Evidence in focus

Publication summary Supporting healthcare

Swanson T, et al. Wounds International (2019)* professionals for over 150 years

Use of the T.I.M.E. clinical decision support tool (CDST) helped to guide
wound bed preparation, dressing selection and wound management
in a case series of chronic wounds
Nurse confidence with decision-making, ability to identify wound infections and ability
to manage exudate appropriately, were all enhanced by use of the T.I.M.E. CDST

Study overview

• The first of four case series evaluating use of the T.I.M.E. CDST (Figure) in clinical practice to help guide wound bed
preparation, dressing selection and ongoing management of various chronic wounds
• Five patients were monitored and reviewed for up to one month at the Cambourne Clinic in Australia,
by two practice nurses who were not wound specialists, but were familiar with T.I.M.E. principles
• Nurses were provided with information on wound management and dressings, and a folder including a weekly
T.I.M.E. CDST form, a T.I.M.E. CDST poster, nurse reflection and perception forms and patient consent forms
• Nurses were also given instructions on how to document assessments, photograph wounds and gain consent
from patients as well as consent for publication from primary care physicians and practice managers

Key results

• Clinical outcomes for the five patient cases where the T.I.M.E. BRANDED POP POSTER

CDST was applied in a real-world setting alongside local

clinical pathways are summarised below (Table) T.I.M.E. clinical decision support tool
Use MolecuLight i:X™ wound
assessment tool to measure

• Use of T.I.M.E. CDST in these five chronic wounds helped to:

wound surface area and
evaluate bioburden level
Assess patient, wellbeing and wound
Establish diagnosis and baseline characteristics for appropriate support and comorbidities that may impact healing. Record wound type, location, size, wound bed condition,
signs of infection / inflammation, pain location and intensity, comorbidities, adherence / concordance to treatment

−−Effectively support and direct wound management Bring in multi-disciplinary team and informal carers to promote holistic patient care
Record referral to others such as surgical team, wound specialist nurse, dietician, pain team, vascular and diabetes team, podiatrist, physiotherapist, family carers and trained counsellor

−−Optimise wound care delivery Control or treat underlying causes and barriers to wound healing
Record management plan for: systemic infection, diabetes, nutritional problems, oedema, continence, mobility, vascular issues, pain, stress, anxiety,
non-adherence / concordance with offloading and compression, lifestyle choices

Decide appropriate treatment

−−Identify and address underlying conditions,
1. IDENTIFY THE BARRIERS TO WOUND HEALING 1. IDENTIFY THE BARRIERS TO WOUND HEALING

3. WOUND MANAGEMENT OUTCOME 3. WOUND MANAGEMENT OUTCOME

as well as patient barriers to healing Necrotic Slough

Viable healthy wound bed
Non-inflamed,
non-infected wound

Infected
Deep infected Suspected
cavity wound biofilm

2. SELECT PRIMARY & SECONDARY INTERVENTIONS 2. SELECT PRIMARY & SECONDARY INTERVENTIONS

• Non-wound specialist practice nurses who used

Debridement Manage bioburden

T I
Hydrogel* Deslougher* Antimicrobial*

IODOFLEX
INTRASITE™ GEL or IODOFLEX™ or ACTICOAT™ DURAFIBER™

the T.I.M.E. CDST reported that it enhanced:

or IODOSORB
INTRASITE CONFORMABLE IODOSORB™ Range Range Ag
Range
Tissue Infection and / or
non-viable1-2 Inflammation1-2
1. IDENTIFY THE BARRIERS TO WOUND HEALING 1. IDENTIFY THE BARRIERS TO WOUND HEALING

M E
−−Confidence in wound management decision-making, Moisture
imbalance1-2
Edge of wound
non-advancing1-2

especially for atypical wounds

Dry Non-advancing or abnormal wound edge

2. SELECT PRIMARY & SECONDARY INTERVENTIONS 2. SELECT PRIMARY & SECONDARY INTERVENTIONS

Restore moisture balance Promote epithelialisation and healthy periwound skin

3. WOUND MANAGEMENT OUTCOME 3. WOUND MANAGEMENT OUTCOME

Hydrogel* Foam , Gelling fibre or NPWT† NPWT and Skin Care

−−Ability to identify wound infections

INTRASITE GEL ALLEVYN™ GENTLE ALLEVYN LIFE, Optimal moisture balance Advancing edge of wound
BORDER, ALLEVYN ALLEVYN LIFE Non- PICO or RENASYS
or INTRASITE GENTLE, DURAFIBER Bordered, DURAFIBER SECURA™ / PROSHIELD™ Range§
CONFORMABLE or PICO™‡ or RENASYS™

