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Alternate universes – Einstein’s insanity

Wound Care Advisor
Wound Care

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 starting point is always a combination of dressing regimens worthy of computer code in their simplicity. The only thing usually missing is the diagnosis. It’s as though they come from an identical planet in an alternate universe.

The issue is that there is the complete dissociation of what is done for a given wound care problem in one practice setting versus another. Having stayed as far away from hospital-based wound care as possible, I continue to be amazed by hospital wound teams touting their expertise while using two to three times a day dressing changes and therapies that are the antithesis of any identifiable evidence. They actually expect entities receiving their cases (including home healthcare agencies, LTAC, skilled facilities, and others) to copy the identical care scenario regardless of their widely variable situations. In fact, the only constant is the patient and his or her condition. (more…)

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Breaking silos: Effective wound healing means treatment across the continuum

Wound Care Advisor

Around 6.5 million patients in the U.S. suffer from chronic wounds, such as pressure injuries or ulcers. Treatment costs $25 billion each year, representing a sizable and growing problem. Despite the wide impact of chronic wounds, it’s rare to see specialized, effective wound care delivered across the care continuum.

A chronic non-healing wound is a surrogate marker for illness. These patients require holistic management of their co-morbidities and continuity across care settings.

Despite this, a great deal of emphasis has been placed on treating wounds as singular events, managed topically with expensive dressings and support surfaces. This is only a small part of wound healing.

As a physician focused solely on wound care, I have learned that we must shift the focus from simply treating the wound to treating the wounded patient. The impact in the post-acute care setting in particular is worthy of evaluation and discussion, as up to 29% of patients in long-term care facilities will experience a pressure ulcer, posing serious legal, financial, and staffing implications.

For those providers working outside long-term care, there is little understanding of challenges facing LTC providers. Acute providers do not often ask, for example, how are my LTC partners reimbursed? How are they staffed? What are the requirements and regulatory pressures they face? Asking these questions would facilitate a more productive dialogue with a focus on collaborative prevention, rather than waiting until a chronic wound occurs in the LTC setting.

Creating an integrated wound care community

To address the needs of the present and growing population of patients with chronic wounds, Healogics developed an integrated wound care community model, to coordinate the wound healing process across all care settings. The program utilizes Healogics Specialty Physicians, a subspecialty group of physicians and providers with extensive training solely focused on wound care.

HSPs provide expert inpatient consultation and ensure safe transition of patients out of the hospital into the appropriate care setting. Because HSPs see the patient regardless of post-discharge venue, patients receive the same quality of care whether they are going home, to a skilled-nursing, assisted living, or LTC setting. Because chronic wounds are surrogate markers for illness, we have realized it’s essential to have an integrated, multi-setting, and multi-disciplinary process to treat the patient and their co-morbidities.

Data collected at a pilot IWCC site in the Midwestern U.S. from 2014 to 2016 revealed very positive trends for chronic wound patients. In the acute care setting, the average length of stay decreased from 9.41 days to 5.64 days, and total cost of care per patient was reduced from $10,670 to $7,248.

We’re excited by these promising results, which were revealed at the American College of Wound Healing and Tissue Repair Conference last December. We look forward to refining and expanding the model by helping our partners in acute and LTC settings standardize their practices, use evidence-based clinical guidelines, mobilize technologies and processes, and pay critical attention to patient safety and value-based outcomes.

When it comes to wound healing, no venue of care should operate alone—an integrated solution that creates continuity for the patient is critical. There are four things LTC facilities can do to break down the silos:

Read more at McKnight’s

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Frequently asked questions about support surfaces

Wound Care Advisor

The National Pressure Ulcer Advisory Panel (NPUAP) describes support surfaces as “specialized devices for pressure redistribution designed for management of tissue loads, microclimate, and/or other therapeutic functions.” These devices include specialized mattresses, mattress overlays, chair cushions, and pads used on transport stretchers, operating room (OR) tables, examination or procedure tables, and gurneys. Some support surfaces are part of an integrated bed system, which combines the bed frame and support surface into a single unit. (more…)

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Herpes zoster: Understanding the disease, its treatment, and prevention

Wound Care Advisor
Herpes zoster: Understanding the disease, its treatment, and prevention

Herpes zoster (HZ, also called shingles) is a painful condition that produces a maculopapular and vesicular rash. Usually, the rash appears along a single dermatome (band) around one side of the body or face.

