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Diabetic Footwear: If The Shoe Fits, Wear It

April 29th, 2016

When it comes to diabetic wound care, footwear matters – and proper diabetic patient shoe assessment is key.

Diabetic Footwear

 

Wound clinicians know how devastating foot amputations are for diabetic patients. But what you might not know is that a whopping 50% of diabetic foot amputations are a direct result of patients wearing improper footwear. Surprised? Unfortunately, this staggering statistic is accurate. But the good news is that there’s something we can do about it. If we get diabetic patients to wear the proper shoes, we can cut diabetic foot amputations in half.

Where to start

If you want be on the diabetic wound prevention team (and we hope you do), shoe evaluation is key.  Which means you must be able to properly assess fit and wear patterns.  And the only way to do this is to start by first asking the patient to wear the same shoes to the appointment that he or she wears every day.

But take note: a polite request might not do the trick, as patients are commonly tempted to wear different, nicer or newer shoes that won’t get them “in trouble.”  So be firm, and explain the importance of a proper footwear assessment and its role in preventing ulceration and amputation.

What to look for

Once you have your diabetic patient’s shoes in front of you, here are the qualities you will need to look for (and hopefully find):

  • A closed toe that mimics the shape of the foot – a wide toe box that allows toes to move and accommodates any foot deformity. Pointed or open toes are not suitable.
  • An overall firm and snug fit, but with 1cm between the longest toe and the end of the shoe (when the patient is standing). We don’t want added pressure to the tops of the toes or on the toenails.
  • Heels less than 1 inch, because the taller the heel, the greater the pressure on the ball of the foot. This leads to increased callous formation and ulcerations.
  • A firm heel. Hold the sides of the heel between your thumb and forefinger and push. If the heel compresses, it won’t give the patient enough support when walking.
  • Shoes with laces, buckles or elastic to hold them in place. Slip-ons require that the toes curl in order to hold the shoe on, increasing the chance of callous formation or ulceration on the top of toes.
  • A smooth sole without seams.
  • Cushioning to absorb shock and reduce pressure on the feet.
  • Material that “breathes.” Avoid plastic and vinyl, as they can encourage fungal infections.

Provide the proof

If a patient is resistant or doesn’t understand why their shoes aren’t appropriate ones, you may have to demonstrate and provide the proof. This is where the Harris mat comes into play – a device that creates an ink imprint of the patient’s foot and reveals areas of higher pressure.  During your footwear evaluation, use the Harris mat, or try this related technique:

  • Ask the patient to stand on a white piece of paper.
  • Trace the outline of the foot with a marker.
  • Then, align the patient’s shoe on top of the outline.

If the outline of the foot expands beyond the shoe, you’ve identified improper fit.  You’ve also produced an excellent visual aid for your patient.

Take it and shake it

Have you ever heard of the “take it and shake it” technique? This is something your patient should get in the habit of doing before putting on their footwear.

First, they should point the toes of the shoes up toward the ceiling, and shake it. Why? Because all types of small objects end up in shoes – pebbles, Legos, paper clips – you name it. A diabetic patient with neuropathy won’t feel these objects, even after a severe wound has developed.  As we discussed in the blog “Urgent! Risks and Diagnosis of Diabetic Foot Infections,” 56% of all diabetic foot ulcers become infected, and an infected foot wound precedes about two-thirds of amputations.

Further educate your patients

There are things that diabetics can do to help prevent further complications, including how they shop for shoes, and their foot care at home. Provide patients and their families instructions on how to to do both.

First, share these pointers for successful new shoe shopping:

  • Patients should be re-measured each time they get new shoes.
  • Shop late in the day – when feet are typically more swollen and at their largest.
  • Try on both shoes and walk around in them to ensure they are comfortable.
  • If the patient has serious foot problems or deformities, they should be referred for specially molded inserts and or shoes.

In addition to knowing how to purchase new shoes, diabetic patients must practice proper foot care at home. Unfortunately, sharing the following instructions will not likely make you popular, but they are crucial nevertheless:

  • Their feet must be inspected (either by themselves or a caregiver) every single day, and without exception.
  • If the patient cannot pick up his or her feet to inspect the bottoms, provide a mirror, or have them enlist the help of a family member.
  • Diabetic patients should not ever walk barefoot, period. Even if the distance from the bed to the toilet is only six steps, the patient should always put on some type of shoes. Without shoes, the risk of injury to the bottom of his or her feet is increased exponentially.
  • Finally, 82.1% of diabetics have skin with dryness (xerosis), cracks or fissures, which can lead to foot ulcers. Therefore, the skin must be kept moist. For a discussion about keeping the skin moist on diabetics, see the related post, “Dry Skin Alert: Foot Xerosis in Diabetic Patients”.

Are you on the team?

Are you ready to be a part of the diabetic wound prevention team? We hope you are excited to take an active part in helping educate your diabetic patients about proper foot care. What are the biggest challenges you face when talking to diabetic patients about footwear? Are there other techniques or ideas you’d like to share? Please tell us about your experiences, or leave related comments below.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Pressure Injuries? (Don’t) Say It Ain’t So!

April 19th, 2016

Mounting pressure to call pressure injuries (aka pressure ulcers) something else has caused a stir – and clinicians in wound care are feeling the heat. Find out why.

Pressury Injuries - Don't Say It Ain't So

One of the most basic principles of healing a wound is to determine the cause – and then remove it. It sounds so simple, doesn’t it? But this is easier said than done, as many wounds have similar characteristics, and we don’t always have all the facts at our disposal in order to pinpoint the cause.

Unfortunately, this process has become further – and unnecessarily – complicated, thanks to increasing pressure (no pun intended) on wound clinicians to name a pressure injury something else. See? We told you it was complicated. Here’s what you need to know.

Why all the pressure?

A pressure injury is still a pressure injury, no matter what it’s called. In the end, whether it’s labeled a bedsore, decubitus or “de-cube,” this type of wound is bad news for the patient and caregiver. No wound clinician wants to see these develop under their watch.

But the emphasis on naming pressure injuries something else has increased, because traditionally, pressure injuries are equated to poor nursing care. As Florence Night­in­gale, the “Mother of Nursing,” wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing.”

Unfortunately, as more hospital complications’ data is made available to the public, reports of complications (such as pressure injuries) increasingly have a negative effect on individual perceptions – right or wrong – regarding the care a hospital delivers.

To make matters worse

In addition, recent attention given to Medicare’s “present on admission” rule and “never” events has elevated pressure injuries high up the chain of “no-no’s,” and puts the hospital at risk for non-reimbursement. As a result, many private insurers have followed Medicare’s lead in denying coverage for pressure injuries that occur in the hospital. Unfortunately, all the focus on reimbursement is beginning to challenge even the best wound care experts, who simply want to get the patient’s wound healed.

Today, mounting pressure from upper management has caregivers trying to bargain and rationalize their way out of calling it what it is (a pressure injury), and instead calling it something else, sometimes in desperation. Here are some examples:

  • It’s a bruise – not a deep-tissue injury.
  • This is a shearing ulcer, not a pressure injury.
  • It’s not an ischial pressure injury, but a diabetic ulcer because the patient is a diabetic.

Sadly, wound care experts are being forced to question and doubt themselves because money, quality assurance, and reputation are on the line when an in-house wound is labeled a pressure injury.

What should you do?

Just like a detective in a crime scene investigation, determining wound etiology requires us to gather all the facts. Once the facts are in, systematically comparing and contrasting the clinical findings aids differential identification in order to pin down the type of wound present.

So as a “wound detective,” it’s important that we assess and investigate all the following when searching for the cause:

  • patient’s medical history
  • recent activities (such as surgery, extensive X-rays, or long emergency-
    department waits)
  • comorbidities
  • specific wound characteristics, such as location, distribution, shape, wound bed, and surrounding skin.

Naming the wound is an important first step in intervening. If the wound is caused by pressure, call it a pressure injury and jump into action. Remove the cause, heal the wound, and prevent further breakdown. Quite simply, don’t let yourself be influenced by those who aren’t experts in wound care.

Are you feeling the pressure?

Have you felt pressure from upper management at your facility to name pressure injuries something else? How do you deal with it? Does your facility support the basic idea of calling a pressure injury what it is, and getting down to the business of healing the wound? We would love to hear about your experiences or thoughts regarding this topic. Please leave your comments below.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Pressure Injury (Ulcer) Staging: More Real-World Answers

April 15th, 2016

More real-world wound care questions and answers relating to pressure injury staging, including slough, debridement and skin breakdown.

More Real-World Pressure Injuries

 

Can’t get enough of pressure injury staging? Neither can we. That’s why we’re excited to present even more questions and answers about this topic, based on what wound clinicians experience out in the field (versus what we might learn from textbooks or in a classroom).

In our first such post – packed with some awesome pressure injury staging questions from the field – we discussed slough, levels of destruction and debridement. Here, you’ll find out more about pressure injury staging as it relates to abrasions, surgical flaps, skin breakdown due to clothing, and more. So here they are – five more tips for staging pressure injuries, based on real questions from clinicians.

 

Question: I know that friction and shearing contribute to pressure injury development, but when do I stage it? For example, if a patient’s elbow rubs across the surface of the bed and it results in missing epidermis, is this now an abrasion or a Stage 2 Pressure Injury?

Answer: The situation you describe would be an abrasion. Incidentally, it’s worthwhile to consider the role of friction and pressure injuries. Friction force occurs when two objects rub against each other. Friction isn’t a direct cause of pressure injuries, but can contribute to shear stresses in skin and in deeper tissue layers which, in combination with pressure, results in pressure injuries.

 

Q: A patient’s waistband dug into his side and caused skin breakdown. Is this considered a pressure injury?

A: Yes. Pressure, along with friction from the constriction of the waistband, is most likely the cause of the skin breakdown. This would be considered a pressure injury.

 

Q: A patient has a cast or device removed and there is skin breakdown underneath. Is this a pressure injury?

A: Yes, this would be considered a Medical Device Related Pressure Injury, and would need to be staged using the staging system according to depth of the tissue destruction. For a more detailed discussion (and an education credit), view the WCEI webinar “Medical Device and Moisture Associated Skin Breakdown.”

 

Q: My patient has a pressure injury that is 100% filled with slough, and I’ve determined it’s unstageable. In addition to documenting length and width, should I also try to determine a depth? Can you technically have a depth that is 0.1 cm?

A: It can be difficult to measure depth in superficial partial-thickness injuries or wounds covered with slough. If the depth is less than 1 mm, document as < 0.1 cm. If a wound is open, it will have depth, because at least the epidermis has been penetrated. The epidermis has a thickness of 0.1 to 0.6 mm, and the dermis thickness can range from 2 to 4 mm.

 

Q: Can pressure injury staging be used for venous ulcers?

A: No. The National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel state that a pressure injury classification system can’t be used to describe tissue loss in wounds other than pressure injuries.

 

Q: If a Stage 4 Pressure Injury is repaired with a surgical flap, would it still be a Stage 4 or would it be unstageable?

A: According to the Centers for Medicare & Medicaid Services (CMS), if a muscle flap, skin advancement flap, or rotational flap is performed to surgically replace a pressure injury, the area is considered a surgical wound and is no longer a pressure injury. If the flap fails, continue to code the area as a surgical wound until it’s healed.

What are your questions?

