Position of peripheral venous cannulae and the incidence of thrombophlebitis: an observational study

Title.  Position of peripheral venous cannulae and the incidence of thrombophlebitis: an observational study.
Aim.  This paper is a report of a study conducted to investigate the most suitable location of peripheral venous cannulae to reduce the incidence of thrombophlebitis.
Background.  Peripheral intravenous cannulae are used for vascular access, but the site of insertion and size of the cannula could expose patients to local and systemic infectious complications. Small cannula size is an important factor in reducing the incidence of thrombophlebitis, but cannula location has not yet been studied. Evidence-based knowledge on how to prevent these complications is needed.
Method.  An observational survey carried out was carried out in 2007 with 427 patients in one Italian hospital. A structured observation protocol was used to survey the frequency of thrombophlebitis and the realtionship of location and size of peripheral intravenous cannulae. The variables evaluated were age, gender, cannula size and site of cannula location. Chi-square or Student t tests were used, and the adjusted odds ratios and relative 95% confidence intervals are reported.
Results.  The frequency of peripheral intravenous cannulae thrombophlebitis was higher in females (OR:1·91;CI:1·20–3·03; P  < 0·006). The highest incidence was found in patients with cannulae inserted in the dorsal side of the hand veins compared to those with cannulae inserted in cubital fossa veins (OR:3·33;CI:1·37–8·07; P  < 0·001).
Conclusion.  The use of cubital fossa veins rather than forearm and hand veins should be encouraged to reduce the risk of thrombophlebitis in patients with peripheral intravenous cannulae.     

The care and handling of peripheral intravenous cannulae on 60 surgery and internal medicine patients: an observation study

The purpose of this study was to analyse the actual routines surrounding the use of peripheral cannulae and the occurrence of complications Thirty surgery patients and 30 internal medicine patients were observed daily at a medium-sized hospital The patients were followed from the time the cannula was inserted until after withdrawal and until both the insertion site and the vein were free from pain The results showed that most of the cannulae were placed on the upper side of the hand and sizes most frequently used were 1-0 and 1-2 mm The fixation was unsatisfactory in 23 cases already after the second day Twenty-three cannulae were removed after 24 hours Thirty-seven (62%) patients were stated to have thrombophlebitis phlebitis in different degrees Only seven cannulae fulfilled the criteria for good cannula care and handling The frequency of complication was especially high when fructose-glucose, antibiotics or anticoagulants were given There was no documentation in the patient record, according to current laws in Sweden The complications observed were redness, swelling, haematoma, subcutaneous swelling and suppurating infection The study showed that the longer the cannula had been in situ , the greater were the complications (very distinct after 24 hours) The care and handling was unsatisfactory to very unsatisfactory in 52% of the cases Complications can last for a very long time In this research, pain was noted up to 5 months after the cannulae were removed     

Effect of education on evidence-based care and handling of peripheral intravenous lines

Deficient routines in use, care, handling and documentation of peripheral intravenous vein cannulae (PIV) have previously been reported, and complications have been noted in 50-75% of the patients. The aim of the study was to examine whether specially trained nurses change their actions to decrease complications when using cannulae. The study included 36 nurses assigned to experimental and control groups. The experimental group followed an education programme explaining how to use and take care of a PIV. To evaluate the intervention document analysis, observations and patient interviews were performed in 99 patients with 172 PIVs in situ for less than 24 h. After the education programme, fewer complications, more carefully performed care and handling, and better documentation and information were found in the experimental group. Nurses in the control group followed current routines, which resulted in a greater degree of complications. Education in evidence-based care and handling gives nurses the opportunity to improve their ability to use theoretical knowledge in clinical problems.     

Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care

Aims. One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record. Background. With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care). Design. A cross‐sectional retrospective review of health records. Methods. Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper‐based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed. Results. Significantly more patient records showed notes of pressure ulcer grade (p < 0·001), size (p = 0·004), risk assessment (p = 0·002), nursing history (p = 0·040), nursing diagnoses (p < 0·001), nursing goals (p < 0·001) and nursing outcomes (p = 0·016) in 2006 than in 2002. One third of the recordings used preformulated templates. Conclusions. Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow‐up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system. Relevance to clinical practice. Education related to the use of the electronic health record and evidence‐based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user‐friendly.     

