Management of Oncology Wounds

Transcription

1 EWMA Educatinal Develpment Prgramme Curriculum Develpment Prject Educatin Mdule: Management f Onclgy Wunds Latest revisin: May 2016

2 ABOUT THE EWMA EDUCATIONAL DEVELOPMENT PROGRAMME The Prgramme is designed t assist students and healthcare prfessinals wh wrk with patients with wunds and related skin cnditins and wish t develp and/r increase their knwledge and skills in rder t meet patient needs. Overall, the Prgramme aims t: Prvide students and healthcare prfessinals with the knwledge and skills t equip them t perfrm their rle in the delivery f ptimal wund care. Prvide cntemprary, interdisciplinary, prduct/brand neutral wund management educatin that is endrsed by EWMA. Prvide quality standards against which ther rganisatins can evaluate existing wund management prgrammes. Achieve Eurpean acceptance by develping an educatinal framewrk that is in line with Eurpean Cmmissin educatinal initiatives in rder t disseminate best practice in wund care. ABOUT THE CURRICULUM DEVELOPMENT PROJECT The Curriculum Develpment Prject is at the heart f the Educatinal Develpment Prgramme. The aim f the Prject is t develp a flexible curriculum, cnsisting f a number f mdules. All mdules are based n a standard template but individually fcused n a specific aspect f wund management. Each mdule is develped by a small grup cnsisting f members f the EWMA Educatin Cmmittee and/r affiliated wund care key specialists. Fr an updated list f the currently available mdules please visit the educatin sub page at ABOUT THIS MODULE The Management f Onclgy Wunds mdule aims t: Braden participant s knwledge and understanding f the assessment and management f nclgy wunds, palliative wund care and assciated cnditins. Evaluate strategies t prmte effective inter-prfessinal cllabrative wrking fr patients with nclgy wunds and palliative care needs. Page 2 f 9

3 MODULE CONTENT 1. Elabrating Bdy Eurpean Wund Management Assciatin (EWMA) 2. Date f prductin f mdule April Latest review date May Mdule intended learning utcmes This mdule prvides pprtunities fr health prfessinals t develp and demnstrate knwledge and understanding, skills and ther attributes in the fllwing areas: A. Intellectual Skills Knwledge and Understanding Participants will have knwledge f the: Tumurs and tumur-related wunds basic knwledge Nrmal and impaired wund healing 1. Pathphysilgy f cancer in relatin t the skin a. Tumur develpment. b. Primary skin tumurs. c. Tumur infiltratin f the skin thrugh lcally advanced, metastatic r tumur recurrence. 2. Epidemilgy f nclgy wunds. 3. Principles f medical curative and/r palliative treatments. 4. Evidence-based treatment mdalities. 5. Evidence-based symptm management: lcal and systemic. 6. Evidence-based lcal wund management. 7. Supprtive care t patients and families. B. Practical Skills Skills and Attributes: Participants will be able t: 1. Apprpriately assess a patient with an nclgy wund. 2. Differentiate between multiple presenting symptms. Page 3 f 9

4 3. Make effective treatment decisins, initiate further investigatins and knw when t refer t specialist services. 4. Mnitr and evaluate treatment utcmes with bjective scales and measures. 5. Identify the psychscial impact that wunding has n the individual and sciety. 6. Evaluate the prvisin f cancer and palliative care services, and ther services available fr the assessment and management f patients with nclgy wunds. 7. Ability t functin in a multidisciplinary team C. Affective cmmunicatin skills 5. Teaching/learning methds & strategies Acquisitin f 4.A & 4.B (see abve) is thrugh a cmbinatin f lectures, small grup wrkshps, prblem based learning and learning in practice thrughut the mdule. There is als the pssibility f using e-learning in cmbinatin with traditinal learning methds. Thrughut, the learner is encuraged t undertake independent study bth t supplement and cnslidate what is being taught and t braden individual knwledge and understanding f the subject. 6. Assessment methds Assessment methds will need t vary fr each prfessinal grup. Understanding will be assessed in a variety f ways i.e. pen discussin, frmal written exercises, seminars, case studies, practice wrk-bks. Thrughut, the learner is expected t cnslidate the develpment f practical skills / management skills in the clinical setting. 7. Unit cntent A. Overview / epidemilgy Incidence and prevalence data Natinal/Internatinal guidelines and targets Critique f existing epidemilgical studies t prmte understanding f their limitatins and the need fr ppulatin based data B. Pathphysilgy f cancer Tumur develpment Tumurs assciated with skin manifestatins Tumurs that infiltrate the skin thrugh lcal advancement, metastases and tumur recurrence Skin cancers with wund frmatin: malignant melanma, squamus cell carcinma, basalima, Kapsi s sarcma, Primary breast cancer with r withut cutaneus metastases, gynaeclgical cancers e.g. cancer f the vulva, and head-and-neck cancers. Page 4 f 9