Everyone who’s been out in the wound care field knows that there’s no better education than those real-world experiences. We’re sure there are more questions out there just waiting to be answered. Please ask them here! What challenges or wound care questions do you wrestle with in your facility? And do you have the answers? Post them below … we might use them for a future blog!

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Wound Care News: National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology

April 13th, 2016

Breaking Wound Care News

The term “pressure injury” replaces “pressure ulcer” in the National Pressure Ulcer Advisory Panel Pressure Injury Staging System, according to the NPUAP. The change in terminology more accurately describes pressure injuries to both intact and ulcerated skin. In the previous staging system Stage 1 and Deep Tissue Injury described injured intact skin, while the other stages described open ulcers. This led to confusion because the definitions for each of the stages referred to the injuries as “pressure ulcers”.

In addition to the change in terminology, Arabic numbers are now used in the names of the stages instead of Roman numerals. The term “suspected” has been removed from the Deep Tissue Injury diagnostic label. Additional pressure injury definitions agreed upon at the meeting included Medical Device Related Pressure Injury and Mucosal Membrane Pressure Injury.

CLICK HERE to read the National Pressure Ulcer Advisory Panel’s full press release.

 

 

 

You Can Do It! Five Steps for WOW Poster Presentations

April 6th, 2016

You’re only five steps away from taking your wound case to Las Vegas as a Wild On Wounds poster presenter.

Wound Care Poster Presentation

 

Whether you’re a first-time attendee or a seasoned conference goer, nothing compares to the experience of attending the annual Wild on Wounds (WOW) National Conference. Not only are there plenty of options for academic- and research-oriented clinicians, this event provides real-world wound care education, networking and solutions for professionals who treat wound patients at the bedside, home, or clinic. It also provides a great opportunity for individuals who have experienced a particularly challenging or interesting wound care case in the form of the poster presentations.

WOW Poster Presentations

Every year, one of the highlights of WOW is the poster presentations. In fact, being named a poster presenter can be one of the most satisfying moments of your professional career. Past presenters will often tell you that the process is challenging (in a good way), invigorating, and makes you feel thrilled to be an active part of the conference agenda. Networking and sharing with clinicians who are excited to learn about your case can enhance your entire conference experience, as you will gain confidence and feel proud of your capacity to be successful in healing.

But presenters aren’t the only ones who benefit – your facility will too. Your poster can be exhibited at an open house, or it can be a useful tool when teaching wound care skills to your associates. Your facility’s status can be elevated from your wound-care success and credibility. And your marketing staff can create hand-outs to show discharge planners and physicians how to enhance admissions and patient flow, and find ways to use your experience as a promotions tool.

The best part? You get to go to Las Vegas for the whole WOW experience!

Five Steps to Awesomeness

You’ve probably seen a conference poster session before and thought, “Hey, I’ve had a wound-care success story that would be perfect for this!” But then you probably considered your busy work and personal schedule, and the thought of tackling such a time-consuming and monumental task felt impossible. Even with a good dose of motivation, where do you begin?

It’s not as complicated as you think. Sometimes all it takes is the courage to just plunge in once you know the how-tos to make it happen. That’s why we are so excited to break it down for you right here.

Step 1: Select your wound case study.  Almost every clinician has a success story to share. Hopefully, documentation and pictures (with patient consent) to use are already in place or are easily obtained.

Step 2: Write an abstract. And in case you’re thinking, “But wait, what is that anyway?” here’s your answer. An abstract is a summary of the information and outcome of the case(s) you want to present. A good abstract will make the reader want to learn more about your case and accept it as a poster (a sample abstract is included here for your review). It should be 300 words or less, and include just five paragraph sections plus the title. Here’s how it should be structured:

  1. Purpose – your reason for writing the case study
  2. Objective – what does this case study attempt to solve?
  3. Methodology – what was your approach / what did you do for the patient?
  4. Results – what was the outcome of that treatment?
  5. Conclusion – how does this case add to the knowledge of treatment?

The case study or studies may include a particularly interesting case, challenging wounds, or multiple wounds of the same or varying etiology. The case(s) should be appealing to all attendees at WOW.

Step 3: Submit your abstract.  Review the submission guidelines. Then fill out and send in the submission form.  This year’s form is due by June 30. We can help you with the process, if needed, and will notify you of your abstract’s acceptance. If accepted, you will then create your poster from the abstract.

Step 4:  Create your poster. If you don’t have the computer skills to do it yourself, don’t worry. There are plenty of resources out there to create the graphic part of it for you (like FedEx, for example). Your product representative might also be able to assist with graphics if you used their product in the care of the wound. They will most likely jump at the chance have some good exposure in front of conference attendees and on the Wound Care Advisor website, which posts all of the completed posters.

Step 5:  Bring your poster to WOW and hang it in your reserved area. At the poster session, there will be clinicians will be eager to discuss your work with you … and the fun of sharing begins! And bonus? There is also an award for best poster. Read all about the experience of our 2015 poster winner in our blog, “Destination WOW? Be a Poster Presenter.”

Poster Questions & Answers?

The poster presentations are such an exciting part of WOW, and we hope you’ll choose to be a part of it. Do you have questions or comments about this process? Please leave them here. And if you’re a past poster presenter, we’d love to read your reflections on the experience, and any words of wisdom you have for future first-time presenters. Let us know what you think by contributing your comments below.

Wild on Wounds℠ (WOW) is the national wound conference designed for healthcare professionals who are interested in enhancing their knowledge in skin and wound management. Clinicians come from all over the US to see, touch and participate in our hands-on workshops. They also learn about all the new and advanced wound care treatments and technologies to better help care for their patients.  For more information visit www.woundseminar.com

 

Real World Pressure Ulcers: Staging Can Be Tricky

March 29th, 2016

This wound care Q&A answers five of the most common questions about pressure ulcer staging dilemmas (that you probably didn’t learn from textbooks).

Pressure Ulcer Staging

 

In the world of wound care, just as in real life, the phrase, “Expect the unexpected” couldn’t be more appropriate. Clinicians can do everything exactly by the book, only to find that a wound just won’t heal, or the source of the problem appears to be one thing but then ends up being another. This is especially true with pressure ulcers.

Oh, sure, we have awesome resources, like the 2007 NPUAP Pressure Ulcer Staging Guidelines. And then there’s our interactive and informative, “What Stage is It?” practice test.

But in the real world, staging pressure ulcers can be downright tricky. We see pressure ulcers happening from pressure, pressure with shearing, and even caused by medical devices. In addition, pressure ulcers may not develop in exactly the way would we expect, or sometimes we see a pressure ulcer heal only to see it open up again later.

That’s why we’re here to help – by addressing five of the most common pressure ulcer staging questions we get in the field that ultimately cause staging dilemmas.

Question: Can a wound have two stages? My patient has a Stage III pressure ulcer, but I also see dark purple around part of it. Should I document it as Stage III with suspected deep-tissue injury (sDTI)?

Answer: A wound cannot have two stages. The entire pressure ulcer should be staged based upon the deepest level of tissue destruction in the ulcer. In this case, the wound would be considered Stage III.

Q: If a wound first presents as an sDTI and then becomes open, should I chart it as a healing sDTI or restage it as it presents?

A: Staging is based on the deepest level of destruction through the layers of skin and tissue structures; therefore, you stage according to what level of destruction you see and/or feel. So, as the ulcer changes characteristics, you should restage it based upon what you see. Remember to refer back to the definitions for each stage, and if you can’t tell what you are looking at, document the wound as unstageable for now and recheck later to see if you can put an accurate stage on it.

Q: What would be the new stage for a Stage II pressure ulcer that develops slough?

A: Again, staging is based on the deepest level of destruction through the layers of skin and tissue structures, and you would stage the ulcer according to the level of destruction you see and/or feel. If the Stage II ulcer is covered in slough to the extent you can’t see or palpate the deepest level of tissue destruction, it would be considered unstageable.

Q: If a pressure ulcer heals but later reopens at the same site, how should it be staged?

A: According to the National Pressure Ulcer Advisory Panel (NPUAP), when a pressure ulcer reopens in the same site, the ulcer should be listed at the previous staging diagnosis. For example, if it was a Stage III before it closed, it would be a Stage III when it reopened. Pressure ulcers heal to a progressively shallower depth. They don’t replace lost dermis, subcutaneous fat or muscle before they re-epithelialize. Instead, the full-thickness ulcer is filled with scar tissue composed primarily of endothelial cells, fibroblasts, collagen, and extracellular matrix. A Stage IV pressure ulcer, therefore, can never become a Stage III or lower stage pressure ulcer.

Q: Once a pressure ulcer is debrided, does it become a surgical wound and no longer need staging?

A: According to the Centers for Medicare & Medicaid Services (CMS), a pressure ulcer that has been surgically debrided remains a pressure ulcer, and isn’t considered a surgical wound.

What’s Your Staging Challenge?

Now that we’ve discussed five of the most common pressure ulcer staging challenges, we’d like to hear from you. What type of staging challenges have you experienced?  Do you find it more difficult to assess pressure ulcers in certain kinds of situations or with specific patient populations?  Please tell us about your experiences. And if you have additional questions about this topic you’d like answered, post them here – we may use them for future blogs!

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

 

What Stage Is It? Test Your Pressure Ulcer Staging Skills

March 24th, 2016

How well do you know your guidelines for staging pressure ulcers?  View the slideshow and test yourself!

Note: if you have any difficulties opening the slideshow, CLICK HERE to view it in SlideShare.

Test Your Pressure Ulcer Staging Skills from Wound Care Education Institute

Want to learn more about pressure ulcers and pressure ulcer staging?  View this 1-hour WCEI webinar “Is It Pressure? now and earn an education credit.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

It’s Complicated! Ostomy Patients and Peristomal Skin

March 18th, 2016

This overview details the five main categories of peristomal skin complications that wound specialists commonly treat in ostomy patients.

Peristomal Skin Complications

If you’ve worked with ostomy patients for any length of time, you know that maintaining a proper seal can be difficult once the peristomal skin (the skin surrounding a stoma) has been compromised. The resulting complications can drastically reduce an ostomy patient’s quality of life, and lead to social isolation, anxiety, and depression. Additionally, when patients need to change their pouches multiple times per day, it also poses a tremendous financial burden.

Unfortunately, ostomy patients with peristomal skin complications often don’t even recognize that complications they are experiencing are treatable. They simply accept it as part of their new life with a stoma, and forgo seeking help. The good news is that we are in the position to not only learn more about peristomal skin complications, but also help educate our patients so that when they suffer from complications, they know there are solutions.

The Basics

Peristomal skin complications usually fall into one of five categories:

  • mechanical trauma
  • infection
  • chemicals and irritants
  • diseases
  • skin allergens

Of all ostomy patients, ileostomy patients have the most complications. That’s because the output from their stomas (the effluent) is watery and caustic. In fact, peristomal skin complications have been estimated to be as high as 57% for patients with ileostomies, 48% with ileal conduits (from urostomies), and 35% with colostomies.  Incidentally, the rate of complications in colostomy patients is lower because it’s easier to contain stool, which is more solid.

So let’s get specific and take a closer look at each type of peristomal skin complications.

Mechanical Peristomal Skin Trauma

Mechanical trauma results from pressure, friction, or shear. Pressure can result from an ill-fitting ostomy appliance, ostomy belt or convex pouching system. Friction occurs from abrasive cleansing, improper pouching removal techniques, and frequent appliance changes.  The tissue damage can be partial to full thickness.