Handling and control of peripheral intravenous lines

The purpose of the study was to describe nurses' routines in connection with the planning, care and handling, and documentation of a peripheral intravenous cannula (PIV) and also to examine factors that control how nurses act. Nurses and physicians in three English hospitals were interviewed. The results showed a difference between nurses' and physicians' opinions about PIV routines, except in few cases. The PIV was inserted by the physicians while the nurses took care of and documented its care and handling. In many cases the insertion of the PIV was also documented by the nurses. Although small PIVs and short insertion time had previously been recommended, many physicians preferred large cannulae and an insertion time of between 3 and 7 days. All nurses and six physicians had the opinion that the cannula should be changed more often, but this did not happen. Some physicians maintained that the nurses' care and handling varied. On the other hand some criticism had been expressed by the nurses about unclear directives from the physicians. English participants were aware that unsatisfactory routines existed and that the policy had not always been followed.     

The validity and reliability of an instrument to assess nursing competencies in spiritual care

Aim. This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses’ competencies in providing spiritual care. Background. Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature. Design. Survey. Method. The participants were students from Bachelor‐level nursing schools in the Netherlands (n = 197) participating in a cross‐sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach’s alpha and the average inter‐item correlation. In addition, the test–retest reliability of the instrument was determined at a two‐week interval between baseline and follow‐up (n = 109). Results. The spiritual care competence scale comprises six spiritual‐care‐related nursing competencies. These domains were labelled:
1 assessment and implementation of spiritual care (Cronbach’s α 0·82)
2 professionalisation and improving the quality of spiritual care (Cronbach’s α 0·82)
3 personal support and patient counseling (Cronbach’s α 0·81)
4 referral to professionals (Cronbach’s α 0·79)
5 attitude towards the patient’s spirituality (Cronbach’s α 0·56)
6 communication (Cronbach’s α 0·71). These subscales showed good homogeneity with average inter‐item correlations >0·25 and a good test–retest reliability. Conclusion. This study conducted in a nursing‐student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale. Relevance to clinical practice. The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.     

Nurses’ clinical reasoning concerning management of peripheral venous cannulae

Aim. The aim was to describe nurses’ clinical reasoning regarding peripheral venous cannulae management by focusing on the clinical information and circumstances considered during the decision‐making process. Background. On every shift nurses make several decisions, among others concerning the management of peripheral venous cannulae. Thrombophlebitis is a common complication associated with its use, although more severe complications can arise. There are clinical practice guidelines within the area, but they are not always adhered to. Previous studies have examined decisions related to the management of peripheral venous cannulae, but did not include observations in a naturalistic setting. Design. A qualitative study combining observations and interviews. Methods. Participant observation facilitated open interviews about the clinical reasoning behind decision‐making in observed situations, as well as semi‐structured interviews regarding clinical reasoning about the general management of peripheral venous cannulae. Transcribed interview texts were analysed with content analysis. Results. Three main categories describe clinical information and circumstances: the individual patient situation, the nurse’s work situation and experience of peripheral venous cannulae management. The overall theme of the interview texts was that the clinical reasoning was a balancing act between minimising patient discomfort and preventing complications from the peripheral venous cannulae. Conclusions. At all times the patients’ well‐being was considered, but the ways the nurses approached this differed depending on how they considered clinical information in the individual patient situation, circumstances in their own work situation and their experience of peripheral venous cannulae management. Relevance to clinical practice. Knowledge of the clinical information and circumstances considered in naturalistic settings, is valuable when implementing and adjusting clinical practice guidelines to local settings. This knowledge is also useful in nursing education as student nurses’ and nurses’ ability to balance between preventing complications and avoiding discomfort is important for enhancing patient care.     

