool has been shown to provide a structured approach to wound management, reduce variation in practice and enhance nurse confidence with decision making. The clinical impact of the TIME CDST is demonstrated by a number of successful real world examples,(5-7) which has recently been published as a case series. For details of the case series and various tools and resources to support your clinical practice, please contact your local Smith & Nephew representative, or email us at profed.anz@smith-nephew.com

00:39:38

SPEAKER:
The information presented in this podcast is for educational purposes only. It is not intended to serve as medical advice. Products listed and outline of care are examples only. Product selection and management should always be based on comprehensive clinical assessment. For detailed products information including indications for use, contraindications, precautions and warnings, please consult the product's applicable instructions for use prior to use. Helping you get closer to zero inaccuracy in wound assessment.

References:

1) Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned in the past 10 years? Int Wound J 2014; 9 (Suppl. 2):1–19

2) Moore Z , Dowsett C, et al .TIME CDST: an updated tool to address the current challenges in wound care. JOURNAL OF WOUND CARE; 2019;28(3): 154-161.

3) World Union of Wound Healing Societies (WUWHS) (2020) Strategies to reduce practice variation in wound assessment and management: The TIME Clinical Decision Support Tool. London: Wounds International

4) Schultz G, Sibbald G, Falanga V, et al. Wound bed preparation: a systematic approach to wound management WOUND REP REG 2003;11:1–28

5) Blackburn J, Ousey K, Stephenson J. Using the new T.I.M.E. Clinical Decision Support Tool to promote consistent holistic wound management and eliminate variation in practice: Part 5, survey feedback from non-specialists. Wounds International. 2019;10(4):40–49

6) Swanson T, Duynhoven K, Johnstone D (2019) Using the new T.I.M.E. Clinical Decision Support Tool to promote consistent holistic wound management and eliminate variation in practice at the Cambourne Medical Clinic, Australia: Part 1. Wounds International 10(2): 38-47

7) Walters S, Snowball G, Westmorland L, Spanjers J, Rozells A, Carville K. Using the new T.I.M.E. Clinical Decision Support Tool to promote consistent holistic wound management and eliminate variation in practice: Part 4 at Silver Chain Group, Perth, Australia. Wounds International 2019 ;10(4):32-39

8) International Wound Infection Institute (IWII) Wound infection in clinical practice. Wounds International 2016.


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Speaker

Wendy White

MWoundCare. BEd. RN. Plast Cert. MACN. FWA

Credentialed Wound Clinician (CWC)

Fellow Wounds Australia

Wendy has 30 years of wound & skin care specific clinical expertise from a wide range of settings and in private practice. She is a qualified educator and has delivered quality education, clinical and professional support services in national and international arenas including healthcare, residential, government, industry and insurance settings for the past 13 years.Wendy’s areas of wound related clinical interest, research or publication include skin tear prevention and management, minimising wound related pain (including low resource setting), assessment & differentiation of neuropathic pain, wellbeing when living with a wound, clinicians as advocates, person engagement & partnerships, pressure injury prevention & management frameworks for change and advancing debridement knowledge & practice skills acquisition training programs. Wendy is a recipient of a Wounds Australia Fellowship (previously known as the Australian Wound Management Association), in recognition of her contribution to clinical practice, education, research and leadership in wound management throughout Australia, and the Asia Pacific region.

More from this speaker
Prof. Keryln Carville

RN, PhD, STN (Cred)

Professor Primary Health Care & Community Nursing

Silver Chain Group and Curtin University, Western Australia

Keryln has extensive clinical experience and is committed to research and education within the domains of wound and ostomy care. Keryln Chairs the Pan Pacific Pressure Injury Alliance and she is the Evidence Chair on the International Wound Infection Institute. Keryln was appointed a Fellow of Wounds Australia in 2006, and Life Membership of the Australian Association of Stomal Therapy Nurses in 2015.

She was awarded Life Membership of Silver Chain Nursing Association (award number 35 since inception in 1906), and the inaugural award for Life Time Achievement in Nursing in WA in 2010. She has over 100 publications and has delivered many key note presentations.

More from this speaker
Theresa “Terry” Swanson

Nurse Practitioner Wound Management

RN, NPWM, PGCert (Periop),

CertWNDM, MHSc FAWMA, FMACNP

Terry commenced wound management in the early 1990’s and her practice was shaped by an article in 1994 by Keith Cutting and Keith Harding on theCriterial for identifying wound infection.  She was invited to attend an international wound infection forum in 2006 which was the first meeting for the International Wound Infection Institute (IWII).  Her passion for identifying and managing wound infection has continued to grow.   Terry has served as the Chair of the IWII and is the current Vice Chair.  In 2016 she led the project for the development of the IWII Wound Infection in Clinical Practice: Principles of best practice.  Her expertise and passion for the subject of wound infection was acknowledged with Terry being invited and participating in the Global Wound Biofilm Expert Panel research and publications.

Terry has published and presented on chronic wounds and wound infection nationally and internationally.  She was the lead author and editor for the bookWound Management for the Advanced Practitioner. Terry was the Scientific Chair of the 2018 Wounds Australia National Conference and has held positions of responsibility of various nursing and wound related boards locally, nationally and internationally.  She was admitted as a fellow and life member of AWMA/ Wounds Australia for her dedication and influence in the wound management.

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