Inappropriate footwear is the most common source of trauma in patients with diabetes. Frequent and proper assessment of appropriate footwear is essential for protecting the diabetic foot from ulceration. Here is a step-by-step process for evaluating footwear. Be sure to evaluate footwear with the patient walking, standing, and sitting.

Have you ever ridden a bicycle with a wobbly wheel? The ride isn’t smooth, and you notice every bump in the road. As you focus on your discomfort, you may be distracted from the beautiful vistas you’re riding past. Think of the bicycle as your overall health, which carries you through life. For most of us, learning how to ride a bike begins in childhood as we learn…

Management of biofilm recommendations The Journal of Wound Care has published “Recommendations for the management of biofilm: a consensus document,” developed through the Italian Nursing Wound Healing Society. The panel that created the document identified 10 interventions strongly recommended for clinical practice; however, panel members noted that, “there is a paucity of reliable, well-conducted clinical trials which have produced clear evidence related to the effects of biofilm presence.”

Wound patient’s bill of rights The Association for Advancement of Wound Care has developed the “Wound Care Patient’s Bill of Rights.” The 10 points include the right to: • know what wound treatment options are available to you • know the benefits, risks, and side effects of your wound care treatments • participate in the development of your treatment plan with your wound care team • have…

Sad but true: Much of what we do as healthcare professionals is based on reimbursement. For nearly all the services and products we use in wound care and ostomy management, Medicare, Medicaid, and insurance companies control reimbursement. For many years, these payers have been deciding which interventions, medications, products, and equipment are the best, and then reimbursing only for those items. If we want to use something not on the list,…

Negative pressure wound therapy (NPWT) uses negative pressure to draw wound edges together, remove edema and infectious material, and promote perfusion and granulation tissue development. The tissue stretch and compression created by negative pressure during NPWT promotes tissue perfusion and granulation tissue development through angiogenesis, cellular proliferation, fibroblast migration, increased production of wound healing proteins, and reduction of wound area. NPWT has been used to improve healing in a variety of wounds, including traumatic…

It’s been a stressful day at work—nothing new. One confused patient pulled off her ostomy bag, you’re having difficulties applying negative-pressure wound therapy on another, and a third patient’s family is angry with you. We all experience stressful days, but unfortunately, sometimes we take our stress out on each other. Too often, this ineffective way of identifying and managing stress leads nurses to engage in lateral violence.

The goal of wound-bed preparation is to create a stable, well-vascularized environment that aids healing of chronic wounds. Without proper preparation, even the most expensive wound-care products and devices are unlikely to produce positive outcomes. To best prepare the wound bed, you need to understand wound healing physiology and wound care basics, as well as how to evaluate the patient’s overall health and manage wounds that don’t respond to treatment. (See…

On April 13, 2016, the National Pressure Ulcer Advisory Panel (NPUAP) announced changes in pressure ulcer terminology and staging definitions. Providers can adapt NPUAP’s changes for their clinical practice and documentation, but it’s important to note that, as of press time, the Centers for Medicare & Medicaid Services (CMS) has not adopted the changes. This means that providers can’t use NPUAP’s updates when completing CMS assessment forms, such as the Minimum…

Nurses and therapists often wonder if their license permits them to perform sharp wound debridement. Scope of practice varies significantly from state to state, so it’s imperative to check your state for specific guidance, but we can address some of the challenges clinicians face in deciding whether they can perform this valuable service for patients. Sharp debridement vs. other forms

Modified Braden risk score proposed A study in Ostomy Wound Management states the risk classification of patients using Braden Scale scores should comprise three (rather than five) levels: high risk, with a total score ≤11; moderate risk, with a total score of 12 to 16; and mild risk, with a total score ≥17. The retrospective analysis of consecutively admitted patients…

End your year by checking out these resources for your practice.   Sentinel event alert for falls As part of its sentinel event alert “Preventing falls and fall-related injuries in health care facilities,” The Joint Commission has assembled information and multiple resources, including: analysis of contributing factors for falls evidence-based suggestions for improvement Joint Commission requirements relevant to falls links to…

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 an overview of cutaneous candi­diasis. Cutaneous candidiasis is an infection of the skin caused by the yeast Candida albicans or other Candida species. Here’s a snapshot of this condition.

