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Practical Issues in Wound, Skin and Ostomy Management
Laughlin Center for Wound Care and Hyperbarics has been honored as the Wound Care Center of the Year as well as recognized with a national award for continued excellence in wound healing by Healogics Inc., a wound care management company.
Leaders, physicians and clinicians from Laughlin Center for Wound Care and Hyperbarics recently gathered to celebrate the center’s receipt of the Robert A. Warriner III Center of Excellence award, according to a news release.
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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LUBBOCK, TX (NEWS RELEASE) – The Covenant Center for Wound Care & Hyperbaric Medicine has been honored as a Wound Care Center® of the Year by Healogics, Inc., the nation’s leading and largest wound care management company. The center also was awarded Center of Distinction and the President’s Circle Award.
The center has achieved patient satisfaction rates higher than 92 percent, a healing rate of at least 91 percent in less than 31 median days and healed almost 90 percent of its patients in less than 14 weeks. Out of the 630 Centers eligible in 2016, only seven centers across the country received this prestigious award. Covenant’s center was awarded as Center of the Year for the southwest region, which includes Texas, Oklahoma, Louisiana and New Mexico. (more…)
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Dr. Michael Miller is a board certified general surgeon and certified wound care specialist who has practiced wound care exclusively for almost 21 years in Indiana.
He is the CEO and medical director of The Miller Care Group, which provides a variety of specialty care services in a variety of care locations, including house calls, skilled, assisted living and independent living facilities.
Think a Patient Has Rights? They Left.
by Dr. Michael Miller There are few absolutes in my universe. I know that my youngest daughter will gleefully and with full malice (but humorously presented) find something to torment me about every time I see her; referrals from family… Read more…
by Dr. Michael Miller For those of you not as familiar with the Hoosier State as you should be, I used to think it was essentially paradise. Jim Nabors of Gomer Pyle fame is our ubiquitous, tuneful icon with his… Read more…
Hole-ier than Thou, Evidence Based Regardless of the Evidence
by Dr. Michael Miller There are certain phrases that make the hair on the back of my neck stand up. Someone telling me that they are a good Jew, a good Christian, a good Muslim or the ultimate in self… Read more…
If All You Have is a Hammer, What Happens When You Run Out of Nails?
by Dr. Michael Miller Over the years of making house calls for wound care, I found that there was a real need for home based mental health and behavioral care, palliative care, podiatry and lots of other things. We cater… Read more…
Condemning Patients to a Leap of Faith
by Dr. Michael Miller I have several letters after my name. The two that say “DO” indicate that I have the training of a physician and the requisite education and responsibilities that uphold those letters. They should mean to patients… Read more…
Don’t Kid Yourself, Amputation Is Unquestionably A Failure
by Dr. Michael Miller I recently saw an ad for a pending lecture at a national conference that piqued my interest much like “deflate-gate”. The title of this lecture horrifically touted that Amputation need not be considered failure. As a… Read more…
Help Me, Help Me, Help Me…next Tuesday
by Dr. Michael Miller Health care providers are by nature an altruistic bunch. I have the honor of interviewing potential entries to my beloved profession as part of the admissions process at the newest Osteopathic Medical School in Indiana, Marian… Read more…
Alternate universes – Einstein’s insanity
I remain absolutely amazed that there are so many people doing the same thing and yet doing it so completely different. Depending on where a patient’s wound care and orders originate from, the care I try to translate from that… Read more…
Each month, Apple Bites brings you a tool you can apply in your daily practice.
