Jacky is Consultant Nurse (Burns) at Wythenshawe Hospital, (MFT) since 2010 and is the only Consultant Nurse in Burns in the UK. She has worked in burns since 1988 and is committed to improving the patient pathway, quality improvement and service development as well as education of the workforce.
Jacky is a member of the Major Trauma and Burns Clinical Reference Group (CRG) where she represents nurses and the RCN. During this time, she has chaired the development of the Burns Annex for Mass Casualties, developed outcomes and quality dashboards, the rehabilitation prescription and is currently developing education for burns major incidents.
She was the lead for the Surgical Wound Workstream for the National Wound Care Strategy Programme (NWCSP) and published the surgical wound care recommendations.
Jacky is Programme Lead for the Manchester Burns Course at the University of Manchester.
In 2012, Jacky was Nursing Times Nurse of the Year for the development of the Burns Outreach Service which is now replicated across many burns services.
She is passionate about wound care and ensuring the use of effective treatments for both acute and chronic burn wounds.
Presentations at The Society of Tissue Viability 2022 Conference
Chronic Burn Wound Management
After attending this session, persons will be able to:
- Understand that burns can be chronic wounds
- Understand the role of an integrated care pathway in managing these wounds
Chronicity in burns is poorly recognised, however these wounds often take months if not years to heal and have a significant impact on the patient. In clinical practice, burn wounds that remain unhealed for many weeks or months often continue to be treated as burn wounds, as opposed to wounds that have become chronic. This means that they are treated topically with antimicrobials and reassessed every 2–3 days (Edwards 2013).
Having undertaken a previous audit of time to healing in burn wounds, it was identified that from a cohort of 83 patients with deep dermal or full thickness wounds, the mean time to healing was 87 days with a range from 21-376 days regardless of skin grafting. Key indicators of prolonged healing included lack of first aid, lower leg burns, and wound infection. Diabetic patients were represented as per the general population with this not having a significant impact. Other factors which are mirrored in studies, included quicker healing in the under 40year olds, flame burns and TBSA having an impact on time to healing.
This was supported by Guest et al (2019) who found that having reviewed 260 patients with burn, 30% of all the burns healed within 1month, 39% within 6 months, 46% within 12 months and a further 24% by 24 months (a total of 70% healed within 24 months.
To try and manage these wounds an Integrated Care Pathway was developed. The pathway consists of Debridement, Bacterial Burden, Wound Modulation and Steroid Therapy so all the information was in one place and colour coded for each stage of the pathway. This ensures that each section is completed for the appropriate amount of time. All the information is in one place and products in the pathway can be audited.
Use of the Pathway has led to quicker healing of non-healing burns and is now an integral part of caring for burn patients. The pathway continues to develop as new technologies become available and we become more confident in managing these wounds. Earlier acceptance of burn wound chronicity enables us to alter the treatment pathway and heal these wounds before they become long term problems.
- Edwards, J (2013) Burn wound Chronicity – myth or reality? Wounds UK. 9 (3); 4-5
- Guest JF, Fuller GW, Edwards J. (2020) Cohort study evaluating management of burns in the community in clinical practice in the UK: costs and outcomes. BMJ Open;10:e035345
Hypertrophic scar management
After attending this session, persons will be able to:
- Understand the difference between hypertrophic and keloid scars
- Understand how to assess abnormal scarring
- Understand the treatment modalities available to prevent/manage these scars
Scarring has major psychological and physical repercussions – for example, scarring on the face and visible regions of the body can be very traumatic for the patient, whether they are simple acne scars or large, raised surgical or traumatic scars. Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and may cause severe itching, tenderness, pain, sleep disturbance, anxiety, depression and disruption of daily activities.
Keloid and Hypertrophic scar differences will be discussed. Hypertrophic scars present as a deep red to purple colour, and become more elevated, firm, warm to the touch, hypersensitive and itchy as the scar progresses. It is more efficient to prevent hypertrophic scars than treat them. Meaume et al (2014) suggest that early diagnosis of a problem scar can considerably impact the overall outcome. Schmidt et al (2001), suggest that hypertrophic scars appear between 3-5 weeks after trauma, but often patients are discharged with no follow up to check whether hypertrophic scarring is forming.
The management of newly healed wounds to prevent scar formation is one of the most profound things a nurse can do for the patients’ physical and mental well-being. Therefore, nurses need to be as knowledgeable about scar products as they are about wound products, and their responsibility should not end once the wound has healed. Appropriate management of the scar will ensure that the wound remains healed and that the patient is happy with the outcome. The nurse is ideally placed to ensure that scars are appropriately identified and treated as early as possible.
This presentation will discuss practical ways in which hypertrophic scars can be managed.
- Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J. Management of scars: updated practical guidelines and use of silicones. Eur J Dermatol 2014; 24(4): 435-43
- Schmidt A, Gassmueller J, Hughes-Formella B, & Bielfeldt S. (2001) Treating hypertrophic scars for 12 or 24 hours with a self-adhesive hydroactive polyurethane dressing. Journal of Wound Care, 10, 5, 149-153