Developing a cost-effective pressure-ulcer prevention program in an acute-care setting

By Tamera L. Brown, MS, RN, ACNS-BC, CWON, and Jessica Kitterman, BSN, RN, CWOCN

Pressure ulcers take a hefty toll in both human and economic terms. They can lengthen patient stays, cause pain and suffering, and increase care costs. The average estimated cost of treating a pressure ulcer is $50,000; this amount may include specialty beds, wound care supplies, nutritional support, and increased staff time to care for wounds. What’s more, national patient safety organizations and insurance payers have deemed pressure ulcers avoidable medical errors and no longer reimburse the cost of caring for pressure ulcers that develop during hospitalization. (more…)

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Dealing with difficult people

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Unfortunately, most clinicians can’t avoid having to work with difficult people. However we can learn how to be more effective in these situations, keeping in mind that learning to work with difficult people is both an art and a science.

How difficult people differ from the rest of us

We can all be difficult at times, but some people are difficult more often. They demonstrate such behaviors as arguing a point over and over, choosing their own self-interest over what’s best for the team, talking rather than listening, and showing disrespect. These behaviors can become habits. In most cases, difficult people have received feedback about their behavior at some time, but they haven’t made a consistent change. (See Is she a bully or a difficult person? by clicking the PDf icon above) (more…)

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How to fit in fast at your new job

By Gregory S. Kopp, RN, MN, MHA

A new job can be stimulating, but it can also be stressful. Not only will you have new responsibilities, but you’ll also have a new setting, new leaders, and new colleagues. And the quicker you can figure out who’s who and what’s what—without stepping on anyone’s toes—the better off you’ll be.

But establishing positive relationships while performing your new job well can be tricky. And early missteps can have a lasting effect on your working relationships and your effectiveness. That’s why I recommend using the four tactics below, starting on day one. (more…)

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Compassionate care: The crucial difference for ostomy patients

Compassionate care

By Gail Hebert, RN, MS, CWCN, WCC, DWC, LNHA, OMS; and Rosalyn Jordan, BSN, RN, MSc, CWOCN, WCC, OMS

Imagine your physician has just told you that your rectal pain and bleeding are caused by invasive colon cancer and you need prompt surgery. She then informs you that surgery will reroute your feces to an opening on your abdominal wall. You will be taught how to manage your new stoma by using specially made ostomy pouches, but will be able to lead a normal life.

Like most people, you’d probably be in shock after hearing this. More than 700,000 people in the United States are living with ostomies. Every year, at least 100,000 ostomy surgeries are done, preceded by a conversation much like the one above. So how do patients recover from the shock of learning about their pending surgery—and then return to a full life? (more…)

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Improving outcomes with noncontact low-frequency ultrasound

By Ronnel Alumia, BSN, RN, WCC, CWCN, OMS

Achieving excellent wound care outcomes can be challenging, given the growing number of high-risk patients admitted to healthcare facilities today. Many of these patients have comorbidities, such as obesity, diabetes, renal disease, smoking, chronic obstructive pulmonary disease, and poor nutritional status. These conditions reduce wound-healing ability. (more…)

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Preventing pressure ulcers starts on admission

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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Power up your patient education with analogies and metaphors

By Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP

Quality patient education is essential for comprehensive health care and will become reimbursable under healthcare reform in 2014. However, it’s difficult to provide effective education when time for patient interactions is limited. You can enhance your instruction time—and make your teaching more memorable—by using the techniques of analogy and metaphor. (more…)

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Clinical Notes: Debridement, Optimal Wound Healing, Diabetes, Sacral Wounds

Frequent debridement improves wound healing

A study in JAMA Dermatology reports that fre­quent debridements speed wound healing.

“The more frequent the debridement, the better the healing outcome,” concludes “Frequency of debridements and time to heal: A retrospective cohort study of 312 744 wounds.” The median number of debridements was two.

Most of the wounds in the 154,644 patients were diabetic foot ulcers, venous leg ulcers, and pressure ulcers. The study authors note that debridement is a “key process” in wound bed preparation and starting the healing process.

The findings are congruent with previous studies and are based on an analysis of the largest wound data set to date. (more…)

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Clinician Resources: Guideline Clearinghouse, Patient Safety, Diabetic Foot-Ulcers

Here are some resources of value to your practice.

National Guideline Clearinghouse

The National Guideline Clearinghouse, supported by the Agency for Healthcare Research and Quality, summarizes many guidelines of interest to wound care, ostomy, and lymph­edema clinicians. Here are some examples:

You can search for guidelines and compare more than one guideline.

Patient Safety Primers


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Taking care of the caregiver—you

By: Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Why is it that the people who are the most caring toward others neglect their own needs? Have you noticed this?

I’ve seen it time and time again. The healthcare worker who’s always the last to leave work, who always volunteers to work those extra shifts so patient care won’t be compromised, who never says “No” when it comes to something a friend needs. These same compassionate and devoted clinicians seem to always worry about others and not themselves. (more…)

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