Having the proper support surface for beds and wheelchairs is imperative in preventing pressure ulcers. “Pressure” ulcers are named that for a reason—pressure is the primary cause of interruption of blood flow to the tissue. Unfortunately, guidelines for support surface selection tend to make recommendations for the type of surface to use after a pressure ulcer has developed. Another factor that complicates matters is the development of deep-tissue injuries. These injuries start at the bone level, which means that often, tissue damage is extensive before we see visible signs and realize that the support surface we chose might not have been effective enough. (more…)
As healthcare clinicians, our world is full of tasks to be completed. Some are new, but many are tasks we repeat every day and thus have become routine—things we could almost do in our sleep.
But what’s routine for us may not be routine for our patients. For some patients, these routine tasks of ours may be their first encounter with a healthcare situation. (more…)
What do the Los Angeles Lakers, Green Bay Packers, Montreal Canadiens, and New York Yankees have in common? All three have “three-peated”, meaning they have won three consecutive championships. This year, we at Wound Care Advisor, the official journal of the National Alliance of Wound Care and Ostomy (NAWCO), mark our own three-peat—our third annual “Best of the Best” issue. (more…)
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.
By: Donna Sardina, RN, MHA, WCC, CWCMS What do the Los Angeles Lakers, Green Bay Packers, Montreal Canadiens, and New York Yankees have in common? All three have “three-peated”, meaning they have won three consecutive championships. This year, we at Wound Care Advisor, the official journal of the National Alliance of Wound Care and Ostomy (NAWCO), mark our own three-peat—our…
Mild compression diabetic socks safe and effective for lower extremity edema Diabetic socks with mild compression can reduce lower extremity edema in patients with diabetes without adversely affecting arterial circulation, according to a randomized control trial presented at the American Diabetes Association 75th Scientific Sessions Conference.
The resources below will help you address issues in your practice. 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).
By Jennifer Oakley, BS, RN, WCC, DWC, OMS It’s time again for annual staff education, and you, the certified wound clinician, need to teach the staff at your organization. You dream of staff entering a state-of-the-art classroom with computers at each station, mannequins, wound anatomy models, and enough products for each student to do hands-on demonstrations. But when you open…
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),…
By Cindy Barefield, BSN, RN-BC, CWOCN Like many hospitals, Houston Methodist San Jacinto Hospital uses national benchmarks such as the National Database of Nursing Quality Indicators (NDNQI®) to measure quality outcomes. Based on benchmark reports that showed an increased trend of pressure ulcers in critically ill patients in our hospital, the clinical nurses in our Critical Care Shared Governance Unit-Based…
By Beth Hoffmire Heideman, MSN, RN No one wants an ostomy, but sometimes it’s required to save a patient’s life. As ostomy specialists, our role is to assess and intervene for patients with a stoma or an ostomy to enhance their quality of life. We play an active role in helping patients perform self-care for their ostomy and adjust to…
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 vessels and closely resembles blood…
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 from fibers of cotton, rayon,…
By Gail Rogers Hebert, MS, RN, CWCN, WCC, DWC, OMS, LNHA The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other…
By Darlene Hanson, PhD, RN; Diane Langemo, PhD, RN, FAAN; Patricia Thompson, MS, RN; Julie Anderson, PhD, RN; and Keith Swanson, MD Cellulitis is an acute, painful, and potentially serious spreading bacterial skin infection that affects mainly the subcutaneous and dermal layers. Usually of an acute onset, it’s marked by redness, warmth, swelling, and tenderness. Borders of the affected skin…
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.
By Erin Fazzari, MPT, CLT, CWS, DWC Have you seen legs like these in your practice? These legs show lymphedema and chronic wounds before treatment (left image) and after treatment (right image) with complex decongestive therapy (CDT)—the gold standard of lymphedema care. The patient benefited from multidisciplinary collaboration between wound care and lymphedema therapists.