Peristomal Skin Infections

Peristomal skin is prone to infection from bacteria and fungi.  Two common peristomal infections are candidiasis and folliculitis.

Peristomal Candidiasis

Peristomal Candidiasis

Peristomal Candidiasis – This type of infection is an overgrowth of the fungus Candida Albicans surrounding a fecal or urinary diversion.  Fungi thrive in warmth, moisture and darkness.  So when an ostomy patient experiences perspiration, pouch leakage, denuded skin or prolonged wear time, moisture is added beneath the skin barrier.

Of course, this can provide the perfect environment for fungi to grow.  In addition, some patients are simply more predisposed to peristomal candidiasis because of various conditions such as immunosuppression, diabetes, or antibiotic therapy. Such infections can be found anywhere on peristomal skin, but is most commonly found under the skin barrier or under the pouch where it touches the abdomen.

Folliculitis – This is inflammation and/or infection of superficial hair follicles, resulting in isolated lesions or discoloration right at the follicle site.  It can be caused by chemical irritation, such as the effluent, or physical injury, such as rough shaving of the peristomal skin, ripping off the skin barrier, or friction of hair follicles under the skin barrier.   Staphylococcus aureus, streptococci, and pseudomonas aeruginosa are the most common bacteria found with folliculitis.  As with candidiasis, patients with diabetes, immunosuppression or antibiotic therapy are more likely to develop this infection.

Chemicals Irritants

Peristomal Irritant Contact Dermatitis – Following ostomy surgery, as many as 50% of patients experience peristomal irritant contact dermatitis, which is an inflammatory reaction to a chemical that results in well-defined erythema, edema, or loss of epidermis.  Papules and vesicles are often present as well.  You may know this condition as peristomal moisture associated dermatitis (as discussed in the WCEI blog, MASD: Know Your Types). The chemical irritant can be soap, solvents, or adhesives, but it is often the patient’s own effluent leaking from a poorly fitting pouch or seal. It’s especially prevalent in ileostomy patients because their stoma output is watery and caustic.

Hyperplasia

Hyperplasia

Hyperplasia – This condition is known by many names: pseudoverrucous lesions; chronic papillomatous dermatitis; hyperkeratosis; granulomas;  pseudo-epithelial hyperplasia; exuberant tissue growth; and proud flesh. It’s the result of prolonged skin exposure to urine and moisture. Typical causes include:

  • a pouch that is cut too large for the stoma
  • patients with high output liquid stool
  • urostomy patients, if the skin is in contact with alkaline urine
  • a stoma that is flush with surrounding skin or retracted

Hyperplasia presents as patches of discolored, thickened epidermis and papules, nodules, or both.

Alkaline encrustations – In your urostomy patients, you may find crystal-like formations on exposed peristomal skin. These crystals are called alkaline encrustations. When you remove the pouching system, the skin may bleed. This condition is associated with hyperplasia (discussed above), alkaline urine and/or concentrated urine that pools on the peristomal skin, renal calculi or kidney stones, and urinary tract infections.

Disease of Peristomal Skin

Pyodermal Gangrenosum

Pyodermal Gangrenosum

Pre-existing skin diseases such as psoriasis, eczema, or seborrheic dermatitis can cause issues in the skin surrounding the stoma.  But sometimes more serious conditions can develop, such as pyoderma gangrenosum (PG), which is an inflammatory, ulcerative autoimmune disease condition. PG begins as pustules and continues to extremely painful ulcers that may become full-thickness and excavate under the skin. Even though it occurs in 50% of ostomy patients with underlying inflammatory bowel diseases (such as Crohn’s disease and ulcerative colitis), the etiology of peristomal pyoderma gangrenosum remains unknown.

Peristomal Skin Allergens

Peristomal Allergic Contact Dermatitis – Contact skin allergies are fairly common in the population, so it’s not surprising to find that some ostomy patients have allergic reactions to pouching systems, accessories or skin care products. Many patients develop a peristomal contact allergy only after repeated exposure to the offending product, or if they are sensitized to a related cross-reacting substance. Allergic reactions typically include erythema along with itching, papules, vesicles, discoloration, crusting, oozing, or dryness.

Suture Granulomas – Suture granulomas are granulation tissue at the suture skin interface and are a reaction to suture material. These present as scattered, red areas of friable granulation tissue where sutures are present.

Simply Put

Peristomal skin complications not only prevent proper pouching, they undermine the comfort and well-being of our patients. And as always, our mission is to help patients heal and enjoy a higher quality of life whenever possible. By understanding the different types of complications and combining treatment with patient education, we can fulfill that mission tenfold.

To learn more about peristomal skin complications (and earn an education credit while you’re at it), view the WCEI webinar, “Troubleshooting Peristomal Skin Complications.” You’ll find out more specifics about this topic, including clinical characteristics and treatment plans.

What do you think?

Were you already familiar with the five common types of peristomal skin complications? And do you have any particularly challenging cases that relate to ostomy patients and one of these types of complications? We would enjoy hearing all about your clinical experiences regarding this topic. Leave your comments or questions below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Diabetic Wound Care: Monofilament Testing

March 11th, 2016

Detecting neuropathy in the diabetic foot is crucial for patient care, which is why this 10-step test is a must when it comes to injury and ulceration prevention.

Monofilament Testing

 

Healing patients and helping them get on the road to recovery are always at the top of any wound clinician’s list. We are always on alert and in constant assessment mode, looking for ways to prevent further complications or possible injury. So when a patient also happens to be diabetic, our assessment mode goes into overdrive.

One of the most common complications of diabetes is neuropathy, or nerve damage of the extremities. With sensory neuropathy, the patient loses protective sensation and the ability to feel pain and temperature changes. Without protective sensation, the diabetic patient is at an increased risk for foot injury or ulceration, and may not realize anything is amiss until there are serious complications.

Semmes Weinstein 10g Monofilament Test

This is why testing your diabetic patients for neuropathy is so important. In fact, the American Diabetes Association recommends that we screen diabetic patients for neuropathy annually, at minimum. Once we note any diminished sensation, we should check quarterly.

One way to assess protective sensation in the diabetic foot is to perform a Semmes Weinstein 10g Monofilament Test across designated sites on the foot.  The test uses a 5.07 monofilament that exerts 10 grams of force when bowed into a C-shape against the skin for one second.

 

Monofilament Diagrams

 

The test procedure is as follows:

  1. Use the 10gm monofilament to test sensation.
  2. Have patient close his or her eyes.
  3. Apply the filament perpendicular to the skin’s surface.
  4. Be aware that the approach, skin contact and departure of the monofilament should be approximately 1.5 seconds in duration.
  5. Apply sufficient force to allow the filament to bend. (Figure 1).
  6. Do not apply to an ulcer site or on a callous, scar, or necrotic tissue.
  7. Do not allow the filament to slide across the skin or make repetitive contact at the test site. Randomly change the order and timing of successive tests.
  8. Ask the patient to respond, “Yes,” when the filament is felt.
  9. Document response when felt, and test for sensation (Figure 2).
  10. Be aware that neuropathy usually starts in the first and third toes, and progresses to the first and third metatarsal heads. It is likely that these areas will be the first to have negative results with the 10gm monofilament. Repeated testing can demonstrate vividly to the patient the progression of the disease.

Record the results on the screening form, noting a “+” for sensation felt, and a “-” for no sensation felt. The patient is said to have an insensate foot if they fail on retesting at just one or more sites on either foot. Injury is much more likely to occur in these insensate areas and we must take protective measures. Provide patient education verbally and in writing, such as these materials from the American Diabetes Association, and be sure to do a good shoe fit assessment as part of your care plan.

Do you administer this test?

Are you familiar with the Semmes Weinstein 10g Monofilament Test, and do you administer it on a regular basis to your diabetic patients? Have you noticed significant results in terms of prevention and assessment? We are interested to know about your experiences in diabetic foot testing, so please leave your comments below.

 

Free Download - Neuropathic Foot Exam Guide

Click to download this easy-to-use resource for performing foot examinations.

Moisture Associated Skin Damage: Know Your Type

March 4th, 2016

Know how to correctly identify these four common types of Moisture Associated Skin Damage (MASD) for best wound care practices.

MASD Categories

 

It might sound reasonable to assume that Moisture Associated Skin Damage (MASD) is the result of, well … moisture. The fact is that it takes more than just moisture to cause MASD, which is the inflammation and erosion of the skin that’s caused by prolonged exposure to various sources of moisture, including, urine, stool, perspiration, wound exudate, mucous, or saliva.  Skin does not break down in water alone.  However, when moisture on the skin is combined with friction, chemical irritants or bacterial/microbial factors, that’s when the real damage occurs.

For effective wound care, clinicians must be able to properly assess MASD from the onset – even if at first the diagnosis isn’t obvious. It all begins with good clue gathering, and knowing the characteristics of each of the four common types.

Identifying MASD

Because moisture on the skin increases skin permeability (which alters pH and cools the tissue), it compromises the barrier function of the skin’s protective acid mantle. This, in turn, makes the skin more susceptible to friction and shearing forces.

Correct MASD identification is critical for treatment, and should begin as soon as initial signs appear. The first step is to conduct a complete skin assessment. Don’t ever assume that you know what’s going on at first glance. Follow the general rule of thumb for any wound expert, and keep looking! Take your time, be methodical, and note the location, texture, moisture level, maceration, denuding and changes in skin color.

Know your type

Incontinence-Associated Dermatitis (IAD)

One of the most common forms of MASD is incontinence-associated dermatitis (IAD), which is the inflammation of the skin from extended exposure to urine or stool.  You may also know it as perineal dermatitis, irritant dermatitis or diaper rash (in children). The highest-risk patients are those that have both fecal and urinary incontinence.

As mentioned earlier, moisture requires an additional irritant in order to produce MASD. Urine contains ammonia, which increases the skin’s pH and destroys the protective acid mantle.  Adding to the problem, frequent skin cleansing in response to urinary or fecal incontinence can increase the risk of breakdown. Even incontinent briefs can contribute to IAD by causing perspiration in the affected area. Although the briefs pull the actual fluids away, the microclimate remains moist and warm.

So how do you know if it’s IAD? Here are typical characteristics:

  • Found over fatty tissue of the buttocks, perineum, inner thigh and groin (though they can occur over bony prominences).
  • Distributed in a consolidated or patchy formation.
  • Covers diffuse areas, shaped like a mirror image in the skin fold or linear area in the anal cleft.
  • Is superficial or partial thickness in depth. Note: if there’s tissue destruction into the subcutaneous tissue or deeper, it must be staged as a pressure ulcer (for more information, see the WCEI blog “Will the Real Pressure Ulcer Please Stand Up?”)
  • Presents with non-uniform redness in the wound bed, maceration in the surrounding skin and peri-anal redness. No necrosis.
  • Has diffuse and irregular wound margins.

Intertriginous Dermatitis (ITD)

Intertriginous dermatitis, also called intertrigo, is an inflammatory condition of opposing skin surfaces caused by moisture.  You’ll find it in skin folds, such as under the breasts, in the axillary (armpit) area, or inguinal (groin) region. It’s particularly common in obese patients.