5 C. Assessment Diagnstic investigatins Skin assessment Wund assessment Assessment f side effects/adverse effects f treatments Signs f tumur prgressin thrugh the skin Signs and symptms f tumur prgressin t internal rgans and structure, e.g. cugh, majr bleeding. General assessment f the patient including their general cnditin and Quality f Life (QL). D. Preventin Identificatin f risk factrs (sun expsure in melanma, early detectin f ptentially ulcerating malignant tumurs) Identificatin and actins in relatin t signs and symptms f tumur prgressin, e.g. spinal crd cmpressin E. Medical treatments (Indicatins and side effects/adverse effects) Surgery Raditherapy Neutrn/prtne/electrn therapy Chemtherapy Emblisatin Laser treatments- dangers and ptentials Tpical chemtherapy/chemstatic drugs Brachytherapy Electr chemtherapy Targeted therapies F. Organisatin f cancer and palliative services and interdisciplinary team wrking. See fr example: Managing Wunds as a Team - explring the cncept f a team apprach t wund care (Dwnlad at: ) Page 5 f 9

6 G. Symptm management Assessment and differential diagnsis f presenting symptms and hw these may be interrelated, e.g. infectin that is in additin t active tumur infiltratin f the skin Symptms related t the underlying systemic disease, e.g. pain Symptms related t lcal cnditins at the wund site, e.g. stinging frm the area between healthy skin and tumur, lcal maceratin Use f medical treatments fr palliatin f symptms (Including: pain and pruritis: Wrld Health Organisatin analgesic ladder; tpical piids; Transcutaneus Electrical Nerve Stimulatin (TENS); Acupuncture. Pruritus: prducts fr treatment f pruritus, misturizing ltins/creams, raditherapy) Pharmaclgy, pharmackinetics, drug interactins Management f side effects/adverse effecs f different types f treatment Legal and ethical issues cncerning the use f cntrlled drugs; licensed drugs fr unlicensed purpses Palliative Care Drug Frmularies: use f drugs n a named patient basis fr applicatins fr which they are nt licensed e.g. Sucralfate suspensin nrmally used fr gastric ulceratin applied as a tpical preparatin t cntrl lcal bleeding and damage t mucsa by antitumural treatment (Cytstatics and irradiatin) Patient administered drugs, including cntinuus infusins and apprpriate drug cmbinatins H. Lcal wund management Invlvement f the patient and their next f kin in setting gals fr management f the wund Understanding f the functins f tpical preparatins and dressings Understanding the functin f therapeutic beds and seating Understanding the functin f therapeutic bed linen, underclthing and sleepwear t minimise sweating and prmte skin functin and cmfrt Assessment f prblems at the wund site that can be managed with tpical preparatins and wund dressings: Exudate including peri-wund skin prtectin Odur Bleeding Emergency measures Preventive measures (care with bathing, nn-fibrus/nn-adherent dressings, cleaning techniques) Palliative treatments (raditherapy, emblizatin, bleeding, tpical haemstats) Page 6 f 9