By Cheryl Robillard, PT, WCC, CLT, DWC Patients in your clinical practice who develop wounds should prompt a call for “all hands on deck” to manage the situation, but some personnel may be missing the boat. Physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) should be on board your wound care ship so patients can receive care they…

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By Gail R. Hebert, MS, RN CWCN, DWC, WCC, OMS How would you react if you heard a 600-lb patient was being admitted to your unit? Some healthcare professionals would feel anxious—perhaps because they’ve heard bariatric patients are challenging to care for, or they feel unprepared to provide their care.

By Leanne Richbourg, MSN, RN, APRN-BC, CWON-AP, CCCN, GCNS-BC Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is the gold standard for surgical treatment of ulcerative colitis (UC) or familial adenomatous polyposis (FAP). It’s also done to treat colon and rectal cancers, such as those caused by Lynch syndrome (LS). IPAA allows the patient to maintain fecal continence and evacuate…

By: Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS As healthcare clinicians, our world is full of tasks to be completed. Some are new, but many are tasks we repeat every day and thus have become routine—things we could almost do in our sleep. But what’s routine for us may not be routine for our patients. For some patients, these…

By Ann-Marie Taroc, MSN, RN, CPN Are you using the wrong kind of medical tape on your patients? Although we strive to provide the safest care possible, some nurses may not realize that medical tape used to secure tubes and dressings can cause harm. The harm may stem from using the wrong product or using a product incorrectly, which can…

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Having the proper support surface for beds and wheelchairs is imperative in preventing pressure ulcers. “Pressure” ulcers are named that for a reason—pressure is the primary cause of interruption of blood flow to the tissue. Unfortunately, guidelines for support surface selection tend to make recommendations for the type of surface to…

Keeping clinicians up-to-date on clinical knowledge is one of the main goals of the Wild on Wounds (WOW) conference held each September in Las Vegas. Every year, I present the opening session, called “The Buzz Report,” which focuses on the latest-breaking wound care news—what’s new, what’s now, and what’s coming up. I discuss new products, practice guidelines, resources, and tools from the last 12 months in skin, wound, and ostomy management. In…

Using a checklist form to document wound care can make the task easier and faster—and help ensure that you’ve captured all pertinent data needed for assessment, reimbursement, and legal support. But the form itself may not be comprehensive; some important fields may be missing. Recently, we at Wound Care Advisor received a question from a clinician who was having trouble deciding how to code a patient’s wound in her hospital’s…

Self-management ostomy program improves HRQOL A five-session ostomy self-care program with a curriculum based on the Chronic Care Model can improve health-related quality of life (HRQOL), according to a study in Psycho-Oncology. “A chronic care ostomy self-management program for cancer survivors” describes results from a longitudinal pilot study of 38 people. Participants reported sustained improvements in patient activation, self-efficacy, total HRQOL, and physical and social well-being. Most patients had a history of…

Check out the following resources, all designed to help you in your clinical practice. Human trafficking resources Victims of human trafficking often suffer tremendous physical and psychological damage. Clinicians play an important role in identifying potential victims so they can obtain help. Here are some resources to learn more about human trafficking. • “Addressing human trafficking in the health care setting” is an online course that includes a…

Turning programs are essential to prevent and promote healing of pressure ulcers and to prevent the many negative effects of immobility, ranging from constipation to respiratory infections. However, turning a patient often puts a caregiver’s body in an awkward position, which can lead to musculoskeletal damage, especially back injuries. According to the U.S. Bureau of Labor Statistics, healthcare workers suffer…

Nearly all clinicians know exercise is good for our physical and mental health. But incorporating it into our busy lives can be a challenge. The only types of exercise some clinicians have time for are working long shifts, juggling life’s demands, balancing the books, jumping on the bandwagon, climbing the ladder of success, and skipping meals. Clinicians are in a…

Support surfaces are consistently recommended for the prevention and treatment of pressure ulcers. So patients can derive optimal benefits from support surfaces, clinicians must understand how to use them effectively. This article answers several questions about these useful tools.

Topical application of silver nitrate is often used in wound care to help remove and debride hypergranulation tissue or calloused rolled edges in wounds or ulcerations. It’s also an effective agent to cauterize bleeding in wounds. Silver nitrate is a highly caustic material, so it must be used with caution to prevent damage to healthy tissues.