Moisture can become trapped in the skin fold, where there is a lack of air circulation.  The excess moisture causes the dead cells in the uppermost layer of the skin (the stratum corneum) to become saturated and then puff up. The result is rough textures (which means they won’t glide very well), and the result is skin-on-skin friction.

Characteristics of ITD:

  • Found in the skin folds.
  • Distributed in a linear, mirror image on each side of the fold
  • Always partial thickness.
  • Presents as mild erythema (redness) that can quickly progress to erosion, oozing, maceration or crusting.
  • Surrounding skin is often macerated and prone to bacterial and fungal infections such as candidiasis.
  • Can be painful, itchy and may produce odor.

It’s important to realize that a patient can suffer from both IAD and ITD at the same time, coexisting side-by-side.

Periwound Moisture-Associated Dermatitis

Periwound moisture-associated dermatitis occurs when the skin adjacent to a chronic wound becomes exposed to exudate or toxins from bacteria in the wound bed, causing inflammation and erosion. This is a result of too much exudate that hasn’t been properly managed. Left untreated, the periwound will eventually break down and the wound will enlarge.

Infected wounds are especially prone to periwound moisture-associated dermatitis because they produce more exudate.  The condition is more common in the elderly and immunocompromised, but our clinical practices can contribute as well. This can be due to a number of risk factors, including improper dressing selection, infrequent dressing changes, and aggressive tape removal.

Peristomal Moisture-Associated Dermatitis

The final common type of MASD is peristomal moisture-associated dermatitis.  This form of inflammation and skin erosion occurs only in ostomy patients.  It begins at the stoma/skin junction, and can extend outward as much as 4 inches in any direction.  As many as 50% of patients with a stoma experience this condition, which can be extremely detrimental to their quality of life.

Peristomal moisture-assisted dermatitis can happen around any stoma, including tracheostomies, gastrostomies, urostomies, and colostomies.  However, ileostomy patients – those with stomas at the small intestine – have the highest risk since the effluent (output from the stoma) is watery and caustic.  When the pouching system leaks due to improper sizing, an uneven peristomal plane or incorrect wear time, the effluent causes skin irritation and potential breakdown.

Pay close attention to the area around the stoma, keeping a close eye out for potential problems, including well-defined erythema, edema, and loss of the epidermis. You may also see papules, vesicles, itching, crusting and oozing. As with other forms of MASD, it’s important to address the problem early.

Do you know your MASD types?

What types of MASD have you encountered the most in your facility, and have you ever had trouble identifying them? Do you have any tips for MASD identification, and has early identification made a difference in patient outcome? Please tell us about your experiences by leaving your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Wound Assessment: Skin of Many Colors

February 25th, 2016

Understanding the structural differences between light and dark skin is crucial for clinicians, and this free Wild on Wounds webinar will help – plus you’ll get awesome tips for assessing skin of color.

- Cropped

 

Chances are that when you studied skin assessment in US textbooks, most of the case studies or featured photos involved patients with lighter skin tones – common to people of European decent.  Historically (and unfortunately), there’s been a lack of research, guidelines and consistency in treating skin of color.

This lack of diversity in educational resources is not only a disservice to clinicians and patients, it can be downright dangerous. For example, without exposure to proper techniques, you might not recognize a Stage I pressure ulcer in a darker-skinned patient, because non-blanchable erythema (redness) is harder to see.

As our patient population grows increasingly diverse, it is absolutely essential that bedside clinicians understand how skin differs among people of various ethnic and racial backgrounds, and what that means in wound assessment.

Learning starts here

Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS, WCEI Co-founder/ Clinical Instructor

Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS, WCEI Co-founder/ Clinical Instructor

The truth of the matter is that most of us have learned whatever we can about treating skin of color from our own experiences in the field. This is why WCEI Co-founder and Clinical Instructor

Nancy Morgan addressed this topic in her Wild on Wounds (WOW) 2015 National Conference presentation, “How to: Skin of Color.”

Now offered as an on-demand webinar, Morgan discusses the specific characteristics of skin of color, and how clinical conditions present differently in highly pigmented (versus lighter) skin. You can hear her entire presentation – and view it for free – with a special coupon code (listed below).

What makes skin darker?

Skin color is the result of melanin – a brown pigment. The purpose of melanin is to protect the skin by absorbing harmful ultraviolet (UV) radiation from the sun.  As we encounter UV rays, special cells called melanocytes produce additional melanin.

You may be surprised to learn that there’s no difference in the number of melanocytes between skin types. The palest and the darkest person will, on average, have the same number of these cells in their skin. However, the production and concentration of melanin in the epidermis (top layer of skin) is double in darker skin.

Does skin tone matter?

There are many skin tone classification scales used in the field, created mostly by and for dermatologists.  As Morgan states in her presentation, these scales aren’t helpful when it comes to wound care. “We have to do a very thorough visual inspection of the skin, and we have to talk to the patient about his or her baseline skin color.”

More webinar highlights

Besides exploring the basics of skin color and tone, you’ll find out more from Morgan’s webinar, including:

  • Skin conditions more common in darker skin, such as hyperpigmentation, keloid scarring, and xerosis.
  • Useful tips for performing a holistic assessment of a patient with dark skin.
  • Why some clinical conditions – such as sDTI, erythema or cyanosis – can be much more difficult to pick up in skin of color.
  • How other conditions, such as hemosiderin staining, may appear very different than they would in a patient with lighter skin.

Get your free webinarFree Webinar - Skin of Color

Are you ready to learn more about this topic and better address the wound care needs of your patients with dark skin?  Click here and use the code BLOG to access this 60-minute recording, which qualifies for an education credit.

More thoughts?

We’d love to know about your clinical experiences with skin of color: did you receive any official training regarding this topic, or have you mostly learned from your own personal experiences? Is your facility proactive in making sure clinicians are knowledgeable in how skin tone and color effect proper wound assessment? Tell us about your observations and experiences by leaving your comments below.

Wild on Wounds℠ (WOW) is the national wound conference designed for healthcare professionals that are interested in enhancing their knowledge in skin and wound management. Clinicians come from all over the US to see, touch and participate in our hands-on workshops. They also learn about all the new and advanced wound care treatments and technologies to better help care for their patients.  For more information visit www.woundseminar.com

Is it Really a Bruise? Get The Bigger Picture on Skin Lesions

February 18th, 2016

In the world of wound care, clinicians define skin lesions precisely. So what might look like a bruise at first glance could really be a suspected deep tissue injury, purpura . . . or something else. Do you know the difference?

Bruise sDTI or Purpura?

If a picture is worth a thousand words, then in the world of wound care, the same can be said about the appearance of a lesion – where the blood has escaped the vessels and entered the skin. By paying close attention to the color and texture, you can determine if it is more than a simple bruise.

Knowing what to look for – and getting the bigger picture – helps us conduct better assessments. What appears at first glance to be a standard bruise could actually be anything from purpura or petechiae, to an ecchymosis or hematoma. Or wait . . . is it a suspected deep tissue injury (sDTI)?

These terms are often used interchangeably, but within wound care, clinicians define them more precisely.  Confused? Don’t worry, we’re here to help!

Bruise

A bruise (also known as a contusion), is a leakage of blood from the vessels into tissues, and is always the result of blunt force trauma.  Keep in mind that “blunt force” doesn’t necessarily mean your patient has been in a fist fight or hit with a baseball bat. The bruise can be the result of something as simple as bumping into furniture.

So is it a bruise? Here’s how to tell:

  • Bruises typically resolve within two weeks.
  • They are initially a dark maroon or reddish color (because the blood is oxygenated).
  • As the bruise ages, it progresses through the colors of a ripening banana – from green to yellow and then brown – before fading away. Note: these colors will be less obvious with darker skin, so as you make your assessment, compare the site with a symmetrical area, if possible.
  • The skin is always intact.
  • The damage can be superficial, it can be deep, or it can be a combination of the two.
  • The tissues may be painful and swollen, and there may be a localized temperature increase due to the inflammation.

Hematoma

A subdermal hematoma is a collection of blood in the skin, often clotted, bulging or mass-like.  It may be in just the epidermis and dermis, or down into the subcutaneous tissue.   A hematoma is not the same as a bruise, though you may find a hematoma within a bruise. The most common cause of a hematoma is injury or trauma to the blood vessels.

Purpura/Petechiae/Ecchymosis

Purpura consists of red or purple lesions that are similar to bruises, in that they are blood added to the skin tissues.  However, purpura spots are not the result of blunt force trauma. Instead, they are caused by either an inflammatory skin disease or a vascular problem. In addition:

  • Purpura spots don’t blanch when pressed.
  • There is usually no kind of pain associated with purpura.
  • Purpura may be palpable (that is, you can feel a rash-like texture with your fingers) or unpalpable.
  • Unpalpable purpura comes in different types, including petechiae, which are flat purpura spots under 3 mm. These pinpoint-sized spots may be quite difficult to identify in darker skin.
  • Flat purpura spots that are larger than 5 mm are called ecchymosis. These spots tend to be irregular in shape (ranging from a dark maroon to a purple), and can be seen on the skin or in the mucus membranes.

It’s important to note that ecchymosis and bruising are not the same thing, though you may hear some clinicians use these terms interchangeably. Again, ecchymosis is a kind of purpura, and is not caused by blunt force.

Suspected Deep Tissue Injury

Suspected Deep Tissue Injuries (sDTIs) also share some qualities with bruises in that they are non-blanchable, intact, and appear in similar colors – purple or maroon. Alternately, they may be a blood-filled blister.

But here’s the key difference: sDTIs are due to damage from pressure or shear, and not blunt force.  Therefore, you’re more likely to find them over a bony prominence and in patients with a history of immobility. The most common site for an sDTI is the heel.

When you touch the tissue of sDTIs with your fingertips, it could be painful, firm, mushy, boggy, and warmer or cooler compared to adjacent tissue.  It’s important to use palpation on all dark-skinned patients on high-risk areas, because visual assessment cannot be trusted. Swift identification of sDTIs is important because unlike bruises, which will resolve on their own, sDTIs can deteriorate rapidly, exposing additional layers of tissue despite treatment or offloading.

Do you know the difference?

Now that you’ve learned about the differences between bruises, sTDIs and other similar skin conditions, what do you think? Have you been able to distinguish the true identity of patient lesions in the past, or has it been difficult to properly assess them? Has your facility emphasized the need to distinguish between these types of lesions? And which type do you find the most difficult to identify? We’d love to hear more about your experiences – please leave your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Essential Steps for Skin Tear Prevention

February 11th, 2016

Skin tears are a common condition for the patients we care for, which is why it’s so important for clinicians to know who is at risk, and what can be done to minimize them. 

Skin Tear Prevention

Painful. Disfiguring. Traumatic. Skin tears are all of these things, plus they can lead to further complications and serious infections. Unfortunately, they also happen to be a very common condition for the patients we care for. In fact, an estimated 1.5 million skin tears occur each year – and that’s just among institutionalized adults.

In addition to causing pain and discomfort, skin tears can be difficult to treat, and are a direct reflection of the quality of care delivered at our facilities. This is why it is imperative for clinicians to know who is at risk for skin tears, and what we can do to prevent them from happening.

Who is at risk?

