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Control your claims: Pressure ulcer/wound care management

Diabetic Foot Ulcers

One of many dreaded tags from a Centers for Medicare & Medicaid Survey is F-Tag 314 — Pressure ulcers.

CMS writes, “Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.” (more…)

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Pressure ulcer staging

By Nancy Morgan, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
Staging pressure ulcers can get tricky, especially when we’re dealing with a suspected deep-tissue injury (SDTI). The National Pressure Ulcer Advisory Panel defines an SDTI as a “purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue… Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid, exposing additional layers of tissue even with optimal treatment.” (more…)

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Understanding NPUAP’s updates to pressure ulcer terminology and staging

On April 13, 2016, the National Pressure Ulcer Advisory Panel (NPUAP) announced changes in pressure ulcer terminology and staging definitions. Providers can adapt NPUAP’s changes for their clinical practice and documentation, but it’s important to note that, as of press time, the Centers for Medicare & Medicaid Services (CMS) has not adopted the changes. This means that providers can’t use NPUAP’s updates when completing CMS assessment forms, such as the Minimum Data Set (MDS) or Outcome and Assessment Information Set (OASIS). Instead, they must code the CMS assessment forms according to current CMS instructions and definitions. In addition, there is no ICD-10 code for pressure injury. (more…)

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A pressure ulcer by any other name

Just when we think we’ve figured out pressure ulcer staging, it changes again. In April 2016, the National Pressure Ulcer Advisory Panel (NPUAP) held a consensus conference on staging definitions and terminology. The purpose: to analyze and discuss the rationale for the panel’s changes. One of the key changes is replacing the term “pressure ulcer” with “pressure injury.” So instead of calling it a pressure ulcer staging system, NPUAP will refer to it as a pressure injury staging system. The panel explained that the new terminology “more accurately describes pressure injuries to both intact and ulcerated skin.” Other changes include: (more…)

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Nutritional considerations in patients with pressure ulcers

Optimizing nutritional status is a key strategy both in preventing and managing pressure ulcers. In patients across all care settings, compromised nutrition— as from poor intake, undesired weight loss, and malnutrition—increases the risk of pressure ulcers. It contributes to altered immune function, impaired collagen synthesis, and decreased tensile strength. In many cases, malnutrition also contributes to wound chronicity and increases the risk for delayed and impaired wound healing. In patients with chronic wounds, such as pressure ulcers, a chronic inflammatory state can induce catabolic metabolism, malnutrition, and dehydration. (more…)

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Clinical Notes: ostomy, pressure ulcer, burn treatment

Self-management ostomy program improves HRQOL

A five-session ostomy self-care program with a curriculum based on the Chronic Care Model can improve health-related quality of life (HRQOL), according to a study in Psycho-Oncology.

A chronic care ostomy self-management program for cancer survivors” describes results from a longitudinal pilot study of 38 people. Participants reported sustained improvements in patient activation, self-efficacy, total HRQOL, and physical and social well-being. Most patients had a history of rectal cancer (60.5%) or bladder cancer (28.9%). (more…)

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Empowering patients to play an active role in pressure ulcer prevention

Developing a pressure ulcer can cause the patient pain, lead to social isolation, result in reduced mobility, and can even be fatal. According to the Agency for Healthcare Research and Quality, estimated costs for each pressure ulcer range from $37,800 to $70,000, and the total annual cost of pressure ulcers in the United States is an estimated $11 billion.

Nurses understand their role in preventing pressure ulcers, but what role do patients play in the prevention plan? Nurses need to empower the patient to be an active member in health promotion activities and participate in prevention measures. In this article, I highlight the importance of incorporating pressure ulcer prevention into patient education for high-risk patients as a way to empower patients. Empowered patients can help improve outcomes and reduce overall costs of this hospital-acquired complication. (more…)

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Restorative nursing programs help prevent pressure ulcers

Immobility affects all our body systems, including our skin. According to the National Pressure Ulcer Advisory Panel, many contributing factors are associated with the formation of a pressure ulcer, with impaired mobility leading the list.

So what can clinicians do to prevent harm caused by immobility? One often-overlooked strategy is a restorative nursing program. (See About restorative nursing.)

Moving up the time line

Most patients who score poorly for mobility and/or activity impairments on the Braden Scale for Predicting Pressure Ulcer Risk are referred to physical therapy, but too often a restorative nursing program (more…)

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Clinician Resources: NPUAP, Pressure Ulcer Treatment, NIOSH

PDF-iconThe resources below will help you address issues in your practice.

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NPUAP position statement on hand check for bottoming out

Use of the hand check to determine “bottoming out” of support systems should be limited to static air overlay mattresses, according to a position statement from the National Pressure Ulcer Advisory Panel (NPUAP). (more…)

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Clinician Resources: Nutrition, Treatment Algorithms, Pressure Ulcer Prevention

Check out these resources for your practice.

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Be a nutrition champion

One in three patients enters a hospital malnourished. Fight malnutrition by viewing six short videos from the Alliance to Advance Patient Nutrition, including “Rapidly Implement Nutrition Interventions” and “Recognize and Diagnose All Patients at Risk of Malnutrition.” The videos show how to collaborate with the care team to become champions of nutrition and help improve patient outcomes. Watch the videos online or download them for later viewing. (more…)

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Immobility as the root cause of pressure ulcers

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

Many factors can contribute to the formation of a pressure ulcer, but it’s rare that one develops in an active, mobile patient. As the National Pressure Ulcer Advisory Panel 2014 guidelines state, “Pressure ulcers cannot form without loading, or pressure on the tissue. Extended periods of lying or sitting on a particular body part and failure to redistribute the pressure can lead to ischemia and therefore tissue damage.” Thus, immobility is frequently the root cause of pressure ulcer development. (more…)

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Preventing pressure ulcers in pediatric patients

By Roxana Reyna, BSN, RNC-NIC, WCC, CWOCN

As wound care clinicians, we are trained—and expected—to help heal wounds in patients of any age and to achieve positive outcomes. Basic wound-healing principles apply to all patients, whatever their age or size. The specific anatomy and physiology of vulnerable pediatric patients, however, requires detailed wound care. Unfortunately, little evidence-based research exists to support and direct the care of pediatric patients with pressure ulcers. This article describes efforts to reduce pressure ulcers in pediatric patients at Driscoll Children’s Hospital (DCH) in Corpus Christi, Texas. (more…)

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