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Practical Issues in Wound, Skin and Ostomy Management
By Stanley A. Rynkiewicz III, MSN, RN, WCC, DWC, CCS
Developing a successful wound care program requires a strong commitment and a willingness to learn. Our experience with creating such a program at Deer Meadows Home Health and Support Services, LLC (DMHHSS), a nonprofit home-care facility in Philadelphia, Pennsylvania, may help others build a similar wound care program and reap the rewards of a more confident staff as well as improved patient outcomes. (more…)
Read Moreby Dr. Michael Miller
To paraphrase Carol Ann from the Movie Poltergeist…”He’s Baaaaaaaaack” ! At the end of this past May, I had a sudden and disappointing parting of the ways from my prior blog host when I discovered the newest version of the Golden Rule…those that have the gold, make the rules. Is it possible to be too opinionated? Does the textual asbestos statement at the bottom of almost every web page regarding the dissociation between the hosts and the writer’s opinions really have any meaning? I am nonetheless extremely grateful to my prior hosts for allowing me the bytes to educate, illuminate and aggravate. The silent majority, mostly practitioners and patients who appreciate the inside story versus those with the gold (who don’t mind independent thinking, as long as it comes in their flavor of Kool-Aid) have both spoken.
But as PT Barnum said “’There’s no such thing as bad publicity’ and so, recognizing that more and more people are looking for a shoulder to cry on, a voice of reason, and the company that misery loves, “Ramblings of an Itinerant Wound Care Guy” re-emerges with this blog. I want to assure you that I have always relished comments and criticism both of which are proudly posted along with the blog, as long as you agree with me.
But enough fanfare and bravado and back to the bastion of wound dabblers anonymous. My three-month involuntary hiatus did little to quench the fires of indignation regarding medicine in general and wound care in particular. I had the great honor recently of meeting one of the creators of the wound care protocols for a large wound management organization. My initial disdain at our handshake turned to admiration as he explained with great pride, how the guidelines were created for diagnosis and care at their facilities. His background in wound care was impressive and his passion for care was the purest. However, in keeping with the mantra that “No Good Deed Goes Unpunished”, he related how his master plan had become intellectual oatmeal as the docs and nurses reverted to prior, Neanderthal practices. One of the major flies in his ointment was the fact that at least one facility under management had a huge number of men over 70 in treatment including hyperbarics with 100% having the diagnosis of venous insufficiency. Not a single mention of an arterial or diabetic etiology. When he brought it to the medical directors attention, the response was simply that was what had been diagnosed. He has since gone on to what he hopes are greener pastures. As far as the pitiful remnants of the wound caregivers he left behind, we agreed that they all deserve to be patient in their own centers.
To my prior readers who once again have elected to join in on the cacophony of intolerance or a newbie who on the advice of a friend decided to see what that crazy guy is writing about this month, I offer you my thanks and a promise to ignore the golden rule whenever and wherever I can. And by the way…the opinions of the statements made in this blog do not reflect those of the web site, the publisher or the editors…Got it.
Until we ramble next time.
Click here to return to Dr. Miller’s Ramblings of an Itinerant Wound Care Guy Blog page.
Disclaimer: The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, Wound Care Advisor. All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.
Read MoreBy Yolanda G. Smith, MSN, RN, CCRN
Are you able to relax, have fun, and enjoy the simple pleasures of life? Or do you:
This issue’s resources include patient tools and new guidelines.