Although skin tears can occur among all ages, the youngest and oldest patients are at the highest risk. This is due to the structure of both immature and aging skin. In addition, those who are dependent on caregivers for daily activities are particularly vulnerable, since they are regularly positioned and transferred for such things as bathing and dressing. Others who are higher at risk include:

  • Older adults who ambulate independently
  • Those who are critically ill or have multiple risk factors
  • People with a history of skin tears
  • Anyone with impaired mobility
  • Those with sensory or cognitive deficits
  • Patients with visible changes in the skin such as edema, dry skin or purpura
  • Patients on four or more regularly prescribed medications
  • Patients on specific types of medications, including analgesics, antidepressants, anticoagulants, and steroids
  • People who are agitated and combative – they are more likely to bump into objects
  • Those with cardiac, pulmonary or vascular disorders

Skin tear prevention

The truth is that skin tears are not completely preventable. Since part of our job is to support our patients’ independence and improve their quality of life, at some point or another, skins tears will occur. The good news is that, as caregivers, there are things we can do to keep them at a minimum.

Improve patient environments

A patient’s environment can be modified in simple ways that can make a big difference when it comes to skin tear prevention. For instance, you can make sure there is adequate lighting in your patient’s room or living space. Seniors, for example, typically need more light in order to see clearly and avoid accidents. Next, pad furniture corners and other objects that may cause blunt force trauma when bumped, and remove throw rugs that may buckle or slip.  In addition, ensure that the patient is not wearing rings or other jewelry that can snag the skin.

Care for skin properly

Proper skin care can can go a long way in preventing tears. Skin is better able to resist tearing when it’s well-nourished and hydrated, which means nutrition plays a key role. Therefore, consult with a dietitian about the patient’s diet, and make sure they are receiving adequate fluids.

Frequent baths can dry out the skin, which increases the likelihood of skin tears. This can be a problem when facility regulations mandate that patients must have daily or weekly full baths.  If you find that frequent bathing is contributing to dry skin, adjust the full-bath schedule to twice a week, with spot baths in between.  Also, it’s important that when administering a bath, you:

  • Use lukewarm water (not hot)
  • Use soapless, pH-balanced solutions with no rinse or emollient soap
  • Pat the skin dry – do not rub

To keep the skin hydrated following a bath, apply a moisturizing agent. The stratum corneum – or outermost layer of the skin – needs at least 10% moisture. Moisturizers should be applied while the skin is still damp (not completely dry and not soaking wet) to trap that moisture.

There are three types of moisturizers:

  • Humectants promote the retention of moisture, replacing the oils in the skin
  • Occlusives provide a layer of oil on the skin surface, slowing water loss
  • Emollients soften and spread easily on the skin.

A humectant will pull the moisture up from the dermis into the epidermis to help keep skin intact (it’ll even pull moisture out of the air in the room). But humectants need to be coupled with an occlusive product to trap the moisture. In other words, you need to add a layer of oil on the skin’s surface to slow down evaporation.

Meanwhile, we want our skin to be able to slide, right? And that’s the role of emollients. They make the stratum corneum smooth and less susceptible to friction, which can create that skin tear.

More strategies for prevention are to cover fragile skin with long sleeves, pants and knee-high socks, or products such as DermaSaver® or Posey® SkinSleeves™.  If something rubs up against the patient, the clothing or the device will move and hopefully not tear the epidermis from the dermis.

Be gentle, learn more

It goes without saying that we should be extra gentle when lifting, repositioning or transferring patients. By taking your time and softening your touch when caring for those at higher risk of skin tears, the frequency of such occurrences can be decreased.

Educating ourselves and our patients is also an important part of preventing skin tears. We need to understand the risk factors, keep the skin as nourished and moisturized as possible, avoid dangerous edges and surfaces in the environment, and treat patients gently.Skin Tear Webinar Coupon Code

For even more details on the prevention, staging and treatment of skin tears, view this free one-hour webinar recorded at the 2015 Wild On Wounds (WOW) National Conference. For access, click here and use the code SKINTEARS.

What do you think?

Were you already aware of who is most at risk for skin tears, and does this affect how you treat patients? And are there any preventative measures you regularly put in place that seem to help? If you have additional ideas, or any stories to share, please leave them below!

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

 

 

Warm Wound Healing? It’s All About Foam Dressings

February 4th, 2016

Keeping a wound warm is an important part of wound care treatment, and foam dressing does the trick because it effectively maintains optimum temperatures and promotes healing. 

Foam for Warm Wound Healing

 

For wound care clinicians – and anyone else who ever treats wounds – it’s important to know that moist wounds heal faster. However, moisture on any surface (including wounds) will begin evaporating when exposed to air, and at a quicker rate as the surface cools. So the challenge of healing wounds effectively is to keep a wound moist and warm. Fortunately, foam dressings maintain optimum healing conditions, and help our patients heal faster.

Why warm is better

As wound tissues lose moisture, a cooling effect occurs in the wound. Because cells and enzymes function optimally at normal body temperature, a drop of just 2 °C is sufficient enough to negatively affect the biological healing process.

In fact, when a wound dressing is changed, it can take a wound base temperature up to four hours before it returns to normal. This is an important factor to consider when anticipating healing times, as well as when prepping your patient for a dressing change. Additionally, when tissue cooling occurs, it can lead to a higher risk of infection due to vasoconstriction, and hemoglobin’s increased need for oxygen. This, in turn, decreases the amount of oxygen available for neutrophils, which fight infection.

So how does this all tie in to dressings? By using the right type of dressings – and applying them properly – you can create an optimum environment for wound healing. The dressing that keeps the wound bed the warmest is foam.

Foam Dressing

Semipermeable polyurethane foam dressing is nonadherent and nonlinting. It has a hydrophobic or waterproof outer layer, and provides a moist wound environment. Other characteristics of foam dressing include:

  • It is permeable to water vapor, but blocks the entry of bacteria and contaminants
  • It can be purchased in various thicknesses, with or without adhesive border
  • It is available in pads, sheets, and cavity dressings

Consider using foam as primary or secondary dressing for partial- and full-thickness wounds, with minimal to heavy drainage. In addition, foam dressing:

  • Works well for granulating and epithelializing wounds
  • Provides insulation to keep wounds warm
  • As secondary dressing for wounds with packing
  • Can be used to absorb drainage around tubes
  • Helpful for hypergranulation tissue along with compression

The advantages to using foam dressing on wounds are that it:

  • Provides moist wound healing
  • Doesn’t adhere to the wound
  • Provides cushioning
  • Is easy to apply and remove
  • Can be used with infected wounds
  • Provides a bacterial barrier
  • Is effective with hypergranulation
  • Can be used under compression
  • Can be cut to accommodate tubes

The disadvantages to using foam dressing on wounds include:

  • It could be expensive if exudate requires daily dressing changes
  • Wound beds may desiccate if there is no exudate from the wound
  • A secondary dressing might be required
  • If it becomes saturated, it can lead to maceration of the periwound
  • It is contraindicated for use with third-degree burns, dry eschar, and sinus tracts

What do you think?

Knowing that moist and warm wounds heal faster obviously makes using the right dressings (and applying them properly) crucial to effective wound care. Do you regularly use foam dressings, and have you noticed a difference in healing time? And have you learned any special application techniques that help keep wounds at an optimum body temperature? We’d love to hear about your experiences – please leave your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Exudate: The Type and Amount Is Telling You Something

January 29th, 2016

Wound care clinicians need to know about the different types of exudate – and how much is present – for successful wound treatment and healing.

Know Your Exudate

Ooze. Pus. Secretion. The drainage that seeps out of wounds can be called many things, but as wound care clinicians know, the technical term is exudate. This liquid, which is produced by the body in response to tissue damage, can tell us what we need to know about the wound. And while we want wounds to be moist, we don’t want them to be overly moist. Finding that balance can sometimes be a bit tricky – which is why it’s so important to know all about exudate.

Types of Exudate

First, let’s start with the types of exudate we most commonly see in our patients’ wounds. They are:

  • Serous – a clear, thin and watery plasma. It’s normal during the inflammatory stage of wound healing, and smaller amounts are considered normal. However, a moderate to heavy amount may indicate a high bioburden.
  • Sanguinous – a fresh bleeding, seen in deep partial- and full-thickness wounds. A small amount is normal during the inflammatory stage.
  • Serosanguineous – thin, watery and pale red to pink in color.
  • Seropurulent – thin, watery, cloudy and yellow to tan in color.
  • Purulent – a thick and opaque exudate that is tan, yellow, green or brown in color. It’s never normal in a wound bed, and is often associated with infection or high bacteria levels.

Quantity of Exudate

Besides knowing the different types of exudate, you also need to be aware of the amount present in your patients’ wounds. This can be key for proper assessment, and help you choose the best wound treatment. The different exudate levels include:

  • None present – the wound is dry.
  • Scant amount present – the wound is moist, even though no measurable amount of exudate appears on the dressing.
  • Small or minimal amount on the dressing – exudate covers less than 25% of the bandage.
  • Moderate amount  – wound tissues are wet, and exudate involves 25% to 75% of the bandage.
  • Large or copious amount – wound tissue is filled with fluid, and exudate covers more than 75% of the bandage.

Always take into account the amount of exudate when selecting the dressing. We want to promote moist wound healing, but with no adverse effects from too much moisture, such as maceration of the periwound.

What do you think?

When it comes to documenting exudate, do you see one type being identified more than others – like the well-known serosanguineous? And what about the amount of drainage – do you use the terms listed above, or does your clinic use percentages instead? We would love to hear how your facility typically documents exudate, and if you encounter any specific challenges or successes with identifying or treating wounds based on exudate. Please leave your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

 

Destination WOW? Be a Poster Presenter

January 21st, 2016

Wild on Wounds conference attendee shares a wound-care mystery through her first-ever poster abstract, and has a message for fellow clinicians: “Don’t give up!”

Susie Lee, RN WCC, was the 2015 WOW Grand Prize recipient in the poster presentations.

Susie Lee, RN WCC, was the 2015 WOW Grand Prize recipient in the poster presentations.

Susie Lee, RN WCC, traveled from Honolulu, Hawaii last year to attend the Wild on Wounds National Conference (WOW) for the first time, and all because of a challenging wound care case. A nurse for 38 years (and specializing in wound care for the past 10 years), she submitted a poster abstract in order to share her experience with fellow clinicians and conference attendees.

At the time, Susie had never created a clinical poster before, let alone one of such magnitude. And on top of that, she had never been asked to present a case for such a large audience. But this opportunity was a perfect fit for WOW attendees, because they love learning and finding ways to better help and care for wound care patients.

Little did she know that her entry (and all the hard work that went with it) would not only be a smashing success, she would go on to receive the coveted Grand Prize, plus a complimentary conference registration for WOW 2016. The icing on the cake was that she enjoyed learning more about her passion – wound care – in a lively, fun and inspirational environment while attending the WOW conference.

The Case

So what was Lee’s poster topic? It all started with an old wound that refused to heal. Located around a patient’s colostomy site, the wound was a tricky one, accompanied by intermittent appliance leakage. But the kicker? The patient wasn’t feeling pain.

“It was so frustrating,” says Lee. “The wound would get better for months at a time, but then suddenly flare up again. After trying different methods of treatment, none of which seemed to work I researched symptoms and scoured the Internet, looking for related articles, photos and any clue that might help find a solution. A  dermatologist could not provide any diagnosis, so I finally consulted with another wound care nurse colleague.”