In most cases, pain, tingling, burning, or itching occurs a few days before the rash. Next, blisters form, scabbing over in 7 to 10 days. In rare cases, the rash is widespread, resembling varicella zoster (VZ, or chickenpox) rash. Pain can range from mild to severe and may be dull, burning, or gnawing. It may last weeks, months, or even years after the blisters heal. Shingles on the face may impair vision or hearing. (more…)

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Clinician Resources

Wound Care Advisor

Wound patient’s bill of rights

The Association for Advancement of Wound Care has developed the “Wound Care Patient’s Bill of Rights.” The 10 points include the right to:

• know what wound treatment options are available to you

• know the benefits, risks, and side effects of your wound care treatments

• participate in the development of your treatment plan with your wound care team

• have your pain adequately controlled.

The bill of rights is available in both English and Spanish. (more…)

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Instill instead: Negative pressure wound therapy with instillation for complex wounds

Wound Care Advisor

Negative pressure wound therapy (NPWT) uses negative pressure to draw wound edges together, remove edema and infectious material, and promote perfusion and granulation tissue development. The tissue stretch and compression created by negative pressure during NPWT promotes tissue perfusion and granulation tissue development through angiogenesis, cellular proliferation, fibroblast migration, increased production of wound healing proteins, and reduction of wound area. NPWT has been used to improve healing in a variety of wounds, including traumatic injuries, surgical wounds, pressure ulcers, diabetic foot ulcers, and venous stasis ulcers. (more…)

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2016 Journal: January – February Vol. 5 No. 1

Top 10 outpatient reimbursement questions

At the 2015 Wild on Wounds conference, the interactive workshop “Are You Ready for an Outpatient Reimbursement Challenge?” featured a lively discussion among participants about 25 real-life reimbursement scenarios. Here are the top 10 questions the attendees asked, with the answers I provided.

Q Why is it necessary for qualified healthcare professionals (QHPs) such as physicians, podiatrists, nurse practitioners, physician assistants, and clinical nurse specialists to identify the place of service where they provide wound care services and to correctly state the place of service on their claim forms?

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Buzz Report: Latest trends, Part 1

Posted: January 28, 2016

We all lead busy lives, with demanding work schedules and home responsibilities that can thwart our best intentions. Although we know it’s our responsibility to stay abreast of changes in our field, we may feel overwhelmed when we try to make that happen. Keeping clinicians up-to-date on clinical knowledge is one of the main goals of the Wild On Wounds…

Case study: Peristomal pyoderma gangrenosum

Posted: January 28, 2016

As a wound care specialist, you have learned about many skin conditions, some so unusual and rare that you probably thought you would never observe them. I’ve been a nurse for 38 years, with the last 10 years in wound care, and that’s certainly what I thought. But I was wrong. Let me tell you about my challenging patient with…

Clincal Notes: Analysis, Osteomyelitis, sickle cell, maggot

Posted: January 28, 2016

Value of systematic reviews and meta-analyses in wound care “Systematic reviews and meta-analyses—literature-based recommendations for evaluating strengths, weaknesses, and clinical value,” in Ostomy Wound Management, discusses evidence-based practice and how systematic reviews (SRs) and meta-analyses (MAs) can help improve management of wound care patients. The authors of the article explain evidence-based practice and provide useful definitions for key terms. They…

Clinician Resources: Ulcer Prevention, CAUTI, Negative Bacteria

Posted: January 28, 2016

Start the New Year off right by checking out these resources. Pressure ulcer prevention education Access the following education resources from Wounds International: The webinar “Real-world solutions for pressure ulcer prevention: Optimising the role of support surfaces” includes: • an overview of the issue of pressure ulcers • what to consider when choosing a support surface • how to operationalize…