Comparison of postoperative pain management using two patient-controlled analgesia methods: nursing perspective

Title. Comparison of postoperative pain management using two patient‐controlled analgesia methods: nursing perspective. Aim. To compare the effect of fentanyl iontophoretic transdermal system and morphine intravenous patient‐controlled analgesia on the time‐efficiency and convenience of postoperative patient care. Background. Intravenous patient‐controlled analgesia with morphine is effectively used to manage postoperative pain; however, it takes time to set up and administer. Methods. Nurses evaluated patient‐care tasks with fentanyl iontophoretic transdermal system and/or morphine intravenous patient‐controlled analgesia in two phase IIIb studies (n = 1305) using a nurse ease‐of‐care questionnaire. A responder for time‐efficiency and convenience responded with one of the top three positive choices on all items; for satisfaction, a responder chose one of the top two positive choices on both items. Data were collected between March 2004 and April 2005. Findings. In both studies, greater proportions of nurses were responders for fentanyl iontophoretic transdermal system than for morphine intravenous patient‐controlled analgesia, respectively, for time‐efficiency [total hip replacement surgery, 80·9% (250/309) vs. 57·7% (172/298), P < 0·001; abdominal/pelvic surgery, 84·8% (162/191) vs. 57·7% (113/196), P < 0·001], convenience [total hip replacement surgery, 85·5% (271/317) vs. 64·1% (191/298), P < 0·001; abdominal/pelvic surgery, 89·2% (166/186) vs. 62·8% (123/196), P < 0·001], and satisfaction [total hip replacement surgery, 66·6% (247/371) vs. 33·3% (108/324), P < 0·001; abdominal/pelvic surgery, 67·4% (155/230) vs. 38·2% (84/220), P < 0·001]. Higher proportions of nurses favoured fentanyl iontophoretic transdermal system than morphine intravenous patient‐controlled analgesia in both studies (P < 0·001). Conclusion. The fentanyl iontophoretic transdermal system appears to be simpler, easier to use, and more satisfactory for nurses than morphine intravenous patient‐controlled analgesia.     

What is the relationship between nurses’ attitude to evidence based practice and the selection of wound care procedures?

Aim. To investigate qualified nurses’ attitudes to evidence‐based practice and whether this influenced their selection of wound care products. Background. The literature shows that previous studies on attitudes to evidence‐based practice tended to be part of a wider study. The general consensus was that there was a positive attitude to evidence‐based practice. However, there appeared to be no published studies specifically addressing nurses’ attitudes to evidence‐based wound care. Design. Survey design using a questionnaire completed by 156 qualified nurses working in three UK National Health Trusts. Results. A statistically significant difference was seen between those nurses with a tissue viability link nurse role (p = 0·002) and those without a link nurse role; those educated to first degree (p < 0·001) and those without a first degree; and those who had received formal tissue viability training (p < 0·001) and those with informal tissue viability training. There was also a highly statistically significant relationship between the clinical grade of staff and the overall attitude to evidence‐based practice (p < 0·001). Conclusions. Nurses who had attained a higher level academic qualification, had a tissue viability link nurse role and those who had received formal tissue viability training scored generally higher in the wound care knowledge tests and in attitude to evidence‐based practice. Relevance to clinical practice. The care received by patients in relation to wound care could be dependent upon factors that are related to the individual characteristics of the nurse providing the care and these factors, in turn, are related to education and training with respect to wound care. Better general education and better specific training in wound care could lead to better wound care.     

Aged‐care nurses’ knowledge of nursing documentation: an Australian perspective

Aim. This study investigated registered nurses’ knowledge of documentation used in aged‐care nursing home facilities in Queensland, Australia. Background. The purpose of nursing documentation is to communicate health information, facilitate quality assurance and research, demonstrate nurses’ accountability and, within Australia, to support funding of residents’ care. Little is known about the relationship between RNs’ knowledge of nursing documentation, the documentation process within residential aged care and the outcomes of the documentation. Design. Cross‐sectional, retrospective design. Method. The study was conducted with a large sample of RNs (n = 360) located in 162 Queensland aged‐care facilities. Participants completed a postage‐return questionnaire in which they identified factors that influence their knowledge and understanding of documentation. Results. Participants reported that they have considerable knowledge of nursing documentation. They also indicated that they were most knowledgeable about policies on documentation and writing discharge instructions. However, their knowledge of nursing assessments ranked fifth and they were least knowledgeable about reading reports each shift. Conclusions. The modified version of Edelstein's questionnaire provided a valid and reliable instrument for measuring RNs’ knowledge of nursing documentation. A factor analysis of the 16 items in the Knowledge scale showed excellent reliability. The data indicated that RNs in aged‐care facilities have high levels of knowledge about documentation. Specific recommendations relate to the implementation of comprehensive documentation education programs that reflect the needs of organisations and the level of RNs’ skills and knowledge concerning documentation. Relevance to clinical practice. Accurate nursing documentation is relevant to residents’ care outcomes and to government funding allocations. Measuring RNs’ knowledge of nursing documentation can identify factors that impede and facilitate their documentation of care.     