Again, since the patient wasn’t feeling any pain, it was more difficult to diagnose. But finally Lee experienced an aha moment. She learned that the patient had suffered from a stroke on her left side (where the colostomy was), which had caused extensive nerve damage. This suddenly explained the patient’s lack of pain.

The diagnosis? Peristomal pyoderma gangrenosum – a rare condition that causes large, painful ulcers to develop in the area surrounding an abdominal stoma. Working with a nurse practitioner, Lee decided to apply a high-dose of topical steroid cream. And guess what? It worked.

The WOW Experience

Although Lee’s case was difficult, the successful outcome – and the opportunity to share her story so that others might learn from it – inspired her to create the first poster presentation of her life. Being named the Grand Prize recipient was a surprise, for sure. But it was her message that meant even more. “The bottom line for me was to tell other clinicians that no matter how long it takes, don’t give up!” she says. “It’s such a great satisfaction to get a stubborn wound healed – for the patient, certainly, but also for you!”

Attending her first WOW conference was extra special because Lee’s daughter came with her to see the presentation. “It was kind of a role reversal,” she says. “My daughter came to see me participate in something. She was impressed with my poster, and it was nice for her to be proud of me, just like I’m always proud of her!”

As for her WOW trip, Lee says that she loved every minute. “I’ve been to other conferences, and they were really nice, but WOW is a whole other experience,” she says. “They had so many sessions and resources – on topics that I have to deal with every day. I met so many great people, and it was well worth the trip. WOW makes learning fun.”

A Little Background on Susie

Lee’s first class with the Wound Care Education Institute (WCEI) was in 2004, when she completed the Skin and Wound Management course presented by Nancy Morgan, WCEI Co-Founder.  Later, she sat for the Wound Care Certified Examination provided by National Alliance of Wound Care and Ostomy, and then became a WCC. “No doubt about it, my career path is a direct result of WCEI,” she says.

More about WOW

What have your experiences at WOW conferences been, and how many times have you attended? What were your favorite moments, sessions or experiences? Please leave your comments below. And if you’re interested in sharing the details of an unusual or particularly challenging case, get your 2016 Poster Submission Form here. We can’t wait to see you in Las Vegas!

To learn more about the case, “Atypical Presentation of Peristomal Pyoderma Gangrenosum,”  see Lee’s article in the Jan/Feb 2016 issue of Wound Care Advisor.

Dry Skin Alert: Foot Xerosis in Diabetic Patients

January 14th, 2016

Diabetic wound management requires awareness, including knowing the signs and progression of xerosis – an abnormal dryness of skin.

Xerosis in Diabetic Patients

Patients with diabetes are prone to dry skin, particularly when blood glucose levels are running high. And as a clinician, one of the most common types of skin conditions you will see in your diabetic patients is xerosis, which is an abnormal dryness of the skin. This is just one reason why clinicians should routinely inspect the feet of diabetic patients.

According to research, 82.1% of patients with diabetes had skin with dryness, cracks or fissures, which serves as a predictor of foot lesions. In addition, an unpublished survey of 105 consecutive patients with diabetes revealed that 75% had clinical manifestations of dry skin. This serves as further evidence that xerosis in diabetic patients is a threat to foot ulcers, and the more we know about the condition, the better we can treat and heal our patients.

The Signs

The most common characteristics of xerosis include excessively dry, rough, uneven and cracked skin. Other signs include:

  • Possible raised or uplifted skin edges (scaling), desquamation (flaking), chapping, and pruritus.
  • Excessive dryness and scaling on the heels and feet.
  • Possible fissures (linear cracks in the skin) with hyperkeratotic tissue.

Progression and Patterns

The progression of xerosis follows a defined pattern that begins when the skin becomes dry and rough, with pronounced skin lines. As the condition progresses, you’ll see the development of superficial scaling, with fissuring and erythema. In severe cases, a crisscrossing pattern with superficial scaling is present. The skin becomes less elastic and loses both its flexibility and its ability to withstand trauma, which may result in skin breakdown and subsequent infection.

Causes

A number of conditions contribute to the onset of xerosis in diabetic patients, including the loss of natural moisturizing factors and moisture from the stratum cor­neum and intercellular matrix of the skin. Additionally:

  • Sebaceous and sweat glands normally maintain skin lubrication and control the oil and moisture in the foot, but they become atrophied when autonomic neuropathy occurs.
  • Corneocytes (cells that make up the top layer of epidermis) are aligned parallel to each other in normal skin; xerosis causes structural changes to these cells and disrupts the surface, resulting in a rough epidermal surface.
  • The dryness is due to the redistribution of blood flow in the soles of the feet by persistent and inappropriate dilatation of arteriovenous shunts. This activity diverts blood away from the skin surface. When this occurs in combination with alterations in the elasticity of the skin (due to nonenzymatic glycosylation of structural proteins and glycoproteins), the skin splits, creating portals for bacteria to enter.

Treatment

Once you see initial signs of xerosis in your patients, what should you do? Start by applying an agent to the feet every day in order to maintain skin moisture, such as an emollient lotion or cream. Use moisturizers that contain urea or lactic acid.

  1. Urea works by enhancing the water-binding capacity of the stratum corneum. Long-term treatment with urea has been demonstrated to decrease transepidermal water loss. Urea also is a potent skin humidifier and descaling agent, particularly in 10% concentration.
  2. Lactic acid (in the form of an alpha hydroxy acid) can accelerate softening of the skin, dissolving or peeling the outer layer of the skin to help maintain its capability to hold moisture. Lactic acid in concentrations of 2.5% to 12% is the most common alpha hydroxy acid used for moderate to severe xerosis.
  3. Examples of products with urea or lactic acid include Atrac-Tain Cream, Eucerin 10% Urea Lotion, Lac-Hydrin 12%, and AmLactin Foot Cream Therapy.

Additionally, it’s important to avoid:

  • Products that contain alcohol – because they evaporate, and their drying action compounds the original problem.
  • Petroleum-based products, because they seal the skin surface and prevent what little lubrication is made from evaporating. These products don’t penetrate the surface of the skin and don’t replace skin moisture.

Patient education

As always, part of our job is to continuously educate patients and their family members or caretakers. When it comes to your patients suffering from xerosis, make sure they know to:

  • minimize bathing to no more than once a day (or even every other day)
  • use cool or lukewarm water
  • pat – don’t rub – to dry the skin
  • avoid harsh soaps
  • avoid lotions with dyes or perfumes
  • ensure skin moisturizers are applied appropriately and at the right frequency

What do you think?

Knowing the signs of xerosis and how to treat it is crucial for diabetic patients. Have you had experience with this condition, and are there any specific techniques, treatments or products you find most effective? And what are the biggest challenges you face when it comes to this particular type of wound management? We would love to hear about and learn from your experiences! Please share your stories below.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Urgent! Risks and Diagnosis of Diabetic Foot Infections

January 8th, 2016

For effective diabetic wound management, clinicians must know the risk factors for foot infections, and be able to diagnose them properly – and as soon as possible.

Diabetic Foot Infections

Wound care clinicians deal with foot infections all the time, but when the patient is also diabetic, an infection can progress rapidly to a critical state. In fact, it is estimated that around 56% of diabetic foot ulcers become infected, and an infected foot wound precedes about two-thirds of amputations.  Being able to treat diabetic foot infections promptly – before they progress too far – helps prevent amputations, which is why your role is so crucial to a patient’s well-being.

What are the risk factors?

If you are treating a diabetic patient with a foot infection, there are a number of risk factors to consider. These include:

  • 30-day-old wounds
  • Wounds that go down to the bone
  • Recurrent foot infections
  • Peripheral vascular disease
  • An etiology from trauma

In particular, be on high alert with your diabetic patients for what they call an occult (hidden) infection. A diabetic foot ulcer could clearly have an infection, but fail to show any of the classic signs and symptoms that you traditionally look for, like erythema, heat, pain and purulence.

Because a diabetic patient’s immune system is compromised, you might be on the lookout for typical signs but not see any of them at all. This does not mean that an infection isn’t there; only half of diabetic foot ulcer patients will show classic signs, which means we also need to work our patients up for infection.

The best approach? Be persistent and keep looking for more signs, like:

Free Webinar - Diabetic Ulcers

  • Serous exudate (thin, clear, watery)
  • Delay in healing
  • Friable (fragile) granulation tissue
  • Discolored granulation
  • Odor
  • Pocketing in the wound bed

How do we diagnose infection?

Diagnosing infection in any wound, particularly with diabetic patients, is a clinical one (versus a lab diagnosis). So if you ever hear a colleague say, “We’re going to wait for the lab results to see if our patient has a wound infection,” it’s time to stand up and emphatically say, “No!” Why? Because lab results, specifically the swab cultures that are most commonly used, are often inconclusive in the presence of biofilm. Instead of waiting for the results, you need to act immediately.

That’s not to say that lab results aren’t useful. They can sometimes help us confirm infections and target which antibiotic we want to use. But again, most infections are polymicrobial (containing more than one kind of bacteria), and swab cultures don’t pick up everything. We need to use our clinical judgment and supplement with lab and cultures.

The Final Word

As wound care professionals, prevention is obviously our first line of defense against any wound complications from infections. But when caring for diabetic patients, clearly understanding the risk factors for foot infections, and then being able to diagnose conditions as soon as possible, are crucial for effective treatment.

What do you think?

Have you had experience in treating diabetic patients with foot infections? Have you been able to identify the infection in a timely manner? Is there a particular case that was exceptionally challenging or difficult? Please tell us about it, and leave your comments below.

News Flash: Document Education or Risk Facing Pressure Ulcer Citations

December 17th, 2015

Failing to provide and document wound care educational efforts can lead to citations! Most recently, a facility was cited for not providing written documentation to a patient and his family about his Stage II pressure ulcer.

Document Education or Risk Citation

Wound care clinicians love to talk about wounds – preventing, treating and healing them. We love to compare notes, study photographs and learn about new techniques and strategies. But another vital piece of our job involves educating others, whether it be patients, family members or colleagues. Keeping everyone in the loop is essential to achieve the best outcomes, and avoid citations.

What it might look like now

Pressure Ulcer Staging Guide

Click for our FREE Pressure Ulcer Staging Guide

When we say that education must be a part of our pressure ulcer treatment and prevention program, we’re talking about routinely:

  • Providing printed information on the etiology of risk factors
  • Discussing the importance of risk and skin assessments
  • Explaining the role of support surfaces and the importance of positioning
  • Ensuring that each patient has a skin-care program individualized to meet their needs

These components of care are often accomplished during a staff in-service, or at care team meetings that focus on individual patients. But how are our patients and family members being educated on this issue?

Most clinicians would say that it is done by the individual licensed caregiver (often a nurse), as part of their normal daily activities on the unit.  The problem with this approach is that it’s not always documented, and often not very structured.  And this can lead to trouble.

What it must look like now

So what exactly are the expectations when it comes to pressure ulcer education according to today’s standards? Let’s consider what the 2014 International Guidelines for the Prevention and Treatment of Pressure Ulcers has to say about it.

In the section on implementing the guidelines, it speaks directly to patient consumers and their caregivers, and advises us to work with our healthcare teams and learn about pressure ulcer risk factors (and how this relates to their individual situation).  In order to meet this important objective, health care professionals must provide language appropriate printed materials, e-learning packages, and internet resources for the patient.