7 Indicatins, cntraindicatins and methds fr debridement f devitalised tissue (See fr example: EWMA Dcument: Debridement (Dwnlad at: ) Debridement f devitalised tissue (when t maintain dry eschar and when and hw t debride) Stma care Management f c-mrbid cnditins e.g.: Spinal crd cmpressin Recgnitin f symptms and emergency actins required: immediate referral, high dse sterids Care f the patient with weakness and lss f mbility Care f the patient with quadriplegia/paraplegia Care f the patient with cancer-related fatigue Lymphedema: preventin, treatment, lymphedema therapy Nutritin/dietary cnsideratins, including enteral feeding fr patients with head and neck cancer Psych-scial prblems; visibility f the malignancy, clseness/dur/depressin, ptential lss f self and bdy image, measurement f quality f life Dcumentatin e.g. assessment f risks; deep venus thrmbsis, rupture f majr bld vessels, pressure ulcers, infectin, side-effects f immunsuppressives Identificatin f patient centred management bjectives Care planning Evaluatin f utcmes, e.g. TELER (Treatment Evaluatin by Le Rux s methd) Use f evidence based practice/clinical guidelines Referral criteria Interdisciplinary team wrking I. Practical skills - Assessment Wunds: lcatin, fungating wunds; extensin, depth, bacterilgy, dur, exudatin, bleeding ptential, pain. Specific needs assciated with the specific prblems. Surrunding skin: assessment f lcal and systemic symptms and recgnitin f multiple ptentially interrelated r super-impsed prblems, e.g. pain, pruritus, infectin, raditherapy skin reactins; paraesthesia/hyperalgesia/lss f functin which may herald spinal crd cmpressin Nutritinal state Page 7 f 9

8 Quality f life/ impact f wund n day t day living/impact f wund n family and partner/psychscial prblems Dressing perfrmance fr example in relatin t the management f exudate (cnditin f surrunding skin, dressing adherence, leakage, frequency f dressing changes/re-padding, dressing fit/cnfrmability, patient perspectives) J. Practical skills - Preventin Preventin f prgress f tumur and skin manifestatins, dur, pain, pruritis, bleeding, lymphedema K. Practical skills Treatment/Care Treatment f tumur: surgery; raditherapy, chemtherapy; neutrn therapy; laser treatments; electr chemtherapy; tpical chemtherapy/chemstatic drugs, targeted therapy Dcumentatin: gal setting invlving the patient and next f kin when this is pssible; evaluatin f utcmes Nutritinal supprt Psychscial supprt Dressings and tpical preparatins Lymphedema treatment: range f massage techniques; self massage techniques; cmpressin hsiery; cmpressin bandaging Symptm cntrl Hmepathy L. Educatin Educatin f patient and family Educatin f hmecare-staff Educatin f paramedics M. Dcumentatin Dcumentatin f medical cnditin, wund cnditin, nursing care, nutritinal status, lymphedema status, psychscial well-being, educatinal activities directed twards staff and next f kin, patient gals, utcme measures 8. Unit specific learning resurces Bks/Bk chapters Grctt, P, Gethin, G and Prbst, S. (2015). Skin prblems in palliative care. In Cherny, N.I, Falln, M.T., Kaasa, S., Prteny, R. K. and Currw, D. C. (eds.) Oxfrd Textbk f Palliative Medicine 5 th Editin. Oxfrd Medical Publicatins, Oxfrd Lawtn J. (2000). The Dying Prcess. Lndn, Rutledge. Page 8 f 9

9 Naylr, W, Laverty, D and Mallet, J (eds) (2001). The Ryal Marsden Handbk f Wund Management in Cancer Care. Oxfrd. Blackwell Science Twycrss, R and Wilcck, A (2007) Palliative Care Frmulary PCF3. Nttingham Grctt P and Briggs E (2008) Wund pain in palliative care. White R and Harding K (eds). Trauma and Pain in Wund care Vlume II. Aberdeen. HealthCmm UK Web links Recmmendatin fr the care f patients with malignant fungating wunds (2015) available under: %22malignant%20fungating%20wund%22 Page 9 f 9