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Practical Issues in Wound, Skin and Ostomy Management
According to the National Pressure Ulcer Advisory Panel (NPUAP), incidence density is the best quality measure of pressure-ulcer prevention programs. Pressure-ulcer incidence density is calculated by dividing the number of inpatients who develop a new pressure ulcer by 1,000 patient days. Using the larger denominator of patient days allows fair comparisons between institutions of all sizes. (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…)
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By Kulbir Dhillon, MSN, FNP, APNP, WCC
Venous disease, which encompasses all conditions caused by or related to diseased or abnormal veins, affects about 15% of adults. When mild, it rarely poses a problem, but as it worsens, it can become crippling and chronic.
Chronic venous disease often is overlooked by primary and cardiovascular care providers, who underestimate its magnitude and impact. Chronic venous insufficiency (CVI) causes hypertension in the venous system of the legs, leading to various pathologies that involve pain, swelling, edema, skin changes, stasis dermatitis, and ulcers. An estimated 1% of the U.S. population suffers from venous stasis ulcers (VSUs). Causes of VSUs include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. Preventing VSUs is the most important aspect of CVI management. (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…)
Read MoreGive your patients with an ostomy this information from the Transportation Security Administration to help them navigate airport screening:
• You can be screened without having to empty or expose your ostomy, but you need to let the officer conducting the screening know about the ostomy before the screening starts.
• You can be screened using imaging technology, a metal detector, or a thorough patdown.
• Your ostomy is subject to additional screening. In most cases, this means you will pat down your ostomy and then your hands will undergo explosive trace detection. (more…)
Performance scores for rates of hospital-acquired pressure ulcers might not be appropriate for comparing hospitals, according to a study in the Annals of Internal Medicine.
“Hospital report cards for hospital-acquired pressure ulcers: How good are the grades?,” funded by the Agency for Healthcare Research and Quality, analyzed 2 million all-payer administrative records from 448 California hospitals and quarterly hospital surveillance data from 213 hospitals from the Collaborative Alliance for Nursing Outcomes. (more…)
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Hospital pressure-ulcer comparison data not accurate Performance scores for rates of hospital-acquired pressure ulcers might not be appropriate for comparing hospitals, according to a study in the Annals of Internal Medicine. “Hospital report cards for hospital-acquired pressure ulcers: How good are the grades?,” funded by the Agency for Healthcare Research and Quality, analyzed 2 million all-payer administrative records from 448…
A variety of resources to end the year and take you into 2014. On the road again Give your patients with an ostomy this information from the Transportation Security Administration to help them navigate airport screening: • You can be screened without having to empty or expose your ostomy, but you need to let the officer conducting the screening know…
By Nancy Collins, PhD, RD, LD/N, FAPWCA, and Allison Schnitzer Nutrition is a critical factor in the wound healing process, with adequate protein intake essential to the successful healing of a wound. Patients with both chronic and acute wounds, such as postsurgical wounds or pressure ulcers, require an increased amount of protein to ensure complete and timely healing of their…
By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN A pressure ulcer that a patient acquires in your facility or a patient’s existing pressure ulcer that worsens puts your organization at risk for regulatory citations as well as litigation. Unless you can prove the pressure ulcer was unavoidable, you could find yourself burdened with citations or fines, or could even end…
By Kathleen D. Pagana, PhD, RN Are you making connections that benefit your career? Are you comfortable starting a conversation at a networking session? Do you know how to exit a conversation gracefully when it’s time to move on? These are questions and concerns many clinicians share. Career success takes more than clinical expertise, management savvy, and leadership skills. Networking…
By Connie Johnson, BSN, RN, WCC, LLE, OMS, DAPWCA No matter where you work or who your distributors are, ensuring the patient has sufficient ostomy supplies can be a challenge. Whether you’re the nurse, the physician, the patient, or the family, not having supplies for treatments can heighten frustration with an already challenging situation, such as a new ostomy. Here’s…
by 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.…
Dermatologic 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…
By Robyn Bjork, MPT, WCC, CWS, CLT-LANA Margery Smith, age 82, arrives at your wound clinic for treatment of a shallow, painful ulcer on the lateral aspect of her right lower leg. On examination, you notice weeping and redness of both lower legs, 3+ pitting edema, several blisters, and considerable denudement of the periwound skin. She is wearing tennis shoes…
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. Description Hydrated polymer (hydrogel) dressings, originally developed in the 1950s, contain 90% water in a gel base, which helps regulate fluid exchange from the wound surface. Hydrogel dressing are usually clear or translucent and vary…
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By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Collagen, the protein that gives the skin its tensile strength, plays a key role
in each phase of wound healing. It attracts cells, such as fibroblasts and keratinocytes, to the wound, which encourages debridement, angiogenesis, and reepithelialization. In addition, collagen provides a natural scaffold or substrate for new tissue growth. (more…)
By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN
The first 24 hours after a patient’s admission are critical in preventing pressure ulcer development or preventing an existing ulcer from worsening. A skin inspection, risk assessment, and temporary care plan should all be implemented during this time frame. Essentially, it’s the burden of the care setting to prove to insurers, regulators, and attorneys the pressure ulcer was present on admission and interventions were put into place to avoid worsening of the condition. Of course, patients also benefit from having their condition identified and treated promptly. (more…)
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Each month, Apple Bites brings you a tool you can apply in your daily practice.
Xerosis, an abnormal dryness of the skin, is one of the most common skin conditions among patients with type 2 diabetes. While assessing for predictors of foot lesions in patients with diabetes, the authors of one study found that 82.1% of these patients had skin with dryness, cracks, or fissures. An unpublished survey of 105 consecutive patients with diabetes revealed that 75% had clinical manifestations of dry skin. (more…)
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By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN
Navigating through the thousands of wound care products can be overwhelming and confusing. I suspect that if you checked your supply rooms and treatment carts today, you would find stacks of unused products. You also would probably find that many products were past their expiration dates and that you have duplicate products in the same category, but with different brand names. Many clinicians order a product by brand name, not realizing that plenty of the product is already in stock under a different brand name. (more…)
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With so much focus on dressing choices, it’s easy to forget the importance of wound cleansing. Cleaning a wound removes loose debris and planktonic (free-floating) bacteria, provides protection to promote an optimal environment for healing, and facilitates wound assessment by optimizing visualization of the wound. You should clean a wound every time you change a dressing, unless it’s contraindicated.
Here’s a review of how to choose and use a wound cleanser so you can see if your practice is up to date. (more…)
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