Don’t go it alone

Posted: January 28, 2016

A fundamental rule of wound care is to treat the “whole” patient, not just the “hole” in the patient. To do this, we need to focus on a holistic approach to healing, which means evaluating everything that’s going on with the patient—from nutrition, underlying diseases, and medications to activity level, social interactions, and even sleep patterns. We know that as…

Empowering patients to play an active role in pressure ulcer prevention

Posted: January 28, 2016

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…

Medications and wound healing

Posted: January 28, 2016

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 risks and benefits of continuing…

Pros Cons Hydrocolloid Foot Ulcers

Pros and cons of hydrocolloid dressings for diabetic foot ulcers

Posted: January 28, 2016

Diabetic foot ulcers stem from multiple factors, including peripheral neuropathy, high plantar pressures, decreased vascularity, and impaired wound healing. Contributing significantly to morbidity, they may cause limb loss and death. (See Foot ulcers and diabetes.) Initially, hydrocolloid dressings were developed to function as part of the stomal flange. Based on their success in protecting peristomal skin, they were introduced gradually…

Restorative nursing programs help prevent pressure ulcers

Posted: January 28, 2016

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 power of the positive

Posted: January 28, 2016

Being positive in a negative situation is not naïve. It’s leadership. — Ralph S. Marston, Jr., author and publisher of The Daily Motivator website Clinicians may encounter many challenges and stressors in the workplace—long hours, rotating shifts, inadequate staffing, poor teamwork, and pressure to achieve higher performance levels in an emotionally and physically demanding field. But hope exists. Positive psychology…

Top 10 outpatient reimbursement questions

Posted: January 28, 2016

  At the 2015 Wild on Wounds conference, the interactive workshop “Are You Ready for an Outpatient Reimbursement Challenge?” featured a lively discussion among participants about 25 real-life reimbursement scenarios. Here are the top 10 questions the attendees asked, with the answers I provided. Q Why is it necessary for qualified healthcare professionals (QHPs) such as physicians, podiatrists, nurse practitioners,…

2016 Journal: January – February Vol. 5 No. 1

Click here to access the digital edition

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Wise use of antibiotics in patients with wound infections

Wound Care Advisor

Antibiotic resistance is a pressing public health threat not only in the United States, but worldwide. According to the World Health Organization (WHO), it is one of the major threats to human health.

Despite these concerns, antibiotics continue to be widely used—and overused. In long-term care, for instance, antibiotics are the most frequently prescribed medications, with as many as 70% of residents receiving one or more courses per year. And antibiotics are consistently ordered for suspected pressure ulcer infections.

Here is what clinicians who care for patients with wounds can do to help reduce antibiotic resistance. (more…)

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How to manage peristomal skin problems

Wound Care Advisor

For an ostomy pouching system to adhere properly, the skin around the stoma must be dry and intact. Otherwise, peristomal skin problems and skin breakdown around the stoma may occur. In fact, these problems are the most common complications of surgical stomas. They can worsen the patient’s pain and discomfort, diminish quality of life, delay rehabilitation, increase use of ostomy supplies, and raise healthcare costs.

Peristomal skin problems also perpetuate a vicious cycle in ostomy patients: They impair adhesion of the pouching system, which in turn exacerbates the skin problem. That’s why maintaining peristomal skin integrity and addressing skin problems promptly are so crucial. (more…)

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Clinical Notes: Moldable Skin Barrier, hypoglycemia, diabetic food ulcers

Wound Care Advisor

Moldable skin barrier effective for elderly patients with ostomy

A study in Gastroenterology Nursing reports that compared to a conventional skin barrier, a moldable skin barrier significantly improves self-care satisfaction scores in elderly patients who have a stoma. The moldable skin barrier also caused less irritant dermatitis and the costs for leakage-proof cream were lower.

“The application of a moldable skin barrier in the self-care of elderly ostomy patients” included 104 patients ages 65 to 79 who had a colostomy because of colorectal cancer.

