Burns Unit discharge advice Information to help you when you go home Information for patients Burns Unit
Introduction This booklet aims to give you advice and information for after you leave hospital. It answers questions which are often asked by our patients. If you have any other questions which you would like to ask then you can contact the Burns Unit on: 0114 271 4129 A member of staff will try to help you. What should I expect on the day of discharge? On the day of discharge, you will be given the following if you need them: An appointment to return to the ward for dressings or a wound check Medication with an explanation of when to take it. Moisturising cream with an explanation for use. Spare dressings and instructions on what to do with them. Follow-up appointments After discharge from the inpatient service on the Burns Unit, you may be given an appointment to come to the Nurse-led Burns Assessment and Dressing Clinic for a dressing change and therapy input if required. You will see the Rehabilitation Sister at some of your visits. She will be able to advise you on returning to work, school or normal everyday activities. The Occupational Therapist can also answer questions about these issues. When you return for a dressing change or therapy it is a good idea to take painkillers before leaving home. This will help you to be more page 2 of 12
comfortable during your treatment. Further painkillers will not be available or prescribed at this clinic. If you need more painkillers, ask your GP to prescribe them for you. If you need physiotherapy or occupational therapy, please note that they are only available at set times. If you need an appointment outside these times then the Therapists may not be able to see you. When you are discharged from this clinic, any further follow-up you may require with the Consultant or a Therapist will be discussed with you. Is transport available for my appointments? Hospital transport is a limited service which is only available to patients who have been disabled by their burn injuries or those medically unfit to make their way here by any other means. Except for these people, you need to make your own way here for appointments, for example by arranging a lift or using public transport. If you are receiving benefits, you can claim travelling expenses for bus fares or a set amount per mile if you come by car. You must keep your bus tickets and get an Attendance Certificate at every visit and provide proof that you are on benefits. Hospital transport is not available for friends or relatives to come with you, except in very specific circumstances. If hospital transport is provided initially, it will be reviewed at each visit and discussed with you. Appointments with transport are always in the morning and although pick-up times can vary, it is necessary to be ready from 8.00am, unless you are told otherwise. If using hospital transport, it is a good idea to bring money for food and drinks (or bring them with you), as there is often quite a wait for the return ambulance. page 3 of 12
Physiotherapy Not all patients need physiotherapy but if it is required, it is available as an outpatient at certain times only. If your physiotherapist has given you some exercises to do, it is very important to carry on doing these at home. Sometimes as skin heals, it tightens up a little, so keeping a good range of movement all through your treatment and afterwards is very important. Occupational therapy If you need treatment from the Occupational Therapist, such as splint alteration or scar management, it is available during appointments at the Dressing Clinic, but only at certain times. Trying to come for these times might save you an extra visit later on just for therapy. Occupational therapy may be required for many months after your wound has healed but will take place in the Outpatient Therapy Services building after healing has occurred. It is usually much less often than dressing appointments have been. If you require any form of scar management, it is very important that you follow the wear and care instructions provided by the Occupational Therapist. Clinical Psychologist If you or your family have any anxieties or concerns resulting from your burn injury, there is a Trauma Psychologist attached to the Burns Unit. If you have seen them whilst you were an inpatient, you may have been given a number to contact them on. If not, a member of the Burns Team or your GP can arrange for you to see them. Practice Nurses or District Nurses Although Practice Nurses and District Nurses are very capable of doing many types of dressings, they cannot provide the same level of burns expertise you would receive in a Burns Clinic. Nor will physiotherapy or page 4 of 12