General characteristics Document if the diversion is an intestinal or urinary ostomy, whether it’s temporary or permanent, and the location— abdominal quadrant, skin fold, umbilicus. (See Descriptor reference.) Describe the type of ostomy: • colostomy (colon)—sigmoid or descending colostomy, transverse colostomy, loop colostomy, ascending colostomy • ileostomy (small bowel)—ileoanal reservoir (J-pouch), continent ileostomy (Kock pouch) •… Read more…
Assessing footwear in patients with diabetes
Inappropriate footwear is the most common source of trauma in patients with diabetes. Frequent and proper assessment of appropriate footwear is essential for protecting the diabetic foot from ulceration. Here is a step-by-step process for evaluating footwear. Be sure to evaluate footwear with the patient walking, standing, and sitting. Observe wear patterns for areas of high pressure or abnormalities • Check the inside of… Read more…
Causes, prevention, and treatment of epibole
As full-thickness wounds heal, they begin to fill in from the bottom upward with granulation tissue. At the same time, wound edges contract and pull together, with movement of epithelial tissue toward the center of the wound (contraction). These epithelial cells, arising from either the wound margins or residual dermal epithelial appendages within the wound bed, begin to migrate in leapfrog or train fashion across the… Read more…
Topical application of silver nitrate is often used in wound care to help remove and debride hypergranulation tissue or calloused rolled edges in wounds or ulcerations. It’s also an effective agent to cauterize bleeding in wounds. Silver nitrate is a highly caustic material, so it must be used with caution to prevent damage to healthy tissues. Application method Silver nitrate applicators are firm… Read more…
Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here are examples of medications that can affect wound healing. Assessment and care planning for wound healing should include a thorough review of the individual’s current medications to identify those that may affect healing outcomes. Clinicians must then weigh the… Read more…
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here’s an overview of cutaneous candidiasis. Cutaneous candidiasis is an infection of the skin caused by the yeast Candida albicans or other Candida species. Here’s a snapshot of this condition.… Read more…
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here’s an overview of performing a comprehensive skin assessment. In the healthcare setting, a comprehensive skin assessment is a process in which the entire skin of a patient is examined… Read more…
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Medical gauze, a bleached white cloth or fabric used in bandages, dressings, and surgical sponges, is the most widely used wound care dressing. Commonly known as “4×4s,” gauze is made… Read more…
Linear wound measurement basics
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Measurement of wounds is an important component of wound assessment and provides baseline measurements, enables monitoring of healing rates, and helps distinguish among wounds that are static, deteriorating, or improving.… Read more…
What you need to know about transparent film dressings
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Transparent film dressings are thin sheets of transparent polyurethane (polymer) coated with an adhesive. These dressings are available in a variety of sizes and shapes. Description Transparent film dressings provide… Read more…
Understanding the crusting procedure
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. The crusting procedure produces a dry surface and absorbs moisture from broken skin through an artificial scab that’s created by using skin barrier powder (stoma powder) and liquid polymer skin… Read more…
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Exudate (drainage), a liquid produced by the body in response to tissue damage, is present in wounds as they heal. It consists of fluid that has leaked out of blood… Read more…
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Description The spiral wrap is a technique used for applying compression bandaging. Procedure Here’s how to apply a spiral wrap to the lower leg. Please note that commercial compression wraps… Read more…
What you need to know about hydrogel dressings
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Description Hydrated polymer (hydrogel) dressings, originally developed in the 1950s, contain 90% water in a gel base, which helps regulate fluid exchange from the wound surface. Hydrogel dressing are usually… Read more…
What you need to know about collagen wound dressings
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Description Collagen, the protein that gives the skin its tensile strength, plays a key role in each phase of wound healing. It attracts cells, such as fibroblasts and keratinocytes, to the wound, which encourages debridement, angiogenesis, and reepithelialization. In addition, collagen provides a natural scaffold… Read more…
What you need to know about xerosis in patients with diabetic feet
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each month, Apple Bites brings you a tool you can apply in your daily practice. Description Xerosis, an abnormal dryness of the skin, is one of the most common skin conditions among patients with type 2 diabetes. While assessing for predictors of foot lesions in… Read more…