Risk factors for severe hypoglycemia in older adults with diabetes identified

(more…)

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Privacy Policy

This privacy policy has been compiled to better serve those who are concerned with how their ‘Personally Identifiable Information’ (PII) is being used online. PII, as described in US privacy law and information security, is information that can be used on its own or with other information to identify, contact, or locate a single person, or to identify an individual in context. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website.

 

What personal information do we collect from the people that visit our blog, website or app?

 

When ordering or registering on our site, as appropriate, you may be asked to enter your name, email address, mailing address, phone number or other details to help you with your experience.

 

When do we collect information?

 

We collect information from you when you register on our site, subscribe to a newsletter, respond to a survey, fill out a form or enter information on our site.

 

How do we use your information?

 

We may use the information we collect from you when you register, make a purchase, sign up for our newsletter, respond to a survey or marketing communication, surf the website, or use certain other site features in the following ways:

      • To personalize your experience and to allow us to deliver the type of content and product offerings in which you are most interested.
      • To improve our website in order to better serve you.
      • To allow us to better service you in responding to your customer service requests.
      • To administer a contest, promotion, survey or other site feature.
      • To ask for ratings and reviews of services or products

 

How do we protect your information?

 

Our website is scanned on a regular basis for security holes and known vulnerabilities in order to make your visit to our site as safe as possible.

We use regular Malware Scanning.

Your personal information is contained behind secured networks and is only accessible by a limited number of persons who have special access rights to such systems, and are required to keep the information confidential. In addition, all sensitive/credit information you supply is encrypted via Secure Socket Layer (SSL) technology.

 

We implement a variety of security measures when a user places an order enters, submits, or accesses their information to maintain the safety of your personal information.

 

All transactions are processed through a gateway provider and are not stored or processed on our servers.

 

Do we use ‘cookies’?

 

Yes. Cookies are small files that a site or its service provider transfers to your computer’s hard drive through your Web browser (if you allow) that enables the site’s or service provider’s systems to recognize your browser and capture and remember certain information. For instance, we use cookies to help us remember and process the items in your shopping cart. They are also used to help us understand your preferences based on previous or current site activity, which enables us to provide you with improved services. We also use cookies to help us compile aggregate data about site traffic and site interaction so that we can offer better site experiences and tools in the future.
We use cookies to:
      • Understand and save user’s preferences for future visits.
      • Keep track of advertisements.
      • Compile aggregate data about site traffic and site interactions in order to offer better site experiences and tools in the future. We may also use trusted third-party services that track this information on our behalf.
You can choose to have your computer warn you each time a cookie is being sent, or you can choose to turn off all cookies. You do this through your browser settings. Since browser is a little different, look at your browser’s Help Menu to learn the correct way to modify your cookies.
If users disable cookies in their browser:

 

If you turn cookies off, Some of the features that make your site experience more efficient may not function properly.Some of the features that make your site experience more efficient and may not function properly.

 

Third-party disclosure

 

We do not sell, trade, or otherwise transfer to outside parties your Personally Identifiable Information unless we provide users with advance notice. This does not include website hosting partners and other parties who assist us in operating our website, conducting our business, or serving our users, so long as those parties agree to keep this information confidential. We may also release information when it’s release is appropriate to comply with the law, enforce our site policies, or protect ours or others’ rights, property or safety.

However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.

 

Third-party links

 

Occasionally, at our discretion, we may include or offer third-party products or services on our website. These third-party sites have separate and independent privacy policies. We therefore have no responsibility or liability for the content and activities of these linked sites. Nonetheless, we seek to protect the integrity of our site and welcome any feedback about these sites.

 

Google

 

Google’s advertising requirements can be summed up by Google’s Advertising Principles. They are put in place to provide a positive experience for users. https://support.google.com/adwordspolicy/answer/1316548?hl=en

We use Google AdSense Advertising on our website.
Google, as a third-party vendor, uses cookies to serve ads on our site. Google’s use of the DART cookie enables it to serve ads to our users based on previous visits to our site and other sites on the Internet. Users may opt-out of the use of the DART cookie by visiting the Google Ad and Content Network privacy policy.
We have implemented the following:
      • Remarketing with Google AdSense
      • Demographics and Interests Reporting

 

We, along with third-party vendors such as Google use first-party cookies (such as the Google Analytics cookies) and third-party cookies (such as the DoubleClick cookie) or other third-party identifiers together to compile data regarding user interactions with ad impressions and other ad service functions as they relate to our website.
Opting out:
Users can set preferences for how Google advertises to you using the Google Ad Settings page. Alternatively, you can opt out by visiting the Network Advertising Initiative Opt Out page or by using the Google Analytics Opt Out Browser add on.

