Starting a consulting business

wound care business consult

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC

Starting your own consulting business is an exciting and rewarding experience: You’re the boss; you’re in charge. The question is, do you have what it takes? Along with the excitement of being the boss comes the responsibility of decisions and commitment. Your decisions will affect whether the business is a failure or a success.

To succeed in consulting, you must be an expert at recognizing problems and shaping solutions to those problems, and you must possess excellent time-management and networking skills. If you think you have what it takes to be a consultant, read on. This article gives an overview of the process.

Nature of the business

Businesses hire consultants for their expertise to help them identify problems, supplement staff, institute change, provide an objective viewpoint, or teach.
Examples of specific services you can offer include single patient reviews, serving as a member of the wound care team, making wound rounds on all patients, providing education, patient teaching, protocol development, and troubleshooting. These services are provided in many settings—long-term care, home care, long-term acute care, rehabilitation hospitals, acute-care hospitals, insurance companies, and primary-care provider groups. (more…)

Read More

Rare ‘Flesh-Eating’ Bacterium Spreads North as Oceans Warm

Map of cases of the flesh eating bacteria Vibrio vulnificus

Debbie King barely gave it a second thought when she scraped her right shin climbing onto her friend’s pontoon for a day of boating in the Gulf of Mexico on Aug. 13.

Even though her friend immediately dressed the slight cut, her shin was red and sore when King awoke the next day. It must be a sunburn, she thought.

But three days later, the red and blistered area had grown. Her doctor took one look and sent King, 72, to the emergency room.

Doctors at HCA Florida Citrus Hospital in Inverness, Florida, rushed King into surgery after recognizing the infection as Vibrio vulnificus, a potentially fatal bacterium that kills healthy tissue around a wound. While King lay on the operating table, the surgeon told her husband she would likely die if they didn’t amputate.

Just four days after the scrape, King lost her leg then spent four days in intensive care.

“The flesh was gone; it was just bone,” she said of her leg.

Cases of V. vulnificus are rare. Between 150 and 200 are reported to the Centers for Disease Control and Prevention every year, with about 20% resulting in death. Most are in states along the Gulf of Mexico, but, in 2019, 7% were on the Pacific Coast. Florida averages about 37 cases and 10 deaths a year.

But a rise in cases nationally and the spread of the disease to states farther north — into coastal communities in states such as Connecticut, New York, and North Carolina — have heightened concerns about the bacterium, which can result in amputations or extensive removal of tissue even in those who survive its infections. And warmer coastal waters caused by climate change, combined with a growing population of older adults, may result in infections doubling by 2060, a study in Scientific Reports warned earlier this year.

“Vibrio distributions are driven in large part by temperature,” said Tracy Mincer, an assistant professor at Florida Atlantic University. “The warmer waters are, the more favorable it is for them.”

 

The eastern United States has seen an eightfold increase in infections over a 30-year period through 2018 as the geographic range of infections shifted north by about 30 miles a year, according to the study, which was cited in a CDC health advisory last month.

The advisory was intended to make doctors more aware of the bacterium when treating infected wounds exposed to coastal waters. Infections can also arise from eating raw or undercooked seafood, particularly oysters, it warned. That can cause symptoms as common as diarrhea and as serious as bloodstream infections and severe blistered skin lesions.

New York and Connecticut this summer issued health warnings about the risk of infection as well. It’s not the first year either state has recorded cases.

“There’s very few cases but when they happen, they’re devastating,” said Paul A. Gulig, a professor in the Department of Molecular Genetics and Microbiology at the University of Florida College of Medicine.

‘An Accident of Nature’

Vibrio has more than 100 strains, including the bacterium that causes cholera, a disease that causes tens of thousands of deaths worldwide each year.

The V. vulnificus strain likes warm brackish waters close to shorelines where the salinity is not as high as in the open sea. Unlike some other Vibrio strains, it has no mechanism to spread between humans.

It’s found in oysters because the mollusks feed by filtering water, meaning the bacterium can become concentrated in oyster flesh. It can enter humans who swim in salty or brackish waters through the slightest cut in the skin. Infections are treated with antibiotics and, if needed, surgery.