And where can you get such materials? Patient and consumer recommendation documents are currently being developed by the Guideline authors (we will let you know when they are available), but until then, one resource is MedlinePlus, where you can find the following patient handouts:

  • How to Care for Pressure Sores
  • Pressure Ulcer
  • Preventing Pressure Ulcers

No education? Hello, citation!

So besides the fact that a comprehensive pressure ulcer education program is crucial for better outcomes, failing to do so can lead to citations. All patient education, topics, methods, and responses must be documented.

Lesson learned?

The standards of care are always changing, and as wound care professionals, it’s critical to keep up with these changes. Do you and your facility currently meet these expectations when it comes to pressure ulcer education? How do you make sure patients and family members are not only being educated properly, but that these efforts are being documented as complete in the medical record? Please leave your thoughts or comments below.

Pressure Ulcers: Beyond the Risk Scales

December 10th, 2015

When it comes to pressure ulcer prevention and treatment, traditional risk assessment tools don’t always tell the whole story. Find out what does.

Pressure Ulcer Risk Header

As wound care professionals, we know how pressure ulcers can negatively effect patients’ lives. This serious skin condition can not only lead to further complications and higher costs, but can also inhibit a patient’s ability to participate in rehabilitation and ultimately lead an active role in their community.

So the more we can do to properly assess pressure ulcers from the very beginning, the more we can do to help promote healing, reduce hospital stays and accelerate recovery time. Obviously, this involves the use of valuable tools, such as the Braden Scale. But we should also implement a good dose of clinical judgment once pressure ulcer risk is determined. Here’s how:

It’s more than just a Risk Score

The 2014 International Guidelines on the Prevention and Treatment of Pressure Ulcers stress the importance of looking at other factors, and not just the Risk Score when establishing risk levels and interventions for your patients. As mentioned earlier, in order to accurately determine your patient’s risk, the use of traditional tools alone (like the Braden Scale) is no longer considered to be enough.

Since the current condition of the skin is a key factor to consider when determining risk levels and interventions, the Guidelines recommend that both risk and skin assessments should be completed within eight hours of admission.  And anytime a risk assessment is completed, a skin assessment must be done and documented right along with it.  This applies throughout the patient’s stay within your care setting.

What else should you do?

When examining your patient’s chances for developing a pressure ulcer, taking note of their current skin condition is crucial. Are there reddened areas that barely blanch, and are they frequently recurring over the same boney prominence? Answering questions like these is important.

We must always look at the bigger picture of risk, and then factor in additional information such as psychosocial status, size, care setting, support surface, lab data and other sources. According to the National Pressure Ulcer Advisory Panel’s Prevention and Treatment of Pressure Ulcers: Quick Reference Guide, risk factor assessment recommendations include:

  • Use a structured approach to risk assessment that includes assessment of activity/mobility and skin status.
  • Consider the impact of the following factors on an individual’s risk of pressure ulcer development: perfusion and oxygenation; poor nutritional status; and increased skin moisture.
  • Consider the potential impact of the following factors on an individual’s risk of pressure ulcer development: increased body temperature; advanced age; sensory perception; hematological measures and; general health status

In addition, the Reference Guide includes the following recommendations when conducting skin and tissue assessments:

  • In individuals at risk of pressure ulcers, conduct a comprehensive skin assessment: as soon as possible but within eight hours of admission (or first visit in community settings); as part of every risk assessment; ongoing based on the clinical setting and the individual’s degree of risk; and prior to the individual’s discharge.
  • Inspect skin for erythema in individuals identified as being at risk of pressure ulceration.
  • Include the following factors in every skin assessment: skin temperature; edema; and change in tissue consistency in relation to surrounding tissue.
  • Inspect the skin under and around medical devices at least twice daily for the signs of pressure-related injury on the surrounding tissue.

Are you on board?

Using your clinical judgment, along with traditional assessment tools, is a must when it comes to skin and risk assessment for pressure ulcers. We’d love to hear how you have learned to implement both within your facility. Have you noticed a difference in patient recovery? Do you think that this broader approach to assessment is well-known and practiced among your peers? Please leave your stories or comments below.

 

Ouch! Let’s Talk About Skin Tears

December 2nd, 2015

This WCEI free webinar will help wound care professionals understand more about skin tears, including how to treat and prevent them (and help patients heal).

Skin Tears - Prevention and Management

If you’ve ever suffered a significant skin tear, then you know how painful they can be. The inevitable bleeding (and sometimes even disfigurement) during the healing process can take a toll, both physically and emotionally. So you can imagine how awful it would be to experience this same cycle of pain, over and over again.

Unfortunately, skin tears are a common occurrence with institutionalized patients (particularly in older adults), and often lead to further complications. In fact, a reported 1.5 million skin tears occur in this population each year, and that doesn’t even include unreported incidents occurring at home.

But we’re here to help, thanks to our own WCEI Clinical Instructor Gail Hebert, and her presentation at the 2015 Wild on Wounds National Conference in Las Vegas, “How To: Skin Tears – Prevention and Management.” In this free webinar (see access code below), you can listen to her recorded session and arm yourself with the latest information about skin tear treatment, prevention and management. You can also help to bring the number of annual skin tears down while protecting patients and helping support the facilities in which you work.

 

Gail Hebert, RN, BS, MS, CWCN, WCC, DWC, OMS, WCEI Clinical Instructor

Gail Hebert, RN, BS, MS, CWCN, WCC, DWC, OMS, WCEI Clinical Instructor

Ready to learn?

So what exactly is a skin tear? As Hebert explains in the webinar, it’s a traumatic wound caused by shear, friction and/or blunt force trauma that results in either a partial or full thickness injury. And while skin tears certainly occur, to think they are inevitable is short-sighted.

“Our role is to make sure we’ve done everything we can to minimize their occurrences,” says Hebert. “Not just by accepting that skin tears happen and move on, but to work hard at all the variables that can be controlled, so skin tears can be the exception rather than the rule.”

Through Hebert’s webinar, you will learn so much more about skin tears, including:

  • How to identify risks for skin tears and skin tear category classifications.
  • Current evidence-based recommendations for accurate skin tear assessment, prediction, treatment and prevention strategies.
  • Forms and tools you can put to use immediately.

“Skin tears are considered to be negative patient outcomes,” adds Hebert. “So in terms of your facility’s reputation, you don’t want to be known as a place where an excessive number of skin tears take place.” In other words, if people wonder if your facility is doing everything it can to prevent them, you want to be able to respond with a resounding, “Yes!”

 

What people have to say

Those who were able to attend Hebert’s session in person last summer at the WOW Conference had plenty of feedback to share. Here’s a sample:

 

 “Who knew there was enough on this subject matter to actually speak on it for one whole hour? It was great!”

“Excellent speaker, and was happy to hear that I was caring for skin tears in the right manner! Now I can go back to my facilities and students, and pass this information on! Thank you so much! Very engaging speaker!”

“This was a great review for me. I used last year’s skin tear outline to help build our skin tear policy, so I truly appreciate the updated outlines provided with this lecture.”

 

Go ahead, take the skin-tear plunge!

Are you ready to learn more about skin tears and put into practice your newfound knowledge?  Click here and use the code SKINTEARS to access this 60-minute recording, which qualifies for an education credit.

 

 

Tell us your stories

Have you made improvements in your own facility when it comes to skin-tear prevention? What were they, and what results have you noticed? Do you have any other suggestions for skin-tear treatment, prevention or assessment? Leave your comments below.

 

You know you’re a wound care clinician when…

November 27th, 2015

Wound care clinicians are a unique group of professionals with special superpowers:  X-ray vision into the depths of the wound, the ability to smell every type of bacteria, and the drive to heal every wound, no matter what it takes.  Does this sound like you?

1.  You can eat pizza while viewing wound photos.

Eating pizza while reviewing wound photos

 

 

 

2.  You check your pet’s water dish for a slimy biofilm.

Drinking dog

 

 

 

3.  You start naming off anatomy while preparing turkey.

Turkey anatomy lesson

 

 

 

4.  You study the street maggots in the trash and think about how great medical maggots are at debriding wounds

Street maggots

 

 

 

5.  You look at a dressing and wish you could add bling.

Boo Boo Bling

photo courtesy of www.boobooblingshop.com.

 

 

 

6.  Your family can’t handle your workday stories at the dinner table.

Grossing our the family at dinner table

 

If you found yourself nodding, you’re clearly a “Wild on Wounds” superhero.  Keep on healing and have a WOUNDerful day!

Floating Heels: More Than Just Pillow Talk

November 20th, 2015

The way you float the heels matters: new guidelines mean better patient care and lower risk of citations.

Floating Heels

When it comes to wound care, the term “float the heels” means that a patient’s heel should be positioned in such a way as to remove all contact between the heel and the bed. So given this context, is the following statement true or false?

Patients on support surfaces do not require their heels to be floated. 

If you guessed false, then give yourself a gold star. Yes, all patients at risk of breakdown, and those with pressure ulcers on the heel, must have their heels totally offloaded.  This requirement has not changed.

But here’s the catch – what has changed is the manner in which we should be accomplishing this.

Official Floating Heels Guidelines

Traditionally, the most common approach to floating the heels has been by placing pillows under the lower leg, positioned so as not to place pressure on the Achilles tendon and the heel.  Unfortunately, there has always been a problem with this method.

While you might position your patients perfectly in bed, with heels properly floated, the chances that they’ll remain perfectly still once you’re gone is slim to none. Patients naturally move and reposition themselves for comfort, which means upon returning, you will most likely find that the legs and heels are no longer in that same position.

This repositioning is a common occurrence, and leaves your patients vulnerable to the forces of friction, shear and pressure on the heel.  This traditional heel-floating technique often leads to unnecessary heel breakdown, and a failure to protect our patients properly. Additionally, facilities may be cited for floating Stage III heel ulcers on a pillow.

So what’s the official word on the subject? The 2014 International Guidelines on the Prevention and Treatment of Pressure Ulcers tell us that:

  • You can continue to float the heels with pillows under the full length of the calf for short-term use in alert and cooperative individuals.
  • For individuals with Stage I or II pressure ulcers on the heel, you can float the heels, or use a heel suspension device.
  • For individuals with Stage III, Stage IV or Unstageable pressure ulcers, heel suspension devices are strongly recommended.

What is a proper heel suspension device?

First of all, let’s talk about what a heel suspension device is not. A padded bootie (the kind we’ve used for years) simply doesn’t qualify.  Padding will never offload the tissues, it will only serve to somewhat cushion the skin.

What you do need is a lower leg boot specifically constructed to place the heel in a cup-like device that does not allow the heel any contact at all with any surface.   Patients can then reposition themselves in bed without fear of losing the pressure offload.  Some devices also have stabilization bars that can be used to prevent outward or inward rotation of the lower extremity.   When selecting a heel suspension device, it’s important to assess how much heat and humidity will be trapped on the skin underneath the boot.  This is a potential issue, since heat and humidity on the skin can predispose it to breakdown.

Is this a legal matter?

Wound care clinicians often ask if these revised techniques are lawfully required. The short answer is no, they are not. But – and it’s a big but -it is not uncommon for lawyers to refer to these guidelines in court, and question whether practices were in accordance with these standards.

So if you or your practice were subjected to such inquiries in a court setting, would you want your reply to be no? Of course not.  Citing ignorance when it comes to the change in heel-floating standards will not excuse wound care clinicians from the consequences.