By Todd Zortman, RN, WCC, and James Malec, PhD Pressure ulcers are a chronic healthcare burden for both patients and providers. Over 2.5 million patients in the United States are affected annually by pressure ulcers, with nearly 60,000 of those cases directly resulting in death. From a provider’s perspective, the cost of individual care ranges anywhere from $500 to $70,000…
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.…
Leg revascularization fails to improve outcomes in nursing home patients Lower-extremity revascularization often fails to improve outcomes in nursing home patients, according to an article in JAMA Internal Medicine. “Functional outcomes after lower extremity revascularization in nursing home residents: A national cohort study” found that few patients are alive and ambulatory a year after surgery, and those who are alive…
Check out these resources for your practice. 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…
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 for abnormalities. It requires looking…
By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Pressure ulcers have been a health concern for a long time—since at least 5,000 years ago, when evidence of a pressure ulcer was found on an ancient Egyptian mummy. But not until 1975 did the staging classification system we’re familiar with begin. This system was designed to make things easier by…
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…
By Sharon Morrison, MAT, RN Michael had diabetes and a history of elevated blood glucose levels. A long-time drinker, he seemed to have no interest in giving up the habit. I met him while working as a diabetes nurse educator for the Boston Health Care for the Homeless Program, traveling from shelter to shelter to help persons with diabetes set…
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…
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…)
Pressure ulcers have been a health concern for a long time—since at least 5,000 years ago, when evidence of a pressure ulcer was found on an ancient Egyptian mummy. But not until 1975 did the staging classification system we’re familiar with begin. This system was designed to make things easier by creating a universal way to describe and communicate the various levels of tissue destruction. (more…)
Like many hospitals, Houston Methodist San Jacinto Hospital uses national benchmarks such as the National Database of Nursing Quality Indicators (NDNQI®) to measure quality outcomes. Based on benchmark reports that showed an increased trend of pressure ulcers in critically ill patients in our hospital, the clinical nurses in our Critical Care Shared Governance Unit-Based Council (CCSGUBC) identified an improvement opportunity.
By Erin Fazzari, MPT, CLT, CWS, DWC Have you seen legs like those shown in the images below in your practice? These images show lymphedema and venous stasis ulcers, illustrating the importance of collaboration between clinicians in two disciplines: lymphedema and wound care.
Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Silence, roving eyes, fidgeting, excuses, a quick subject change—these are typical responses from healthcare clinicians when asked, “What’s the patient’s ankle-brachial index?” You’d think someone had just uttered a dirty word. The ankle-brachial index (ABI) is a key component of the lower-extremity vascular exam, recommended and in some cases mandated by numerous…
Factors affecting medication adherence in patients with diabetes identified Factors associated with better adherence to antidiabetic medications taken by patients with diabetes include older age, male sex, higher education, higher income, use of mail-order vs. retail pharmacies, primary care vs. nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs.
Learn about resources useful to your practice. Nutrition and pressure ulcers Advances in Skin & Wound Care has published “The role of nutrition for pressure ulcer management: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance White Paper.” The white paper includes evidence-based nutrition strategies for preventing and managing pressure ulcers.
By Terry Eggenberger, PhD, RN, CNE, CNL; Rose O. Sherman, EdD, RN, NEA-BC, FAAN; and Kathryn Keller, PhD, RN Kate Summer, a wound care clinician in a urban hospital, is leading an initiative to reduce pressure ulcers. She knows from experience that more effective communication and collaborative planning by the interdisciplinary team managing these patients is crucial for reducing pressure…
By Cindy Barefield, BSN, RN-BC, CWOCN Like many hospitals, Houston Methodist San Jacinto Hospital uses national benchmarks such as the National Database of Nursing Quality Indicators (NDNQI®) to measure quality outcomes. Based on benchmark reports that showed an increased trend of pressure ulcers in critically ill patients in our hospital, the clinical nurses in our Critical Care Shared Governance Unit-Based…
By Beth Hoffmire Heideman, MSN, RN No one wants an ostomy, but sometimes it’s required to save a patient’s life. As ostomy specialists, our role is to assess and intervene for patients with a stoma or an ostomy to enhance their quality of life. We play an active role in helping patients perform self-care for their ostomy and adjust to…
By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN Research has shown that exercise can help ease symptoms in patients with arterial insufficiency, venous insufficiency, neuropathic disease, or a combination of these conditions. Here’s what you need to know to ensure your patients reap the most benefits from exercise.
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 a brief overview on moldable, bendable, and stretchable adhesive rings and strips used to improve the seal around a stoma. Benefits Adhesive rings and strips can be an alternative to stoma paste for filling…
By Darlene Hanson, PhD, RN; Diane Langemo, PhD, RN, FAAN; Patricia Thompson, MS, RN; Julie Anderson, PhD, RN; and Keith Swanson, MD Cellulitis is an acute, painful, and potentially serious spreading bacterial skin infection that affects mainly the subcutaneous and dermal layers. Usually of an acute onset, it’s marked by redness, warmth, swelling, and tenderness. Borders of the affected skin…
Silence, roving eyes, fidgeting, excuses, a quick subject change—these are typical responses from healthcare clinicians when asked, “What’s the patient’s ankle-brachial index?” You’d think someone had just uttered a dirty word.
The ankle-brachial index (ABI) is a key component of the lower-extremity vascular exam, recommended and in some cases mandated by numerous clinical practice guidelines, including the most recent international guidelines on preventing and treating pressure ulcers. (more…)
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.
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…
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…
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…
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…
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…
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…
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…
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 you stop to think about it, what government did she mean? Federal? State? Local? (more…)
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 what’s coming up. I discuss innovative new products, practice guidelines, resources, and tools from the last 12 months in skin, wound, and ostomy management. (more…)
