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Practical Issues in Wound, Skin and Ostomy Management
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. (more…)
Read MoreCheck out these resources for your practice.
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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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 have little, if any, gain in function. The study, which included 10,784 patients, was based on data from nursing homes participating in Medicare or Medicaid. (more…)
Read MoreBy 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 are characteristically irregular. Although cellulitis may occur in many body areas, this article discusses the most common location—the lower limb. (more…)
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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…
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. (more…)
Read MoreFactors 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. (more…)
Read MoreBy 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 themselves are confused about reimbursement or what their role on the wound care team can be. (more…)
Read MoreBy 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…)
Read MoreGuidelines 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 ankle walking braces as optimum off-loading modalities.” The authors reviewed about 90 studies. (more…)
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Below are resources you may find helpful to your practice.
The Agency for Healthcare Research and Quality (AHRQ) has established “AHRQ’s Safety Program for Nursing Homes: On-Time Prevention,” designed to improve long-term care by turning daily documentation into useful information that enhances clinical care planning.
On-Time uses electronic medical records to develop weekly reports that identify residents at risk for common adverse events in nursing homes to help clinical staff intervene early. Facilitators help the team integrate these reports into clinical decision making to improve care planning.
For each adverse event, the website provides a description of the reports and suggested meetings and huddles where the reports may be used, the functional specifications for programming the reports, description of implementation tools, and a 2-day training curriculum for facilitators.
The National Sleep Foundation has issued new recommendations for appropriate sleep durations. Check below to see if your patients—and you—are getting enough sleep:
• newborns (0-3 months): 14-17 hours
• infants (4-11 months): 12-15 hours
• toddlers (1-2 years): 11-14 hours
• preschoolers (3-5 years): 10-13 hours
• school-age children (6-13 years): 9-11 hours
• teenagers (14-17 years): 8-10 hours
• younger adults (18-25 years): 7-9 hours
• adults (26-64 years): 7-9 hours
• older adults (65+ years): 7-8 hours.
Access “National Sleep Foundation’s sleep time duration recommendations: Methodology and results summary” in Sleep Health.
The website for the Association for the Advancement of Wound Care (AAWC) has several resources related to venous ulcers:
• AAWC Venous Ulcer Guideline 3.12
• AAWC Venous Ulcer Guideline Evidence 6.13
• AAWC Venous Ulcer Guideline Algorithm Presentation 8.13
• AAWC Venous Ulcer Guideline Checklist 7.13.
The resources are available at no cost.
The Johnson & Johnson Wound Care Resource™ App helps patients identify, track, and provide recommendations on wound care treatment.
The free app includes treatment videos and coupons to help patients save on wound care treatment supplies. The app is available for download on iTunes.