What you need to know about hydrocolloid dressings
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each month, Apple Bites brings you a tool you can apply in your daily practice. Description A hydrocolloid dressing is a wafer type of dressing that contains gel-forming agents in an adhesive compound laminated onto a flexible, water-resistant outer layer. Some formulations contain an alginate… Read more…
An Unna boot is a special dressing of inelastic gauze impregnated with zinc, glycerin, or calamine that becomes rigid when it dries. It is used for managing venous leg ulcers and lymphedema in patients who are ambulatory. When the patient walks, the rigid dressing restricts outward movement of the calf muscle, which directs the contraction… Read more…
How to do a Semmes Weinstein monofilament exam
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each month, Apple Bites brings you a tool you can apply in your daily practice. Description According to the American Diabetes Association, all patients with diabetes should be screened for loss of protective sensation in their feet (peripheral neuropathy) when they are diagnosed and at… Read more…
Sample procedure for nonsterile dressing change
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each month, Apple Bites brings you a tool you can apply in your daily practice. Description • Nonsterile dressings protect open wounds from contamination and absorb drainage. • Clean aseptic technique should be used to change nonsterile dressings. • In the event of multiple wounds,… Read more…
By Nancy Morgan, MBA, BSN, RN, WOC, WCC, CWCMS, DWC Each month, Apple Bites brings you a tool you can apply in your daily practice. Description • Semipermeable polyurethane foam dressing • Nonadherent and nonlinting • Hydrophobic or waterproof outer layer • Provides moist wound environment • Permeable to water vapor but blocks entry of… Read more…
By Nancy Morgan, MBA, BSN, RN, WOC, WCC, CWCMS, DWC Each month Apple Bites brings you a tool you can apply in your daily practice. Description Dressing with calcium and sodium fibers made from seaweed Spun into rope or flat dressing form Actions Transforms into a moist gel consistency when it comes into contact with… Read more…
What you need to know about hydrocolloid dressings →
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each month, Apple Bites brings you a tool you can… Read more… →
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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC What exactly is wound exudate? Also known as drainage, exudate… Read more… →
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What you need to know about collagen wound dressings →
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Description Collagen, the protein that gives the skin its tensile… Read more… →
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By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Wound pain can have a profound effect on a person’s life… Read more… →
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FAQs for pressure ulcer staging →
By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Staging pressure ulcers can be challenging. Below are some common questions—and… Read more… →
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Is your wound-cleansing practice up to date? →
By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS With so much focus on dressing choices, it’s easy to forget… Read more… →
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Starting a consulting business →
By Donna Sardina, RN, MHA, WCC, CWCMS, DWC Starting your own consulting business is an exciting and rewarding experience: You’re… Read more… →
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Understanding stoma complications →
By Rosalyn S. Jordan, RN, BSN, MSc, CWOCN, WCC, OMS; and Judith LaDonna Burns, LPN, WCC, DFC About 1 million… Read more… →
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How dietary protein intake promotes wound healing →
By Nancy Collins, PhD, RD, LD/N, FAPWCA, and Allison Schnitzer Nutrition is a critical factor in the wound healing process,… Read more… →
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Medicare reimbursement for hyperbaric oxygen therapy →
By Carrie Carls, BSN, RN, CWOCN, CHRN, and Sherry Clayton, RHIA In an atmosphere of changing reimbursement, it’s important to… Read more… →
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What you need to know about hydrogel dressings →
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can… Read more… →
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By Nancy Morgan, MBA, BSN, RN, WOC, WCC, CWCMS, DWC Each month Apple Bites brings you a tool you can… Read more… →
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Managing venous stasis ulcers →
By Kulbir Dhillon, MSN, FNP, APNP, WCC Venous disease, which encompasses all conditions caused by or related to diseased or… Read more… →
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Providing wound care in the home: An option to explore →
By Connie Johnson, RN, BSN, WCC, LLE, DAPWCA Jim, a 52-year-old patient with colon cancer, received a new ostomy. He… Read more… →
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By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can… Read more… →