“It’s almost an accident of nature,” Gulig said. “They have all these virulence factors that make them really destructive, but we’re not a part of this bug’s life cycle.”

Once inside the human body, the bacteria thrive.

Scientists don’t believe the bacteria eat flesh, despite how they’re often described. Rather, enzymes and toxins secreted by the bacterium as it multiplies break down the human tissue in the area below the skin, causing necrosis, or death of tissue cells.

The infection spreads like wildfire, Gulig said, making early detection critical.

“If you take a pen and mark where the edge of the redness is and then look at that two or four hours later, the redness would have moved,” Gulig said. “You can almost sit there and watch this spread.”

Researchers have conducted studies on the bacteria, but the small number of cases and deaths make it tough to secure funding, said Gulig. He said he switched his research focus to other areas because of the lack of money.

But growing interest in the bacteria has prompted talk about new research at his university’s Emerging Pathogens Institute.

Examining the bacteria’s genome sequence and comparing it with those of Vibrio strains that don’t attack human flesh could yield insights into potential drugs to interfere with that process, Gulig said.

Shock and Loss

Inside the operating room at HCA Florida Citrus, the only signs of King’s infection were on her shin. The surgeon opened that area and began cutting away a bright red mush of dead flesh.

Hoping to save as much of the leg as possible, the doctor first amputated below her knee.

But the bacteria had spread farther than doctors had hoped. A second amputation, this time 5 inches above the knee, had to be performed.

After surgery, King remained in critical care for four days with sepsis, a reaction to infection that can cause organs to fail.

Her son was there when she awakened. He was the one who told her she had lost her leg, but she was too woozy from medication to take it in.

It wasn’t until she was transferred to a rehab hospital in nearby Brooksville run by Encompass Health that the loss sank in.

A former radiation protection technician, King had always been self-reliant. The idea of needing a wheelchair, of being dependent on others — it felt like she had lost part of her identity.

One morning, she could just not stop crying. “It hit me like a ton of bricks,” she said.

Six different rehab staffers told her she needed to meet with the hospital’s consulting psychologist. She thought she didn’t need help, but she eventually gave in and met with Gerald Todoroff.

In four sessions with King, he said, he worked to redirect her perception of what happened. Amputation is not who you are but what you will learn to deal with, he told her. Your life can be as full as you wish.

“They were magic words that made me feel like a new person,” King said. “They went through me like music.”

Physical therapy moved her forward, too. She learned how to stand longer on her remaining leg, to use her wheelchair, and to maneuver in and out of a car.

Now, back in her Gulf Coast community of Homosassa, those skills have become routine. Her husband, Jim, a former oil company worker and carpenter, built an access ramp out of concrete and pressure-treated wood for their single-story home.

But she is determined to walk with the aid of a prosthetic leg. It’s the motivation for a one-hour regimen of physical therapy she does on her own every day in addition to twice-weekly sessions with a physical therapist.

Recovery still feels like a journey but one marked by progress. She has nicknamed her “stump” Peg. She’s now comfortable sharing before and after pictures of her leg.

And she’s made it her mission to talk about what happened so more people will learn about the danger.

“This is the most horrific thing that can happen to anybody,” she said. “But I’d sit back and think, ‘God put you here for a reason — you’ve got more things to do.’”

What to Know About ‘Flesh-Eating’ Bacterium Vibrio vulnificus

Infection Symptoms:

  • Diarrhea, often accompanied by stomach cramping, nausea, vomiting, and fever.
  • Wound infections cause redness, pain, swelling, warmth, discoloration, and discharge. They may spread to the rest of the body and cause fever.
  • Bloodstream infections cause fever, chills, dangerously low blood pressure, and blistering skin lesions.

To Protect Against Vibrio Infections:

  • Stay out of saltwater or brackish water if you have a wound or a recent surgery, piercing, or tattoo.
  • Cover wounds with a waterproof bandage if they could come into contact with seawater or raw or undercooked seafood and its juices.
  • Wash wounds and cuts thoroughly with soap and water after contact with saltwater, brackish water, raw seafood, or its juices.