*Use appropriate secondary dressing as per your local protocol

−−Ability to manage exudate appropriately Evaluate and reassess the treatment and wound management outcomes
Evaluate: Record wound progression within given timelines. Flag if no change, go back to A, B, C and change treatment where indicated

Developed with the support of Glenn Smith3 and Moore et al. 20194
†NPWT: Negative Pressure Wound Therapy. ‡Level of exudate for wounds suitable for NPWT. §SECURA Range includes
SECURA Moisturising Cleanser, SECURA Total Body Foam, SECURA Dimethicone Protectant, SECURA Extra Protective
Cream, No Sting Skin Prep; PROSHIELD Range includes PROSHIELD Plus and PROSHIELD Foam and Spray. ||ALLEVYN
Range includes ALLEVYN LIFE, ALLEVYN GENTLE BORDER and ALLEVYN GENTLE BORDER LITE.
Reference: 1. Schultz GS, Sibbald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound
management. Wound Rep Reg (2003);11:1-28. 2. 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 2012; 9 (Suppl. 2):1–19.
3. Smith G, Greenwood M, Searle R. Ward nurse's use of wound dressings before and after a bespoke educational
programme. Journal of Wound Care 2010, vol 19, no.9. 4. Moore Z, Dowsett C, Smith G, et al. TIME CDST: an updated
tool to address the current challenges in wound care. Journal of Wound Care, vol 28, no 3, March 2019: 154-161.
The products used in the T.I.M.E. clinical decision support tool may vary in different markets. Not all products referred
to may be approved for use or available in all markets. Please consult your local Smith & Nephew representative for
further details on products available in your market. Intended for healthcare professionals outside of the US only.
Smith & Nephew does not provide medical advice. The information presented is not, and is not intended to serve as, medical
advice. For detailed device information, including indications for use, contraindications, precautions and warnings, please
consult the product’s Instructions for Use (IFU) prior to use. It is the responsibility of healthcare professionals to determine
and utilise the appropriate products and techniques according to their own clinical judgment for each of their patients.
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Figure. T.I.M.E. CDST – including product suggestions

Continued P2 >>

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Evidence in focus (continued)

Key results (cont.)

Patient case/wound type Clinical outcome applying T.I.M.E.

Case 1 After +28 days, a buruli ulcer had been identified and the patient
Buruli ulcer (atypical wound) was referred to a dermatologist

Case 2 After +30 days, the wound was on a healing trajectory with use
Skin tear (hypergranulation) of cleansing, debridement, antibiotics and compression

Case 3 After 25 days, cleansing, debridement and antibiotics

Venous leg ulcer (infected; resulted in a superficial wound on a healing trajectory
sideroderma) with visible granulation tissue

Case 4 After 14 days, the wound had healed in a timely manner using
Skin tear (itchy; signs of cellulitis) a combination of cleansing, antibiotics and patient education

Case 5 After +28 days, a healthy viable wound bed was achieved,
Venous leg ulcer (trauma related) with pink, perfused wound edges using antibiotics, appropriate
dressing selection and compression

Table. Treatment outcomes of five patient case studies managed using the T.I.M.E. CDST

Conclusion

Use of the T.I.M.E. CDST provided a structured approach to wound management and enhanced nurse
confidence with decision-making, ability to identify wound infections and ability to manage exudate
appropriately in this chronic wound case series.

Considerations

• Practice/community nurses were invited to participate in the study using the T.I.M.E. CDST as a treatment guide for
non-specialists in wound care via social media

Study citation
*Swanson
* T, Duynhoven K, Johnstone D. Using the new T.I.M.E. Clinical Decision Support Tool to promote consistent holistic wound management
and to eliminate variation in practice in Victoria, Australia: Part 1. Wounds International. 2019;10(2):38–47.
Available at: Wounds International

Advanced Wound Management, Smith & Nephew, Medical Ltd, 101 Hessle Road, Hull HU3 2BN, UK
19696-en V1 0619. Published June 2019. ©2019 Smith & Nephew. ™Trademark of Smith & Nephew. All rights reserved. GMC0865 www.smith-nephew.com