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Compression therapy for chronic venous insufficiency, lower-leg ulcers, and secondary lymphedema →
By Nancy Chatham, RN, MSN, ANP-BC, CCNS, CWOCN, CWS, and Lori Thomas, MS, OTR/L, CLT-LANA An estimated 7 million people… Read more… →
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Who can perform sharp wound debridement? →
Nurses and therapists often wonder if their license permits them to perform sharp wound debridement. Scope of practice varies significantly from state to state,… Read more… →
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What’s causing your patient’s lower-extremity redness? →
By Robyn Bjork, MPT, CWS, WCC, CLT-LANA The ability to understand or “read” lower-extremity redness in your patient is essential… Read more… →
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Topical application of silver nitrate is often used in wound care to help remove and debride hypergranulation tissue or calloused rolled edges in wounds… Read more… →
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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC An essential part of weekly wound assessment is measuring the… Read more… →
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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
The World Health Organization defines palliative care as care that affirms life and views death and dying as part of a normal process, intends neither to speed nor delay death, provides relief from pain and other distressing symptoms, and offers support to the patient and family. (more…)
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by Dr. Michael Miller
There are few absolutes in my universe. I know that my youngest daughter will gleefully and with full malice (but humorously presented) find something to torment me about every time I see her; referrals from family practice docs arrive well marinated in multiple antibiotics with nary a diagnosis in sight (save for the ubiquitous “infection”); and that regardless of what I recommend, offer, beg, plead, or cajole, that the patient has the complete and total power to make their decisions regarding their care and who provides it. Unless they are deemed by multiple authorities to be incapable of making a decision, until the appropriate paperwork or an emergency situation exists mandating immediate lifesaving action, the ball bounces squarely in their court…or so I thought. (more…)
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by Dr. Michael Miller
I have several letters after my name. The two that say “DO” indicate that I have the training of a physician and the requisite education and responsibilities that uphold those letters. They should mean to patients that my ultimate goal is to offer (and provide when the fates allow) the entire spectrum of medical care referable to what I am good at and what they came to seek solace for. Nothing less and if I keep my ego in check, certainly nothing more. Patients run the gamut of their perception of the medical field. But like the old sales nemesis called “Bait and Switch”, what is offered on the sign all too often does not truly match what is seen on the shelves. Arrogant people are that way because they are good at what they do and not afraid to tell others. As a child, we are told to let others brag about us but failing to let people know what we can and can’t do is integral to our patients’ survival and our success. The problem is that the glitz and glamour of being a healer all too often clouds our success. Some time ago, I blogged about the pseudo-utilitarianism of all those so-called “Wound Certification” Exams. At first blush, these seem to be the key to health, wealth, omniscience and outcomes equaled only by those wound care management companies. (more…)
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by Dr. Michael Miller
I recently saw an ad for a pending lecture at a national conference that piqued my interest much like “deflate-gate”. The title of this lecture horrifically touted that Amputation need not be considered failure. As a full time wound care doc, I work to identify those conditions that place patients at risk of all consequences both limited and catastrophic. We use the catchy title of “Limb Preservation”. We start the process by engaging in the unusual behavior of making definitive diagnoses, then systematically address them in as comprehensive manner as possible. I am proud to tell you that while there are occasions in which a terminally damaged digit is lost, that we have rarely sacrificed the greater part of a foot and more, have had only 3 lower extremity amputations in the last 5 years on patients who’s care remained exclusively with us. Of course, when a patient for whom we have created and implemented a “Limb Pres” care plan is taken out of our system (usually via a hospitalization for a reason other then the lower extremity problem), the facility forces that be unfortunately but infrequently demonstrate their inadequacy and paranoia by gang-harangueing the patient and family. They are lambasted with lurid tales of the condition marching up the leg engulfing the foot, knee, torso, and brains much like a flesh-eating PacMan. The patient’s confidence now neutered has little chance against this persistent onslaught of inadequacy and so, much like the Queen song, “Another One Bites The Dust”. (more…)
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