Who Is Most at Risk:

  • Anyone can get a wound infection. People with liver disease, cancer, or diabetes, and those over 40 or with weakened immune systems, are more likely to get an infection and have severe complications.

Sources:

This article was produced in partnership with the Tampa Bay Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

 

Read More

Winning the battle of skin tears in an aging population

ON DEMAND webinar

Winning the battle of skin tears in an aging population

This April 25th, 2017 webinar overviews a significant challenge that healthcare providers encounter daily.

“Skin tears” may sound like a relatively minor event, but in reality, these injuries can have a significant impact on the quality of patients’ lives in the form of pain, infection, and limited mobility. The incidence of skin tears has been reported to be as high as 1.5 million annually, and with an aging population, this number is likely to go higher. In this webinar, experts will explain how nurses can use an evidence-based approach—including following practice guidelines to assess the wound and select the proper dressing—for managing skin tears and minimizing their negative effects.

 

Our Speakers

The skin tear challenge

Kimberly LeBlanc, MN, RN, CETN(C) Advanced practice nurse

Kimberly LeBlanc
MN, RN, CETN(C)
Advanced practice nurse, KDS Professional Consulting President, International Skin Tear Advisory Panel
An expert in skin tears, Kimberly will briefly set the stage by addressing the seriousness of skin tears and briefly addressing assessment such as classification.

The main focus will be on management, including goals of care, wound cleaning, wound bed preparation, and dressing selection.

Content will include information from the 2016 consensus statement on skin tears published in Advances in Skin & Wound Care.

|

Tips and techniques for managing dressings for skin tears

Shannon Cyphers, RN, BSN, WCC Clinical Account Manager ConvaTec, Inc.

Shannon Cyphers
RN, BSN, WCC

Clinical Account Manager, ConvaTec, Inc.
Shannon will present wound and skin care product applications to help manage skin tears.

|

Submit below to view the Webinar and download Slidedeck

Questions or comments?  Please contact [email protected]

*By downloading this (product) you are opting in to receiving information from Healthcom Media and Affiliates. Or the details, including your email address/mobile number, may be used to keep you informed about future products and services.
Read More

Case study: Working under a time crunch in a short-stay facility

short stay facility

By Janet Wolfson, PT, CWS, CLT-LANA

After landing my dream job as the wound care coordinator at an inpatient rehabilitation facility (IRF), I found myself trying to determine how much healing could be achieved for our more challenging patients, given the constraints of reimbursement and what can be done in the typical 10 to 14 days of a patient stay.

Here’s an example of how I worked with our team to help one of these challenging patients. (more…)

Read More

2015 Journal: March – April Vol. 4 No. 2

Wound Care Advisor Journal Vol4 No2

Palliative wound care: Part 2

By preventing and relieving suffering, palliative care improves the quality of life for patients facing problems associated with life-threatening illness. This care approach emphasizes early identification, impeccable assessment, and treatment of pain and other issues—physical, psychosocial, and spiritual.

When relieving distressing symptoms takes higher priority than healing the wound, the patient may choose palliative  wound care after consulting with the medical team. Addressing such issues as pain, odor, exudate, bleeding, infection, and cosmetic appearance, this treatment approach couples the elements of traditional wound care with symptom management. When delivered correctly, it brings patient-centered care to life.

Read more

Clinical Notes : Diabetes, medical honey, silver dressings, clostridium

Guidelines for optimal off-loading to prevent diabetic foot ulcers  “The management of diabetic foot ulcers through optimal off-loading,” published in the Journal of the American Podiatric Medical Association, presents consensus guidelines and states the “evidence is clear” that off-loading increases healing of diabetic foot ulcers. The article calls for increased use of off-loading and notes that “current evidence favors the use of nonremovable casts or fixed…

Finding common ground: Surviving wound care communication

By Jennifer Oakley, BS, RN, WCC, DWC, OMS The author describes how to overcome challenges to effective communication in the healthcare setting. Accurate communication among healthcare professionals can spell the difference between patient safety and patient harm. Communication can be a challenge, especially when done electronically. With an e-mail or a text, you can’t hear the other person’s voice or…