Retracted: Investigating factors associated with nurses’ attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong

Aims. To explore nurses’ attitudes towards perinatal bereavement care and to identify factors associated with these attitudes. Background. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and that nurses with positive attitudes to bereavement care can help bereaved parents to cope during their grieving period. Design. Survey. Method. Data were collected through a structured questionnaire; 657 nurses were recruited from Obstetrics and Gynaecology units in Hong Kong and Shandong during 2006. Outcome measures included attitudes towards perinatal bereavement care, importance of hospital policy and training support for bereavement care. Results. The majority of nurses in this study had a positive attitude to bereavement care. Results show that only 21·6% (n = 141) of the nurses surveyed had bereavement‐related training. In contrast, about 89·8% (n = 300) believed they needed to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·5% (n = 592) would share their experiences with their colleagues and seek support when feeling under stress. A regression model showed that age, past experience in handling grieving parents, recent ranking and nurses’ perceived attitudes to hospital policy and training provided for bereavement care were the factors associated with nurses’ attitudes to perinatal bereavement care. Conclusions. Nurses in both cities emphasised their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used by nursing educators to educate their students on issues related to delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.     

The prevalence of peripheral intravenous cannulae and pattern of use: A point prevalence in a private hospital setting

Aims and objectives

To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards.

Background

Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital‐acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people.

Design

Observational, point prevalence study.

Methods

Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail.

Results

Approximately one‐quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one‐third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one‐third of these were receiving intravenous fluids.

Conclusions

There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids.

Relevance to clinical practice

Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake.     

HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa

Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Aim. This paper is a report of a study exploring HIV/AIDS‐related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Background. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. Method. A cross‐sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in‐depth interviews. Findings. Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0·05), but less HIV/AIDS training when compared to PHC nurses (P < 0·001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0·001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0·01) and training (P < 0·05). Three out of four nurses reported that they practised universal precautions (76·1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. Conclusion. There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.     

Practice nurses and older people: a case management approach to care

Aim. This paper reports on aspects of a study designed to answer the research questions: (i) To what extent do practice nurses use the five cyclical elements of a case management approach when caring for people aged over 75 years? (ii) What determines or deters practice nurses’ use of the cyclical elements of a case management approach in caring for older people? Background. Case management is an approach that uses a cyclical process of assessment, planning, implementation, monitoring and evaluation to provide systematic proactive care to people with complex health and social care needs. In England, specialist practice nurse case managers for older people have been piloted in ten primary care trusts and the posts are to be implemented nationally by 2008. No baseline work has, however, considered the applicability of developing the existing generalist practice nurse workforce. Method. A 26‐item structured postal questionnaire was used to explore both practice nurses’ use of a case management approach when working with older people, and what factors influenced the care provided. A random sample of 500 practice nurses was selected from the Royal College of Nursing Practice Nurse Association member database. Results. A 45% response rate was achieved. Practice nurses assessed, planned and implemented care, but reviewing medication opportunistically and evaluating the care were uncommon. A case management approach was significantly (P = 0·005) more likely to be used in on‐going management activities than in one‐off treatment room care. Practice nurses with postregistration education in district nursing were significantly (P = 0·016) more likely to refer patients to social care services. Lack of time and the central role of the general practitioner were the main reasons for not incorporating case management into practice. Conclusions. The extent to which practice nurses used elements of a case management approach was highly variable and influenced by individual professional expertise, the nature of the consultation and the practice nurse's position in the general practice.     