scar management be available from either of these. However, it may be possible for some of your dressings to be done by them. Please discuss with the ward nurses what is best for you. Generally, District Nurses are only available for people who can t go to their GP surgery for dressings. If a District Nurse is needed, this will be arranged by the nurses on the ward. They will also send information about your dressing and injury to the District Nurse. One week's supply of dressings will be given to you to give to the District Nurse. If you are going to the Practice Nurse at your GP surgery, a letter telling them about your burn and its treatment and some dressings will be given to you to pass on to them at your first appointment. How do I care for my wound / graft / donor site? If you have dressings, they should be left in place (and kept clean and dry) until your appointment here or your District Nurse visit / Practice Nurse appointment. Only change the dressings yourself if you have been asked to do so and been given full instructions and the correct dressings. When the wound has healed, you will be given a set of instructions about looking after your skin. If you have a donor site, it usually takes around 2 weeks to heal. Unless you have been specifically told otherwise, the base dressing should be left in place for the whole of this time and kept clean and dry. These wounds usually heal best if they are not interfered with, although sometimes it will be necessary for your nurse to replace soiled padding or loose tape. page 5 of 12
Bathing / showering If you have a dressing you must keep it clean and dry but you can still shower or bath if you can manage to do so without wetting the dressing. Quite often it may be possible for you to change your own dressings, especially if a family member helps you. In this case you can bath or shower once the old dressings are off and before you put clean dressings on. However, some dressings are designed to be worn for several days and in this case you would have to keep them dry until they are due for changing. Only change your own dressings if you have been asked to do so and been given the right dressings. You will not be able to have a bath or a shower at the Burns Assessment and Dressing Clinic as there are no facilities for this. There are waterproof covers which go over leg or arm dressings which can be bought over the internet. Limb-o is one make. Please ask your nurse how long you are likely to be wearing dressings and whether you can change them yourself to help you make a decision about whether to buy one of these. For simple hand or foot covers, you may find a tough freezer bag or bin liner firmly taped in place and removed straight afterwards works well for you. Skin changes When a burn first heals it is often a different colour to the rest of your skin. It is usually more red, purple or pink due to the extra blood supply brought in by your body to heal itself. If the burn has healed quickly, it usually fades in the weeks after the burn has healed but can remain for longer. People with black skin often notice that their new skin grows back pink initially. How skin pigment returns is very unpredictable, sometimes it comes back lighter, sometimes darker and sometimes rather unevenly or, it can match your normal skin colour exactly. What is certain is that it changes, usually for the better over the weeks and page 6 of 12
early months after healing. In other words, what you see when you have first healed is not the end result and often it can improve fairly quickly. Cosmetic Camouflage is a kind of make-up which can be used to disguise permanent changes in skin pigmentation. This is a service which is available at the Northern General Hospital through the Pharmacy Department. If you think that you would be interested in this you can be referred for an appointment. If you are still seeing a member of the Burns Team then they can refer you. If you are not seeing a member of the Burns Team, then your GP can refer you. Scarring can be a problem after burns have healed. Usually, it is only a problem for people whose burns have taken longer than 3 weeks to heal and people who have had a skin graft. The kind of scarring we are talking about is hard, lumpy, raised scarring which can often be quite red in colour. This is called hypertrophic scarring and people who are likely to develop it are referred for scar management. Occasionally, people who are not in the above groups do start to develop this scarring due to their genetic make-up. If you are going to develop it, it will happen in the first 6-8 weeks after healing and if you think that it is developing then you should contact the Burns Unit and explain your concerns. If you are thought likely to develop hypertrophic scarring for any of the above reasons, you will be referred to the Occupational Therapist who will assess you and start scar management if you both feel it is right for you. Care in the sun It is important to avoid sun exposure to any healed or unhealed burns. Keep unhealed burns out of the sun completely. When fully healed, keeping the area covered with fabric the sun can t get through, or wearing Factor 50 suncream is strongly recommended. Broad-brimmed hats or peaked caps can also be used to help protect the page 7 of 12
