Rosemary Kendell
Fiona Stanley Hospital, Locked Bag 100, Palmyra DC, WA 6961 rosemary.kendell@health.wa.gov.au
One of the most challenging of the sequelae to burn injury is hypertrophic scarring which is most commonly treated by compression therapy. Compression is delivered in varying forms from tubular bandages, ready-to-wear garments, through to custom-made pressure garments in a variety of designs. While there remains some conjecture and debate about the effectiveness of compression, it is a certainty that non-compliance renders compression completely ineffective. If the garment is not worn, no compression is applied to the scar.
Historically, the decision-making that accompanies the prescription of pressure garments has been driven by cost, policy, timing or clinician preference. However, with the current emphasis on patient-centred care, it is so important that compression therapy is delivered in the most patient-centric method possible. While clinicians cannot overlook the limitations of cost, there are numerous ways that compliance can be encouraged and facilitated, merely by thoughtful and holistic pressure garment prescription.
This paper will review the current practices in pressure garment prescription in various centres in Australia and New Zealand, and will then propose a rubric that can be used to aid pressure garment prescription. This rubric is routinely used by Occupational Therapists working in the Burns Unit at Fiona Stanley Hospital, and seeks to address the multi-factorial influences on garment prescription – oedema, stage of healing/skin fragility/risk of breakdown, risk of scarring, degree of hypertrophy, environmental factors, ability to don/doff, compliance and personal preference.
This tool aids the professional development of junior therapists, informs clinical decision-making, ultimately promotes compliance, and therefore improves patient outcome.
Key Words
Pressure garment prescription, Improved outcomes
Biography
Senior Occupational Therapist in the Burns Unit at Fiona Stanley Hospital.