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Skin Care & Treatment

Clinician Resources

Wound patient’s bill of rights The Association for Advancement of Wound Care has developed the “Wou…

No more skin tears

Imagine watching your skin tear, bleed, and turn purple. Imagine, too, the pain and disfigurement yo…

Don’t go it alone

A fundamental rule of wound care is to treat the “whole” patient, not just the “hole” in the patient…
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Nutritional Supplements

Wound Care Advisor

BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
Wound healing and nutrition go hand in hand. Without adequate fluids, calories, and protein, wound healing can be delayed.

Protein is extremely important in wound healing. Patients with wounds require almost double the protein intake (1.2 to 1.5 g/kg/day) of those without wounds. All stages of wound healing require adequate protein. The basis of the human body structure, protein is responsible for making enzymes involved in wound healing, cell multiplication, and collagen and connective-tissue building. (more…)

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How are you differentiating the “big three”?

Wound Care Advisor

BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
Lower extremity ulcers are often referred as the “big three”—arterial ulcers, venous ulcers, and diabetic foot ulcers. Are you able to properly identify them based on their characteristics? Sometimes, it’s a challenge to differentiate them.

Arterial ulcers tend occur the tips of toes, over phalangeal heads, around the lateral malleolus, on the middle portion of the tibia, and on areas subject to trauma. These ulcers are deep, pale, and often necrotic, with minimal granulation tissue. Surrounding skin commonly is pale, cool, thin, and hairless; toenails tend to be thick. Arterial ulcers tend to be dry with minimal drainage, and often are associated with significant pain. The patient usually has diminished or absent pulses. (more…)

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Think a Patient Has Rights? They Left.

Wound Care Advisor
Patient Rights

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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Hole-ier than Thou, Evidence Based Regardless of the Evidence

Wound Care Advisor
evidence based medicine

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 serving lies, “I ONLY practice EVIDENCE BASED MEDICINE”.  People who are what they claim they are do not need to announce it.  A short conversation, watching them work, others opinions about them all answer the question before it is asked.  Like the RN who asked for a recent presentation on the true science behind NPWT (no, you don’t really understand it).  She made sure to tell me not only that she practiced only EVIDENCE BASED MEDICINE but then gave me several examples which incidentally had absolutely no scientific evidence (save for articles from lots of dabblers doing lots of crazy things to people and writing about them).  I am now awaiting her response as she may have to realize that her version of EVIDENCE BASED is no more real than Kim Kardashian’s celebrity. (more…)

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If All You Have is a Hammer, What Happens When You Run Out of Nails?

Wound Care Advisor
hammer

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 to those who are home bound based on the classic definition involving the word “Taxing”. One of the more prevalent problems affecting all patients involves the nebulous but ubiquitous, nerve jangling, aptly named, “5th Vital Sign”, namely pain. As a part of my medical group, we have created a program that provides pain management not just to the home bound but all those whose lives and lifestyles are affected adversely by it. The program is a monument to government bureaucracy involving multiple layers of paperwork, mental health evaluations, testing of bodily fluids for both illegal and legal substances and then, the actual evaluation of the patient commences. After all hurdles are vetted and then jumped, then and only then does a prescription for the appropriate nostrum leave the pad. In wound care, we treat based on the etiology, the location, the related factors, the amounts of drainage, the surrounding tissues and so on, ad nauseum. Not surprisingly, in pain management, the scenario is much different. In wound care the mantra of the dabbler is see the hole, fill the hole. In pain management, the goal is to minimize pain to maximize functionality but the overriding questions are how this is accomplished. (more…)

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Condemning Patients to a Leap of Faith

Wound Care Advisor
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 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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Wound care treatment explained at Rotary

Wound Care Advisor
Wound Care Solutions at Community Hospitals and Wellness Centers-Bryan

When treating people for wounds, the care team preforms both a comprehensive diagnosis and comprehensive treatment, Kathy Khandaker, director of wound care at Community Hospitals and Wellness Centers-Bryan, told the Bryan Rotary Club at its Friday meeting.

The wound care clinic opened at CHWC in 2006, added ostomy care in 2007, continence care in 2010 and added a full-time physician in 2015. The care team includes a wound care nurse, a hyperbaric oxygen therapy technician and a receptionist in addition to the physician. (more…)

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Wound care center honored

Wound Care Advisor
Advanced Wound Care Center at Cookeville Regional Medical Center

Even though the Advanced Wound Care Center at Cookeville Regional Medical Center only opened in the summer of 2015, the team already has exceeded clinical outcomes in 2016.

And it’s those numbers that got the center a Center of Distinction award.

“It’s impressive,” Scott Vinsant, area vice president of Healogics, said. “This shows clinical excellence.”

Healogics, based out of Jacksonville, Fla., is a provider of advanced wound care services and provides speciality wound care for an underserved and growing population. (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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Managing chronic venous leg ulcers — what’s the latest evidence?

Wound Care Advisor
Managing chronic venous leg ulcers — what’s the latest evidence?

Chronic venous leg ulcers (CVLUs) affect nearly 2.2 million Americans annually, including an estimated 3.6% of people over the age of 65. Given that CVLU risk increases with age, the global incidence is predicted to escalate dramatically because of the growing population of older adults. Annual CVLU treatment-related costs to the U.S. healthcare system alone are upwards of $3.5 billion, which are directly related to long healing times and recurrence rates of over 50%.

CVLUs are not only challenging and costly to treat, but the associated morbidity significantly reduces quality of life. That makes it critical for clinicians to choose evidence-based treatment strategies to achieve maximum healing outcomes and minimize recurrence rates of these common debilitating conditions. These strategies, which include compression therapy, specialized dressings, topical and oral medications, and surgery, are used to reduce edema, facilitate healing, and avert recurrence. (more…)

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