skin for people who have had facial burns. New skin is far more easily sunburnt than other skin (like a baby s) and if it becomes tanned, it may never fade back to its normal colour, leaving a permanent brown mark on the skin. This also applies to donor sites. After the first year, exposure to the sun may be possible depending on the severity of the original burn. After two years, normal exposure to the sun should be fine if built up gradually. However, suncream should still be worn as part of normal sun safety. Diet When you go home, for most people a normal, healthy, well-balanced diet containing sources of protein such as meat, fish, milk, cheese, nuts etc. is perfectly suitable. If anything else was required, such as supplements or vitamins, you would have been prescribed these on discharge. This healthy diet will help any remaining healing and also help to prevent skin breakdown. Smoking Stopping smoking will help wounds to heal and grafts to take. This is because smoking reduces the blood supply to the healing wound which can slow it down. If you would like to stop smoking whilst you are in hospital there is help available; just ask. If you feel that you are unable to stop smoking, it can still help if you cut down. Activity and rest When you first go home after your injury you may find that you feel very tired all the time. This is quite normal. Give yourself time to rest and recover. When resting, we suggest that if you have burned your leg or arm / hand, that you keep them up (elevate page 8 of 12
them). This will help to reduce swelling and improve circulation and comfort. Try to reintroduce normal activities gradually and build up your tolerance to exercise again by doing little and often and more each day. Sleeping Sometimes this may be a problem due to pain or discomfort. If this is a problem for you, try taking a painkiller just before you settle down. Sometimes you might just not feel tired at night. This can also be quite normal, especially if you have been napping in the day or are just not yet doing very much during the day to make yourself tired. This will improve with time. You can try having fewer or shorter naps in the day or increasing your level of activity if you are able. A bedtime routine can also help, or a warm milky drink. Some people find that avoiding bright computer or mobile phone screens just before settling also helps. Sometimes the problem can be nightmares or flashbacks relating to your accident. This is quite normal after a traumatic injury and many people do experience this. Gradually these should settle down and become less and less of a problem to you. If it does continue and is causing you anxiety and emotional problems, contact the ward or your GP. There is a Trauma Psychologist attached to the Burns Unit who will speak to you if you wish. Clothing It may be more comfortable to wear loose fitting clothes in a soft fabric such as cotton, to avoid rubbing or chafing to newly healed skin. Looser clothes will also fit better over any remaining dressings. page 9 of 12
Sexual relations There is no fixed rule about this. Basically, if you are not disturbing any wounds or dressings which might cause wound breakdown, then you can resume sexual activity when you feel ready to. Returning to work If you have a heavy manual job or work in a dirty environment, we generally advice that you do not go back to work until all wounds are healed. Sometimes, especially if you have had a lengthy period off work, it can be hard to go back to work full-time straight away. Sometimes shorter shifts or fewer days at work for the first week or two can help you to settle back in without becoming too tired. Driving Do not drive until you have a full range of movement and no restrictive dressings that might affect your driving ability. You also need to be able to do an emergency stop. Make sure your Insurance Company is aware if you are still wearing dressings. General recreation It is important to resume your normal physical activities as soon as possible, but sometimes this is not advisable straight away. Swimming is good exercise once the skin is fully healed, providing all the chlorine is washed from the skin soon afterwards, as this can cause skin irritation. Football, rugby and other contact sports should be avoided whilst wounds are healing and the new skin is delicate. Generally, after a skin graft we would advise you to wait about 6 weeks before resuming page 10 of 12
contact sports, but this could be less for burns that have healed very quickly. Is there anything else I should look out for? Whilst you have burn wounds it is important to look out for any signs of infection. These signs may be related to the burn wound or you may start to feel generally unwell. Once you have healed these will no longer be a concern. Signs relating to the wound may include: Redness around the wound, particularly if spreading up the limb away from the burn A strong, offensive smell from the wound or dressing A rash, near the wound or on the body generally A high temperature A lot more pain in or around the wound It is important to seek medical advice if you develop any of these symptoms. Do not wait until your next appointment. Who should I contact if I have any concerns? If you have any urgent concerns or have been discharged completely from burns follow-up care, you can call us on: 0114 271 4129 Depending on the problem, it might be necessary to contact your GP. If you are still coming to the Burns Assessment and Dressing Clinic and the problem is not urgent, you can ask your question at the appointment but if the problem is urgent, you must not wait until your next appointment; contact the Burns Unit on the above number. If your concern is regarding your scar management or pressure garments, the Occupational Therapist will have provided you with a page 11 of 12
number for their department. If you have lost this or it is outside normal office hours, Burns Unit staff will try to help you; please contact us. Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD2656-PIL503 v6 Issue Date: March 2018. Review Date: March 2021