Successful documentation of wound care

May 22, 2014February 25, 2020 Wound Care Advisor

By Cheryl Ericson, MS, RN, CCDS, CDIP

Providers are often surprised at how pages upon pages of documentation in a patient’s health record can result in few reportable diagnosis and/or procedure codes, which often fail to capture the complexity of the patient’s condition. However, providers need to be aware of the implications of coding. As healthcare data become increasingly digital through initiatives such as meaningful use, coded data not only impact reimbursement but also are increasingly used to represent the quality of care provided. Here’s a closer look at how documentation and coding work in the context of wound care. (more…)

Understanding the crusting procedure

May 22, 2014February 25, 2020 Wound Care Advisor

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.

The crusting procedure produces a dry surface and absorbs moisture from
broken skin through an artificial scab that’s created by using skin barrier powder (stoma powder) and liquid polymer skin barrier. The crusting procedure is most frequently used on denuded peristomal skin to create a dry surface for adherence of an ostomy pouching system while protecting the peristomal skin from effluent and adhesives. Crusting can increase pouching-system wear time, resulting in fewer pouch changes and less disruption to irritated peristomal skin. The crusting procedure can also be used for other denuded partial-thickness weeping wounds caused by moisture. (more…)

The DIME approach to peristomal skin care

May 22, 2014February 25, 2020 Wound Care Advisor

By Catherine R. Ratliff, PhD, APRN-BC, CWOCN, CFCN

It’s estimated that about 70% of the 1 million ostomates in the United States and Canada will experience or have experienced stomal or peristomal complications. Peristomal complications are more common, although stomal complications (for example, retraction, stenosis, and mucocutaneous separation) can often contribute to peristomal problems by making it difficult to obtain a secure pouch seal. This article will help you differentiate types of peristomal complications, including how to prevent and manage them. (more…)

Clinical Notes: Pressure Injury Prevention, Diabetes, LIV

May 22, 2014February 25, 2020 Wound Care Advisor

Incidence density best measure of pressure-ulcer prevention program

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…)

Guidelines for safe negative-pressure wound therapy

March 25, 2014February 25, 2020 Wound Care Advisor

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…)

Achieving a work-life balance

March 25, 2014February 25, 2020 Wound Care Advisor

By Julie Boertje, MS, RN, LMFT, QMRP, and Liz Ferron, MSW, LICSW

Almost everyone agrees that achieving a work-life balance is a good thing. Without it, we risk long-term negative effects on our physical and mental health, our relationships, and our work performance. But many clinicians have a hard time achieving this balance due to job demands, erratic work schedules, or the inability to say no when someone asks for help.

The challenges of stress and burnout

Stress and job burnout can cause, contribute to, or result from a poor work-life balance. They disrupt our normal patterns, behaviors, and feelings.

Of course, no one can escape stress altogether. Sometimes stress is a good thing, but we need to be able to identify when it’s a problem. For many clinicians, stress springs from the desire to provide good service and care in all parts of their lives. This desire can create stress, especially when barriers exist to achieving it. (more…)

Becoming a wound care diplomat

March 25, 2014February 25, 2020 Wound Care Advisor

By Bill Richlen, PT, WCC, CWS, DWC, and Denise Stetter, PT, WCC, DCCT

The Rolling Stones may have said it best when they sang, “You can’t always get what you want,” a sentiment that also applies to wound care. A common frustration among certified wound care clinicians is working with other clinicians who have limited current wound care education and knowledge. This situation worsens when these clinicians are making treatment recommendations or writing treatment orders not based on current wound-healing principles or standards of care. (more…)

Mastering the art of meetings

January 30, 2014February 25, 2020 Wound Care Advisor

By Toni Ann Loftus, MBA, RN, MHA

Meetings are a powerful communication tool. They bring together people who can look at an issue from their own unique perspective and contribute to a solution acceptable to many disciplines. Generally, meetings are held to:

• discuss common issues
• brainstorm ideas for solving specific concerns
• make collaborative decisions about a shared concern or problem. (more…)

Avoid surprises when connecting between care settings

January 30, 2014February 25, 2020 Wound Care Advisor

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

As wound care clinicians, we know that an interdisciplinary, holistic approach to prevention and management of a wound is crucial to positive outcomes, no matter where the patient is being seen. Yet too often when a patient transfers from one care setting to another, the only wound information that’s communicated is the current topical treatment. Most transfer forms only include generic spaces for “any skin concerns” and “treatments,” with no prompts for obtaining additional information. In fact, clinicians in many care settings frequently report they had no idea the patient had a wound until he or she was admitted.

