Abstract
The study reported here describes a 1 year programme to promote best practice in maintaining skin integrity, ensuring consistent clinical practices in relation to skin care, and managing skin breakdown. The analysis included baseline data on skin breakdown; comparisons of policy and practice with clinical guidelines and best practice locally, interstate and internationally; a quality improvement trial focusing on mobility, skin condition, diet and hydration, hygiene and elimination; and implementation of best practice, including analysis of the relative quality and clinical outcomes of products, practices and documentation strategies. Product evaluation by nurses and patients showed that all mattresses trialled were effective in minimising or preventing skin breakdown. All chair cushions were rated effective in preventing breakdown -some were easier to use than others, although all were rated highly by patients.
A retrospective chart audit indicated substantial improvements in consistent use of the Braden scale. and the number of risks identified. Completed risk assessments increased by 19.6% to 70%: Initial assessment increased from 16.5% to 44.6%, with identification of dietary insufficiency increasing from 3.4% to 10.6%. Hospital acquired pressure lesions were reduced from 6.4% to 5.8%. The most notable improvement (from 1.3% of patients to 43.9%) occurred in the completion of subsequent pressure risk assessments, with a modest increase in repositioning. The use of overlays and special mattresses increased with heel raisers increasing from 11% to 82.4%. The project demonstrated the value of a comprehensive team approach to clinical care and demystfied evidence-based practice (EBP)

Abstract
Saline soaked dressings are often used on wounds healing by secondary intention within the acute care sector. Nurses need to act as patient advocates with other healthcare providers and use evidence-based practice from reliable research findings to guide practice towards care that is effective, feasible, appropriate and meaningful for the patient. As such, the levels of research-based evidence into the efficacy of saline soaked gauze dressings are discussed. This article identifies many potential issues with the use of these dressings such as patient discomfort, prolonged inflammation, localised hypothermia, infection risk and increased costs.

Abstract
Residents at the Quadriplegic Centre located in Perth, Western Australia, were studied. The Quadriplegic Centre is a 100-bed hospital for the specialist management of people with paralysis as a consequence of spinal cord injury or diseases of the spinal cord. Clinical staff at the Quadriplegic Centre became aware of the OPAL001 filtrate and cream, derived from pawpaw (papaya) and peach, and the apparent efficacy in healing various types of ulcers. Staff initiated a trial involving patients that had suffered Stage II-IV pressure ulcers, including some of more than 5 weeks’ duration that were difficult to heal. Daily treatment consisted of application of the filtrate to the ulcer and the cream to the surrounding skin with non-adherent dressing. Treatment appeared to be effective, and persistent large and deep ulcers were healed. There was improved mobility among patients, as well as less turning and bedside care. A retrospective cost analysis shows savings arose from reduced nursing care and fewer products being used for wound care. The preliminary data presented show some evidence for OPAL001 therapy reducing costs and improving outcomes; the situation where costs decrease and health outcomes improve is both unusual and highly desirable for healthcare decision makers. A randomised clinical trial is required to show that these observations are real effects from therapy.

Abstract
The aim of this project was to improve access to appropriate, timely and safe application of high compression bandaging for clients with suspected venous leg ulcers (VLUs) with the use of the Lanarkshire Oximetry Index (LOI) when an ankle-brachial pressure index (ABPI) has not be done. An additional aim was to decrease concerns generalist community nurses (GCN) had in relation to the application of high compression bandaging and its effect on blood flow in the lower limbs. This clinical practice improvement project builds on the work done by Field 1 researching why district nurses in the United Kingdom do not apply high compression bandaging. This current project involves community nurses in NSW.
The literature review highlighted that there was no research that specifically investigated nurses’ concerns and confidence in their ability to apply high compression bandaging without interfering with the client’s blood supply. Bianchi et al. 2 published a paper that demonstrated a method of increasing nurses’ confidence in their ability to apply high compression bandaging without placing the patients’ limb at risk. This method of detecting the arterial status, the LOI, is conducted by the use of a pulse oximeter.
Following the implementation of the LOI project, the survey results showed that use of the LOI is achieving a reduction in the time delay for investigations to be performed to ensure safe application of high compression bandaging for clients who have not already had an ABPI. Use of the LOI is results in an increase in nurses’ confidence that high compression bandaging has been applied in a safe manner. In summary, the project highlighted the benefits of the LOI method. This method can be used to assess the arterial status of the limb in combination with a complete assessment of the client and the wound before high compression bandaging is applied.
Since the conclusion of this project, the LOI has become standard practice in SESIH SHN CH and GCNs have now preformed 300 LOIs. Using this tool three clients with critical limb ischemia have been picked up and had urgent surgical intervention. The LOI is now being introduced into the public hospital system.

Abstract
Preventing venous leg ulcer recurrence is of prime importance to the individuals who live with these wounds and the health care providers participating in their care. Though the manifestation of these wounds is well understood, there are gaps in current understandings of how to prevent them. A survey of advanced clinical nurses in a Victorian home nursing service found a range of preventative practices employed and a subsequent review of the literature identified diverse approaches to the prevention of venous leg ulcer recurrence. The results from this survey and the accompanying review are of interest to multidisciplinary wound management practitioners who seek to promote best practice in this area of wound care.