Investigating factors associate to nurses' attitudes towards perinatal bereavement care

Aim. The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May–August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39·3% (n = 130) of nurses had bereavement related training. By contrast, about 89·8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses’ perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses’ attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.     

Use of non‐conventional nurses’ attire in a paediatric hospital: a quasi‐experimental study

Aims:  To test the impact of a multi‐coloured non‐conventional attire on a population of children admitted to a paediatric hospital. Design:  Quasi‐experimental before‐after controlled study. Background:  It has been suggested that non‐conventional nurses’ uniforms in paediatric settings may contribute to lowering children’s distrust towards healthcare providers and reduce fear. Little formal research has investigated on the impact of nursing attire in a paediatric setting. No study has so far analysed the effects in actual use of a non‐conventional, other than the traditional type of uniform, on a paediatric hospitalised population. Design:  A quasi‐experimental study. Methods:  We introduced multi‐coloured nurses’ attire in two wards of a paediatric hospital. Using open questions and semantic differential scales (SDS), we evaluated the effects of this non‐conventional attire on a group of hospitalised children, compared to sex‐and‐age‐matched controls interviewed before the introduction. Parents were also interviewed. Results:  One hundred and twelve hospitalised children and their parents (n = 112) were studied. The percentage of positive words used by children to define their nurse was higher in children interviewed after the introduction of non‐conventional uniforms (96·2% vs. 81·8%, p = 0·01). Children’s perception of nurses was significantly improved by the use of multi‐coloured attire (‘bad’–‘good’ SDS: p = 0·01; ‘disagreeable’–‘nice’ SDS: p = 0·001). Children’s perceptions regarding hospital environment did not change. Parents’ perception of nurses’ uniform adequacy to the role and capability to reassure resulted improved (p < 0·0001, p = 0·0003). Conclusions:  Multi‐coloured non‐conventional attire were preferred by hospitalised children and their parents. Their introduction improved the perception children have of their nurses. Moreover, the coloured uniforms improve the parents perception about the reliability of the nurse. Relevance to clinical practice:  The use of non‐conventional nurses’ attire can contribute to improve the child–nurse relation, which has the potential to ease the discomfort experienced by children due to hospitalisation.     

Inter- and intra-observer (dis)agreement among nurses and doctors to classify colour and exudation of open surgical wounds according to the Red-Yellow-Black scheme

Aim and objectives. Primary: to study the level of agreement among nurses and doctors in classifying the colour and exudation of open wounds according to the Red‐Yellow‐Black scheme. Secondary: to check their agreement with an international expert panel on whether their classification was correct. Background. Nurses and doctors classify open wounds to assess systemic and local treatment options. Nowadays, several classification schemes are being used. The Red‐Yellow‐Black‐scheme is commonly used for classifying open wounds or is part of other, more intricate, wound classification models. Methods. Eighteen representative photographs of red, yellow and black wounds were presented to 63 nurses and 79 doctors from the Department of Surgery. They classified these open wounds for colour and amount of exudation. Group kappa's (κ) were calculated to assess inter‐ and intra‐observer agreement and their agreement with an expert panel. Results. Agreement among the 63 nurses on wound colour (κ = 0·61; 95% CI: 0·49–0·74) and exudation (κ = 0·49; 95% CI: 0·29–0·68) was moderate to good. Agreement among the 79 doctors was similar: κ = 0·61; 95% CI 0·49–0·73 for wound colour and κ = 0·48; 95% CI: 0·36–0·61 for exudation. Nurses’ and doctors’ agreement with the expert panel was also moderate to good: κ‐values ranged between 0·48 and 0·77. Conclusion. Based on the good to moderate inter‐observer agreement as found in this study, the Red‐Yellow‐Black ‐scheme appears to be a reliable and accurate classification scheme to assess open (surgical) wounds. Such a scheme may enable nurses and doctors to select the appropriate treatment modalities and evaluate the progress of the healing process. Relevance to clinical practice. The Red‐Yellow‐Black scheme is a helpful tool to classify all kinds of wounds and can be used as stand‐alone classification method or as part of wound management concepts.