If pressure ulcers were apples: A fun inservice program

 By Karen Culp, RN, WCC I’m one of the nurses responsible for the pressure ulcer prevention education program at the 150-bed skilled nursing facility where I work. We try to keep education sessions simple, fun, and interactive. One day, our administrator asked us to develop a crossword puzzle and “minute to win it” education game that would be appropriate for…

More from The Buzz Report: A wound care clinician’s best friend

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Keeping clinicians up to date on clinical knowledge is one of the main goals of the Wild On Wounds (WOW) conference,held each September in Las Vegas. Each year, I present the opening session of this conference, called “The Buzz Report,”which focuses on the latest-breaking wound care news—what’s new, what’s now, and…

Palliative wound care: Part 2

This approach brings patient-centered care to life.  By Gail Rogers Hebert, MS, RN, CWCN, WCC, DWC, OMS, LNHA Editor’s note: This article is the second in a two-part series on palliative wound care. For the first part, click here. By preventing and relieving suffering, palliative care improves the quality of life for patients facing problems associated with life-threatening illness. This…

Role of rehab in wound care

 By Bill Richlen, PT, WCC, DWC, and Denise Richlen, PT, WCC, DCCT How many times have you heard someone say, “I didn’t know PTs did wound care”? Statements like this aren’t uncommon. The role of physical therapists (PTs), occupational therapists, and speech therapists in wound care is commonly misunderstood by and even a mystery to many clinicians. Sometimes the therapists…

What exactly are “the rules”?

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Editor-in-Chief During a recent wound care presentation, an audience member jumped up to contradict the speaker. “That is incorrect,” she asserted. “The rules state….” When someone asked her what rules she was referring to, she replied, “The government’s rules.” On the surface, that might seem like a straightforward answer. But when…

2015 Journal: March – April Vol. 4 No. 2

Read More

Palliative wound care: Part 2

This approach brings patient-centered care to life.

 By Gail Rogers Hebert, MS, RN, CWCN, WCC, DWC, OMS, LNHA

Editor’s note: This article is the second in a two-part series on palliative wound care. For the first part, click here.

By preventing and relieving suffering, palliative care improves the quality of life for patients facing problems associated with life-threatening illness. This care approach emphasizes early identification, impeccable assessment, and treatment of pain and other issues—physical, psychosocial, and spiritual. (more…)

Read More

Evolution of the deep tissue injury or a declining pressure ulcer?

 By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

A declining pressure ulcer decreases the quality of life for patients and places providers at risk for regulatory citations and litigation. But it’s important for clinicians to determine whether the first appearance of skin injury is truly a stage I or II pressure ulcer or if it’s a deep tissue injury (DTI), a unique staging category for a pressure ulcer. Otherwise, a clinician might think a pressure ulcer is getting worse instead of the change being the normal progression of a pressure ulcer that is presenting as a DTI. (more…)

Read More

Communicating to caregivers: Cornerstone of care

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

The challenge of preventing pressure ulcers is won through our frontline staff—the patient’s caregivers. Caregivers deliver most of the pressure ulcer preventive interventions, such as turning and repositioning, floating the heels, and managing incontinence. That’s why it’s imperative to communicate the patient’s plan of care directly to the caregivers. (more…)

Read More

Building an effective pressure ulcer prevention program

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

As a wound care nurse, do you feel the weight of the world on your shoulders when trying to implement a pressure ulcer prevention program? Many staff members think it’s up to the wound care nurse alone to implement the program. However, a successful program requires involvement from all staff and is a 24/7 endeavor. Here’s how to do it. (more…)

Read More

Creating an effective care plan

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

The development of a care plan related to skin integrity can be challenging for any clinician. It takes a strong understanding of skin integrity risk factors and knowledge of how to modify, stabilize, and eliminate those risk factors. This article provides tips for the care-planning process. (more…)

Read More

What is a comprehensive risk assessment?

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

Prevention of pressure ulcers and skin breakdown begins with a comprehensive risk assessment. Most providers use a skin risk assessment tool, such as the Braden or Norton scale. While these tools have been validated to predict pressure ulcer development, their use alone isn’t considered a comprehensive assessment, and frequently the individual risk factors they identify aren’t carried through to the plan of care. (more…)

Read More
1 2