Abstract
Silver Chain, the largest community care provider in Western Australia, assists older people and individuals living with a disability to remain living independently in the community. Many of these individuals are at risk of developing a pressure ulcer. This paper describes the results of a project that combined the introduction of the Australian Wound Management Association’s (AWMA) Clinical Guidelines for the Prediction and Prevention of Pressure Ulcers 1 into everyday work practices across the organisation with a systematic evaluation of the strategy’s effectiveness.
The project was originally designed to have the four discrete stages of: 1) baseline data collection, 2) guideline implementation, 3) repeat of baseline data collection, 4) ongoing evaluation. The main outcome measures were pressure ulcer prevalence and the adoption of prevention practices recommended by the guidelines. However, the lack of a significant reduction in prevalence when the baseline measures were repeated at one year, prompted the modification of the original design to include two further stages. These involved the implementation of strategies to reinforce the adoption of practice changes, followed by a third prevalence survey.
The project was then found to have been successful in significantly reducing the prevalence of pressure ulcers among our most at risk clients as well as having achieved practice change among our home care staff. However, ongoing monitoring indicates that the practice changes are not being sustained over time and that further research is needed to determine how the adoption of new practices may be better maintained so that a return to baseline levels of pressure ulcer prevalence may be avoided.

Abstract
With regard to the management of partial thickness burns blisters, confusion continues in the literature as to whether to drain the blister, drain and deroof the blister, or leave the blister intact. This in turn creates difference of opinion between medical and nursing colleagues with little in the way of evidence-based recommendations. This paper highlights some of the conflicting research in an attempt to assist in the development of policies of best practice.

Abstract
Until now the Payne-Martin Classification System for Skin Tears has been the only skin tear classification system reported in the literature. Considering that the development of this taxonomy began over twenty years ago, it is rather puzzling that it has been poorly utilised in Australia. Especially in light of the fact that skin tears are perceived to be common wounds amongst frail older or disabled persons 1, 2, 3 and their prevalence can be expected to escalate in line with our ageing population. Stage one of the Skin Tear Audit Research (STAR) study aimed to gain a consensus from Australian nurse experts in wound management on a classification system for skin tears and to test the reliability of the resulting classification system. This paper reports on the processes undertaken to achieve a consensus, the STAR Skin Tear Classification System that resulted, and the reliability testing that it underwent.

Abstract
The current concept in the clinical management of patients focuses on evidence-based quality use of medicines. In the area of wound management it has been purported that evidence-based practice has not kept pace with the numerous wound care products that are now available on the market. So, are wound care products that have been tested for efficacy by randomised controlled clinical trials the only ones that should be used in clinical practice? Is there still a place for those traditional ‘tried and true’ products in the management of wounds? One such product is ichthammol glycerin APF [Australian Pharmaceutical Formulary and Handbook], for which the question remains: Is its current use based on clinically supported evidence?
Ichthammol is derived from marine sediments in Mesozoic era rock formations. It has a high hydrogen/carbon ratio and is low in nitrogen. This is opposite to a tar with which it is often confused. Ichthammol is generated from low temperature carbonisation of shale oil. It is obtained by distillation from certain bituminous schists, sulphonation of the distillate and neutralisation of the product with ammonia to pharmacopeial specifications after which it is available for medical use [British Pharmacopoeia grade (BP)]. Ichthammol is also referred to as ammonium bituminosulphate, sulfonated shale oil and ichthyol although the latter usually refers to the pale version. Dark ichthammol is a result of strong acid treatment and pale ichthammol is the result of light acid treatment. Dark ichthammol is a dense, blackish-brown liquid which is miscible with glycerol (BP). Glycerol, a clear liquid possessing humectant and moisturising actions, therefore serves as a suitable vehicle for topical preparations containing ichthammol, and the resultant preparation is called ichthammol glycerin.
Believed to have been used in wound healing as early as the 1400s, with documented use in dermatology since the late 1880s, ichthammol has also been combined with a number of other ingredients, including mercury. Ichthammol is purported to have antibacterial, antiphlogistine, anti-inflammatory, antiseborrhoic, antieczematous, antimycetic, antiprurinous and blood flow stimulating effects. The literature claims that shale oils inhibit sebaceous secretion, migration of leucocytes and release of chemotactic factors by granulocytes 3. There are four anecdotal case reports of success in its clinical application, one clinical study supporting claims about its efficacy and one randomised control trial (RCT) identified through the Cochrane database. Ichthammol glycerin has been described as being used in combination but not in burn wounds. However, despite the paucity of information on both the mode of action and the antibacterial properties of these agents, they continue to be used in clinical practice in dermatology, vascular medicine and, the subject of this paper, burn wounds.

Abstract