Imagine watching your skin tear, bleed, and turn purple. Imagine, too, the pain and disfigurement you’d feel. What if you had to live through this experience repeatedly? That’s what many elderly people go through, suffering with skin tears through no fault of their own. Some go on to develop complications. A skin tear is a traumatic wound caused by shear, friction, or blunt-force trauma that results in a partial-…

Optimizing nutritional status is a key strategy both in preventing and managing pressure ulcers. In patients across all care settings, compromised nutrition— as from poor intake, undesired weight loss, and malnutrition—increases the risk of pressure ulcers. It contributes to altered immune function, impaired collagen synthesis, and decreased tensile strength. In many cases, malnutrition also contributes to wound chronicity and increases the risk for delayed and impaired wound healing. In patients with chronic…

We all lead busy lives, with demanding work schedules and home responsibilities that can thwart our best intentions. Although we know it’s our responsibility to stay abreast of changes in our field, we may feel overwhelmed when we try to make that happen. Keeping clinicians up-to-date on clinical knowledge is one of the main goals of the Wild On Wounds…

As a wound care specialist, you have learned about many skin conditions, some so unusual and rare that you probably thought you would never observe them. I’ve been a nurse for 38 years, with the last 10 years in wound care, and that’s certainly what I thought. But I was wrong. Let me tell you about my challenging patient with…

Value of systematic reviews and meta-analyses in wound care “Systematic reviews and meta-analyses—literature-based recommendations for evaluating strengths, weaknesses, and clinical value,” in Ostomy Wound Management, discusses evidence-based practice and how systematic reviews (SRs) and meta-analyses (MAs) can help improve management of wound care patients. The authors of the article explain evidence-based practice and provide useful definitions for key terms. They…

Start the New Year off right by checking out these resources. Pressure ulcer prevention education Access the following education resources from Wounds International: The webinar “Real-world solutions for pressure ulcer prevention: Optimising the role of support surfaces” includes: • an overview of the issue of pressure ulcers • what to consider when choosing a support surface • how to operationalize…

A fundamental rule of wound care is to treat the “whole” patient, not just the “hole” in the patient. To do this, we need to focus on a holistic approach to healing, which means evaluating everything that’s going on with the patient—from nutrition, underlying diseases, and medications to activity level, social interactions, and even sleep patterns. We know that as…

Developing a pressure ulcer can cause the patient pain, lead to social isolation, result in reduced mobility, and can even be fatal. According to the Agency for Healthcare Research and Quality, estimated costs for each pressure ulcer range from $37,800 to $70,000, and the total annual cost of pressure ulcers in the United States is an estimated $11 billion. Nurses…

Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here are examples of medications that can affect wound healing. Assessment and care planning for wound healing should include a thorough review of the individual’s current medications to identify those that may affect healing outcomes. Clinicians must then weigh the risks and benefits of continuing…

Diabetic foot ulcers stem from multiple factors, including peripheral neuropathy, high plantar pressures, decreased vascularity, and impaired wound healing. Contributing significantly to morbidity, they may cause limb loss and death. (See Foot ulcers and diabetes.) Initially, hydrocolloid dressings were developed to function as part of the stomal flange. Based on their success in protecting peristomal skin, they were introduced gradually…

Immobility affects all our body systems, including our skin. According to the National Pressure Ulcer Advisory Panel, many contributing factors are associated with the formation of a pressure ulcer, with impaired mobility leading the list. So what can clinicians do to prevent harm caused by immobility? One often-overlooked strategy is a restorative nursing program. (See About restorative nursing.) Moving up…

Being positive in a negative situation is not naïve. It’s leadership. — Ralph S. Marston, Jr., author and publisher of The Daily Motivator website Clinicians may encounter many challenges and stressors in the workplace—long hours, rotating shifts, inadequate staffing, poor teamwork, and pressure to achieve higher performance levels in an emotionally and physically demanding field. But hope exists. Positive psychology…

  At the 2015 Wild on Wounds conference, the interactive workshop “Are You Ready for an Outpatient Reimbursement Challenge?” featured a lively discussion among participants about 25 real-life reimbursement scenarios. Here are the top 10 questions the attendees asked, with the answers I provided. Q Why is it necessary for qualified healthcare professionals (QHPs) such as physicians, podiatrists, nurse practitioners,…