Research suggests that adverse events affect patients with limited English proficiency (LEP) more frequently, are commonly caused by communication problems, and are more likely to result in serious harm compared to adverse events affecting English-speaking patients. Your hospital can take steps to reduce risks of adverse events for patients with LEP with “Improving patient safety systems for patients with limited english proficiency: a guide for hospitals,” from The Disparities Solutions Center, Mongan Institute for Health Policy at Massachusetts General Hospital, Boston, and Abt Associates, Cambridge, Massachusetts. (more…)
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By Joanne Aspiras Jovero, BSEd, BSN, RN; Hussam Al-Nusair, MSc Critical Care, ANP, RN; and Marilou Manarang, BSN, RN
A common problem in long-term care facilities, pressure ulcers are linked to prolonged hospitalization, pain, social isolation, sepsis, and death. This article explains how a Middle East rehabilitation facility battles pressure ulcers with the latest evidence-based practices, continual staff education, and policy and procedure updates. Sultan Bin Abdulaziz Humanitarian City (SBAHC) in Riyadh, Saudi Arabia, uses an interdisciplinary approach to address pressure-ulcer prevention and management. This article describes the programs, strategies, and preventive measures that have reduced pressure-ulcer incidence. (more…)
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By Ron Rock MSN, RN, ACNS-BC
Since its introduction almost 20 years ago, negative-pressure wound therapy (NPWT) has become a leading technology in the care and management of acute, chronic, dehisced, traumatic wounds; pressure ulcers; diabetic ulcers; orthopedic trauma; skin flaps; and grafts. NPWT applies controlled suction to a wound using a suction pump that delivers intermittent, continuous, or variable negative pressure evenly through a wound filler (foam or gauze). Drainage tubing adheres to an occlusive transparent dressing; drainage is removed through the tubing into a collection canister. NWPT increases local vascularity and oxygenation of the wound bed and reduces edema by removing wound fluid, exudate, and bacteria. (more…)
Read MoreAresolution is a serious decision or determination to do, or not to do, something. Traditionally, most New Year’s resolutions focus on self-improvement: losing weight, giving up a bad habit, exercising more, being a better person. Because most of us spend about half of our waking lives at work, perhaps our work lives should be the subject
of some of our resolutions. Here are a few work-related resolutions I’ve come up with: (more…)
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By Marcia Spear, DNP, ACNP-BC, CWS, CPSN
Chronic wound infections are a significant healthcare burden, contributing to increased morbidity and mortality, prolonged hospitalization, limb loss, and higher medical costs. What’s more, they pose a potential sepsis risk for patients. For wound care providers, the goal is to eliminate the infection before these consequences arise.
Most chronic wounds are colonized by polymicrobial aerobic-anaerobic microflora. However, practitioners continue to debate whether wound cultures are relevant. Typically, chronic wounds aren’t cultured unless the patient has signs and symptoms of infection, which vary depending on whether the wound is acute or chronic. (See Differentiating acute and chronic wounds.) (more…)
Read Moreby Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS
With uncertainty over how the Affordable Care Act (ACA) ultimately will affect operations, hospitals and other healthcare facilities are tightening up. In many areas, they’re laying off staff. In May, the healthcare industry lost 9,000 jobs—the worst month for the industry in a decade—and another 4,000 jobs were lost in July.
Medicare, Medicaid, and private insurance companies are reducing reimbursements to care providers, meaning less money is coming in and healthcare facilities have less money to pay out. In my experience, when job cuts are needed, the specialty and subspecialty positions go first. Wound and ostomy care is a subspecialty, so we need to be prepared to protect our jobs—not only for ourselves but for our patients. (more…)
Read MoreDermatologic difficulties: Skin problems in patients with chronic venous insufficiency and phlebolymphedema By Nancy Chatham, RN, MSN, ANP-BC, CWOCN, CWS; Lori Thomas, MS, OTR/L, CLT-LANA; and Michael Molyneaux, MD
Skin problems associated with chronic venous insufficiency (CVI) and phlebolymphedema are common and often difficult to treat. The CVI cycle of skin and soft tissue injury from chronic disease processes can be unrelenting. If not properly identified and treated, these skin problems can impede the prompt treatment of lymphedema and reduce a patient’s quality of life.
This article reviews skin problems that occur in patients with CVI and phlebolymphedema and discusses the importance of using a multidisciplinary team approach to manage these patients. (more…)
Read MoreHere are some resources of value to your practice.
The National Guideline Clearinghouse, supported by the Agency for Healthcare Research and Quality, summarizes many guidelines of interest to wound care, ostomy, and lymphedema clinicians. Here are some examples:
You can search for guidelines and compare more than one guideline.
By T. Michael Britton, RN, NHA, WCC, DWC
As wound care professionals, we’ve all experienced a time when we felt that our patient didn’t have the appropriate wound treatment orders. However, the physician, nurse practitioner, or other prescriber wouldn’t follow your recommendation. This situation is not only frustrating but can delay the healing process. This article explores why a prescriber might not follow your recommendation and offers solutions. It focuses on physicians, because I’ve had the most experience with them. (more…)
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