Here’s how you can get the information you need to best care for the patient being transferred. (more…)

Wound Care Advisor Journal 2014 Vol3 No1

When and how to culture a chronic wound

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.

A case of missed care

Posted: January 30, 2014

By Lydia A. Meyers RN, MSN, CWCN Missed care, a relatively new concept in the medical community, refers to any part ofrequired patient care that is omitted of delayed. It’s not the same as a mistake or error, but like them, missed care can negatively affect patient outcomes. I want to share the case of a patient admitted into home…

Avoid surprises when connecting between care settings

Posted: January 30, 2014

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN As wound care clinicians, we know that an interdisciplinary, holistic approach to prevention and management of a wound is crucial to positive outcomes, no matter where the patient is being seen. Yet too often when a patient transfers from one care setting to another, the only wound information that’s communicated is the…

Clinical Notes: diabetic foot osteomyelitis, BIA, footwear

Posted: January 30, 2014

Antibiotics and conservative surgery yield similar outcomes in patients with diabetic foot osteomyelitis A study in Diabetes Care finds that antibiotics and surgery have similar outcomes related to rate of healing, time of healing, and short-term complications in patients who have neuropathic forefoot ulcers and osteomyelitis, but no ischemia or necrotizing soft-tissue infections. “Antibiotics versus conservative surgery for treating diabetic…

Clinician Resources

Posted: January 30, 2014

Greet the new year by tapping into some new resources. Free app for patients with Crohn’s Disease GI Buddy is a free tool from the Crohn’s & Colitis Foundation of America that patients can use to stay on top of managing their Crohn’s Disease or ulcerative colitis symptoms. Patients can record what they eat, track their treatment and well-being, and…

Fifty shades of wound care at home

Posted: January 30, 2014

By Beth Hoffmire Heideman, MSN, BSN, RN, WCC, DWC, OMS Fifty shades of wound care at home refers to treating the whole patient and the patient’s caregiving supporters—not just the wound. Only by understanding the nuances, or shades, of a patient and his or her environment can clinicians best achieve desired outcomes. Wound healing in home care depends on teamwork.…

Have you made your New Year’s resolutions?

Posted: January 30, 2014

Aresolution 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…

How to apply a spiral wrap

Posted: January 30, 2014

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 The spiral wrap is a technique used for applying compression bandaging. Procedure Here’s how to apply a spiral wrap to the lower leg. Please note that commercial compression wraps come with specific instructions for…

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

Managing venous stasis ulcers

Posted: January 30, 2014

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…

Mastering the art of meetings

Posted: January 30, 2014

By Toni Ann Loftus, MBA, RN, MHA Meetings are a powerful communication tool. They bring together people who can look at an issue from their own unique perspective and contribute to a solution acceptable to many disciplines. Generally, meetings are held to: • discuss common issues • brainstorm ideas for solving specific concerns • make collaborative decisions about a shared…

Quality-improvement initiative: Classifying and documenting surgical wounds

Posted: January 30, 2014

By Jennifer Zinn, MSN, RN, CNS-BC, CNOR, and Vangela Swofford, BSN, RN, ASQ-CSSBB For surgical patients, operative wound classification is crucial in predicting postoperative surgical site infections (SSIs) and associated risks. Information about a patient’s wound typically is collected by circulating registered nurses (RNs) and documented at the end of every surgical procedure.

When and how to culture a chronic wound

Posted: January 30, 2014

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…

2014 Journal: January February Vol. 3 No. 1

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Fifty shades of wound care at home

January 30, 2014February 25, 2020 Wound Care Advisor

By Beth Hoffmire Heideman, MSN, BSN, RN, WCC, DWC, OMS

Fifty shades of wound care at home refers to treating the whole patient and the patient’s caregiving supporters—not just the wound. Only by understanding the nuances, or shades, of a patient and his or her environment can clinicians best achieve desired outcomes.

Wound healing in home care depends on teamwork. Members of the team must understand the unique situation of delivering care in the home and how to help patients adhere to the plan of care. (more…)

Managing venous stasis ulcers

January 30, 2014February 25, 2020 Wound Care Advisor

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…)

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