when to walk?

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Hi,

Please advise.

I'm in the fortunate position of working in a department that works directly with P&O's it is fantastic in so many mutually beneficial ways. Wound care, TCI's, rocker soles, toe fillers, skin care advice, huge benefits I've not seen in so many other places.

My main issue is when to W/B?

1) Many patients are suffering chronic wounds, acute or surgical wounds, are there any guidelines when the patient can weight bear?

(frequently on wards I will see the OT or physio making my patient walk with a frame following surgery, 90% we're against it but, as patients pay for everything outside hosptial is seems sensible for them to receive all the education and training in one place.)

What would your position be on this?

2) Is there a different guideline regarding weightbearing with different wound types?

3) Any guideline regarding amputee patients, we will only permit if a wound is healed. We encounter issues as much of the skin appears so weak that we know with 5 minutes in the protheses it will break.

We have started prescribing walking sticks to assist offloading, appropriate footwear and orthoses, but currently ceased with TCC's (due to an disproportional number of lost chopsticks and forks).

Any comments welcome
thanks

 

Our position is that there should be no direct weight bearing on any wound. If the wound can satisfactorily be off-loaded (either within a TCC or CAM boot or with multi-layer felt) then 'necessary' weight bearing is permitted (bathroom-bed-kitchen etc) but not extraordinary activity (shopping, active work, exercise etc). Patients must understand the rationale for this or it doesn't work and outcomes are seriously compromised.