TIME CDST: an updated tool to address the current challenges in wound care

Abstract

Despite the understanding that wounds are a common problem affecting the individual, the health service and society as a whole, there continues to be a lack of a systematic, structured, evidence-based approach to wound management. The TIME principle was first published in 2003, 1 and has since been integrated by many into clinical practice and research. However, this tool has been criticised for its tendency to focus mainly on the wound rather than on the wider issues that the patient is presenting with. At an expert meeting held in London in 2018, this conundrum was addressed and the TIME clinical decision support tool (CDST) was elaborated upon. This article introduces the TIME CDST, explains why it is required and describes how its use is likely to benefit patients, clinicians and health-service organisations. It also explores the framework in detail, and shows why this simple and accessible framework is robust enough to facilitate consistency in the delivery of wound care and better patient outcomes. Finally, it outlines the next steps for the rollout, use and evaluation of the impact of the TIME CDST.

Efficacy of topical cadexomer iodine treatment in chronic wounds: Systematic review and meta‐analysis of comparative clinical trials

“…An essential part of any treatment protocol for a chronic wound is to minimise or remove the barriers to healing by performing appropriate wound bed preparation as described by wound experts using the T.I.M.E acronym (Tissue (non‐viable), Infection, Moisture imbalance, Edge (not advancing or undermining)). 5 , 6 , 7 This systematic review of clinical studies highlights how CIOD treatment can manage and reduce many of these barriers, helping the wound to progress. The existing evidence for CIOD use in clinical practice spans almost 40 years indicating consistent successful outcomes compared to SOC.…”

“…The presence of biofilm represents a significant clinical challenge, particularly their enhanced tolerance to antimicrobials 1,2 and ability to evade the host immune response 3,4 . Control or removal of these barriers is important to allow host repair and for the wound to progress to healing as part of an effective wound bed preparation protocol 5,6 …”

“… 3 , 4 Control or removal of these barriers is important to allow host repair and for the wound to progress to healing as part of an effective wound bed preparation protocol. 5 , 6 …”

Efficacy of Versajet hydrosurgery system in chronic wounds: A systematic review

“…Wound bed preparation is the first step in the treatment of chronic wounds 36,37 . In recent years, this treatment concept has become widely known as “TIME” 36,38 . As the first step in this process, the “T” stands for the assessment and debridement of non‐viable or foreign materials (including host necrotic tissues, adherent dressing materials, multiple organism‐related biofilms or sloughs, exudates, and debris) on the surface of the wound.…”

“…36,37 In recent years, this treatment concept has become widely known as "TIME". 36,38 As the first step in this process, the "T" stands for the assessment and debridement of nonviable or foreign materials (including host necrotic tissues, adherent dressing materials, multiple organism-related biofilms or sloughs, exudates, and debris) on the surface of the wound. After "T," "I"; controlling inflammation and infection, "M"; restoration of moisture balance, and "E"; wound edge advancement are followed.…”