 

California Online Privacy Protection Act

 

CalOPPA is the first state law in the nation to require commercial websites and online services to post a privacy policy. The law’s reach stretches well beyond California to require any person or company in the United States (and conceivably the world) that operates websites collecting Personally Identifiable Information from California consumers to post a conspicuous privacy policy on its website stating exactly the information being collected and those individuals or companies with whom it is being shared. – See more at: http://consumercal.org/california-online-privacy-protection-act-caloppa/#sthash.0FdRbT51.dpuf
According to CalOPPA, we agree to the following:
Users can visit our site anonymously.
Once this privacy policy is created, we will add a link to it on our home page or as a minimum, on the first significant page after entering our website.
Our Privacy Policy link includes the word ‘Privacy’ and can easily be found on the page specified above.
You will be notified of any Privacy Policy changes:
      • On our Privacy Policy Page
Can change your personal information:
      • By emailing us
      • By logging in to your account
How does our site handle Do Not Track signals?
We honor Do Not Track signals and Do Not Track, plant cookies, or use advertising when a Do Not Track (DNT) browser mechanism is in place.
Does our site allow third-party behavioral tracking?
It’s also important to note that we do not allow third-party behavioral tracking

 

COPPA (Children Online Privacy Protection Act)

 

When it comes to the collection of personal information from children under the age of 13 years old, the Children’s Online Privacy Protection Act (COPPA) puts parents in control. The Federal Trade Commission, United States’ consumer protection agency, enforces the COPPA Rule, which spells out what operators of websites and online services must do to protect children’s privacy and safety online.

We do not specifically market to children under the age of 13 years old.

 

Fair Information Practices

 

The Fair Information Practices Principles form the backbone of privacy law in the United States and the concepts they include have played a significant role in the development of data protection laws around the globe. Understanding the Fair Information Practice Principles and how they should be implemented is critical to comply with the various privacy laws that protect personal information.

In order to be in line with Fair Information Practices we will take the following responsive action, should a data breach occur:
We will notify you via email
      • Within 7 business days
We also agree to the Individual Redress Principle which requires that individuals have the right to legally pursue enforceable rights against data collectors and processors who fail to adhere to the law. This principle requires not only that individuals have enforceable rights against data users, but also that individuals have recourse to courts or government agencies to investigate and/or prosecute non-compliance by data processors.

 

CAN SPAM Act

 

The CAN-SPAM Act is a law that sets the rules for commercial email, establishes requirements for commercial messages, gives recipients the right to have emails stopped from being sent to them, and spells out tough penalties for violations.

We collect your email address in order to:
      • Send information, respond to inquiries, and/or other requests or questions
      • Market to our mailing list or continue to send emails to our clients after the original transaction has occurred.
To be in accordance with CANSPAM, we agree to the following:
      • Not use false or misleading subjects or email addresses.
      • Identify the message as an advertisement in some reasonable way.
      • Include the physical address of our business or site headquarters.
      • Monitor third-party email marketing services for compliance, if one is used.
      • Honor opt-out/unsubscribe requests quickly.
      • Allow users to unsubscribe by using the link at the bottom of each email.

If at any time you would like to unsubscribe from receiving future emails, you can email us at
      • Follow the instructions at the bottom of each email.

and we will promptly remove you from ALL correspondence.

 

Contacting Us

 

If there are any questions regarding this privacy policy, you may contact us using the information below.

woundcareadvisor.com
259 Veterans Lane, Suite 103

Doylestown, PA 18901

USA
[email protected]
215-489-7000
Last Edited on 2017-04-15
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