Have you changed your practice to reflect these new guidelines? 

As responsible wound-care professionals, we know the use of heel suspension devices is the best way to offload.  And because current guidelines support this, if your practice hasn’t already done so, it’s time to implement them now.

Are heel suspension devices already used in your work setting? If so, have you seen a noticeable difference in patient care, compared to the traditional use of pillows and positioning? If not, do you have plans to foster change within your practice? We’re curious to hear your stories. Please leave your comments below.

Five Wound Care Myths That Need to Go Away

November 11th, 2015

Myths Header

 

The field of wound care has come a long way. And with over 25,000 WCEI alumni across the country sharing their skills and knowledge, we’re thrilled to see many outdated notions and practices go by the wayside. Unfortunately, there are still some wound care myths out there that just refuse to die. Here are five of the most frequent incorrect statements we still hear about out in the field.

Myth #1: Wet-to-dry dressings are cheaper to use.

Not only is wet-to-dry substandard care (as we discussed in Wet-to-Dry Dressings: Here We Go  Again), it’s not even cost-effective.

Here’s the math: The daily cost of care for a foam dressing is only $3.55. The daily cost of wet-to-dry is $12.26. Why the big difference? Wet-to-dry dressings require frequent changes, and each dressing change causes a drop in wound temperature.  In order for a wound to heal, it should be close to normal body temperature. So if there is a 2⁰ C drop in temperature, this will slow or stop healing, and it can take up to four hours for that wound to warm up and get back to get back to normal healing temperature.  As we always say, “When the temperature drops, the healing stops.”

Out of all the different dressings out there, foam keeps the wound bed the warmest. And foam dressings can remain in place from 3 to 7 days, decreasing costs, labor and drops in temperature.  As always, with any dressing application, follow the manufacturer’s instructions on proper usage.

Myth #2: Bleeding in a chronic wound is a sign of healing.

“Oh, it’s bleeding! That’s good!”

No, that’s not normal or acceptable.  Sanguineous (bloody) exudate serves as a clue to bedside clinicians that you need to go in and investigate what is causing the bleeding. Start by asking:

  • Is there some sort of malignancy or trauma on the site?
  • Is there a high bioburden?
  • Is the dressing sticking to the wound and causing bleeding upon removal?

By putting on our detective hats and looking at the clues the wound is giving us, we can identify issues sooner rather than later.

Myth #3: Erythema is a sure sign of wound infection.

Erythema

Erythema in the periwound is one of the classic signs of local infection, but it’s not enough to label it as infected.  You need to see at least three signs and symptoms.  Here are some additional signs and symptoms to consider:

  • Foul odor
  • Increasing pain in the wound
  • Heat in the periwound
  • Purulent drainage
  • Edema

If you see at least three of these signs, it means you have local infection and need to immediately treat the wound topically, before it moves into a systemic infection.

Myth #4: Oral or IV antibiotics are indicated for all infected wounds.

Administer oral or IV antibiotics only if infection extends beyond the wound margin, indicating a systemic infection. In other words, you need to see signs and symptoms such as fever, an elevated white blood cell count, or red streaks emanating from the wound.

Oral antibiotics are simply not the most effective treatment for local infections. Many chronic wounds have impaired blood flow, which can compromise the delivery of oral antibiotics to that wound.  Meanwhile, the unnecessary use of antibiotics leads to the development of antibiotic-resistant strains of bacteria.

So make sure you have first identified if this is a local or systematic infection.  If systematic, then you should treat with oral/IV antibiotics.

Myth #5: Clinicians are not responsible if a physician orders inappropriate treatment. 

Physician“I did it because the doctor ordered it.”

We hear this excuse all the time! Would you administer improper heart medication to a patient if you knew it was wrong?  You have to think of wound care the same way. It’s our responsibility to uphold the standards of care. If physicians are unaware of the guidelines and policies, we need to educate them.

Saying that the doctor wrote it and you merely followed orders is not going to protect you legally, and it’s certainly not in the best interest of your patient.  Always practice the current standard of care – no excuses!

What myths do you battle?

While these are some of the most common myths in wound care, we know there are more. What are some of the common misconceptions within your practice, and how to you deal with them? Have you been in a situation where you had to help educate physicians or colleagues? Please tell us about your stories below.

Is That a Rash? Maybe, Maybe Not

November 3rd, 2015

Rash“Take a look at this rash. What is it, and how should we treat it?”

Wound care specialists are often asked to evaluate rashes, and while we want to be competent and effective, sometimes we just don’t know the answer. Because, well … rashes are tricky. So what should you do, and how should you handle such situations?

 

WCEI Co-Founder Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

WCEI Co-Founder Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Check out this free webinar

We’ve got some great answers for you straight from WCEI Co-Founder Donna Sardina, RN, who led a powerful presentation this past summer at WOW 2015 in Las Vegas. This popular session was recorded, and is now available for viewing.

The one-hour webinar, It’s Not Just a Rash! So What Is It? What Do I Do? covered common dermatological conditions in patients, its etiology, and treatment choices. And now, for a limited time only, you have the chance to learn more about rashes from the best, including:

  • How to identify some of the most common dermatological conditions that can be present on your patients.
  • Possible treatment options.
  • When to consult a dermatologist.
  • Pertinent education options for your patient.
  • Additional information about basic rashes.

Learn more about skin

“The skin is the boundary between us and the outside world,” said Sardina. “It reflects internal changes and reacts to external ones. Usually, it adapts easily and returns to a normal state, but sometimes it fails to do so and a skin disorder appears.”

Because of the large number of conditions that can manifest as a generalized rash, Sardina said it’s important to look beyond the appearance of the rash itself and search for clues to determine the cause. This can include taking a closer look at the following:

  • The patient’s history
  • A physical examination
  • Laboratory tests
  • Skin biopsy

Check out the reviews

This workshop, which qualifies for educational credit, was a huge hit with WOW attendees. Here is some feedback from a few of the attendees:

  • This was so helpful to me! I get consults for any skin issue that comes up, including rashes/lesions. The pictures and descriptions were great!
  • I get called upon to look at “rashes” all the time, and have felt a little overwhelmed with it all. But now I feel that I can more effectively identify “rashes” and help with the patient’s plan of care, but still make sure to refer out appropriately and not practice outside my scope of practice.
  • LOVED IT! Thank you so much for presenting this topic. It’s often a struggle to evaluate some of these skin conditions.

Ready to learn about rashes? Check out the one-hour WOW session and see what it’s all about (education credit available). Use coupon code: RASH15. Offer is good through Jan. 4, 2016.

Tell us what you think

What have your experiences been when it comes to your patients and their rashes? Once you enjoy the webinar, please come back and let us know what you think? What were the biggest things you learned, and how will this information help you moving forward in your place of practice? Leave your comments below.

View webinar - It's Not Just a Rash

Will the Real Pressure Ulcer Please Stand Up?

October 28th, 2015

How to know the difference between Incontinence Associated Dermatitis (IAD) and pressure ulcers.

Incontinence Associated Dermatitis (IAD) vs Pressure Ulcer

As wound care clinicians, we treat our patients to the best of our ability and heal wounds – that’s what we do. But unfortunately, even under the best of circumstances, facility-acquired pressure ulcers happen. And we have to document them … because again, that’s what we do.

So then it would stand to reason that no one would ever purposely document this type of pressure ulcer without cause, right? So here is the big question of the day: why is it that Incontinence Associated Dermatitis (IAD), rather than a pressure ulcer, is often documented as a Stage II? We’ve got your answer.

The truth about pressure ulcers and staging

We know that any staged skin lesion, by definition, is an area of skin disturbance caused by pressure, and according to the National Pressure Ulcer Advisory Panel, only pressure ulcers should be staged. We also know that once any skin lesion is staged, you might find yourself sitting on the “hot seat” – having to defend how this new wound developed. And since part of our job is to prevent pressure ulcers, staging areas like this puts us on the defensive when we don’t have to be.  The truth: unnecessary staging could lead to charges of inadequate assessment, since that is exactly what it is.

Let’s take a closer look

So how do we keep from putting ourselves in such an uncomfortable situation? First, let’s review the difference between these two types of lesions.

Incontinence Associated Dermatitis (IAD)

  • IAD is a form of Moisture Associated Skin Damage, and is defined as inflammation of the skin from prolonged exposure to urine and stool.
  • This is usually seen in conjunction with friction and/or chemical and/or bacterial factors – they work together to cause IAD.
  • The skin injury that results is always partial thickness in nature.
  • You may see some loss of epidermis and superficial dermis leading to a partial thickness wound, but these are not pressure ulcers.
  • These are moisture related injuries, and should never be staged.

Pressure ulcers

  • Pressure ulcers are caused by unrelieved pressure or shearing forces (which is not what happens in the case of IAD).

Where it gets complicated

Even though we are talking about two different lesions, there are times when IAD converts to a pressure ulcer. Here’s what you need to know:

  • A previously identified IAD must be considered a pressure ulcer when you see new evidence of full thickness and damage below the dermis (slough, eschar, and granulation tissue are good examples).
  • This indicates that the deeper acting forces of pressure and shearing are present (read more about friction vs. shearing here).
  • You cannot damage the subcutaneous layer and below by moisture alone.
  • Remember – moisture damage to the skin can only be partial thickness.
  • Evidence of full thickness injury means it is no longer considered IAD and there was ischemic damage that took place, which means it is now considered a pressure ulcer. So it’s time to stage it and get to work healing it.

The importance of assessment

Under such circumstances, this would be considered a facility acquired pressure ulcer.  Hopefully, your patient was previously identified as being at risk for pressure ulcer development, and prevention interventions are already in place.

Once staging happens, it’s time to go back and do another full assessment of your patient and the wound, and put in place both the proper treatment plan and more advanced prevention interventions. Moving forward, all incontinent patients should be considered at risk for skin breakdown, and a care plan to prevent IAD and pressure injury should be implemented from the get-go.

What do you think?

We’d appreciate hearing about your own experiences with staging IADs, versus true pressure ulcers. Do all clinicians in your setting who document wound assessments know how to tell the difference between these two types of lesions?  Do you feel you have adequate interventions in place for IAD patients?  And what are your biggest challenges in treating these patients and assuring proper identification of these wounds? Please leave your comments below.

 

Lower Extremity Ulcers: Go With the Flow

October 21st, 2015

Lower Extremity Ulcer - Is this Pressure?

Imagine, if you will, the following scene: a wound care clinician is asked to weigh in on a lower extremity ulcer consultation, and upon arrival is told that it’s a pressure ulcer. So she seeks more information about blood flow:

Clinician #1: Tell me about the blood flow to the lower extremity.

Clinician #2: It seems okay because pulses are palpable on the foot.

Clinician #1: Are there recent Ankle Brachial Index (ABI) assessments in order to obtain a much more reliable assessment of blood flow?

Clinician #2: Um … no.

Here’s the truth

Unfortunately, this kind of conversation happens all the time, so let’s set the record straight: palpation of pulses is not a reliable assessment of blood flow to the foot. They can be misleading and leave you hanging – without the information you need to properly and safely manage the wound.  An ABI will reveal what you need to know about the blood flow to the lower extremity, and give you vital clues to the underlying disease process causing the ulcer. Only when this information has been gathered can you properly develop a plan of care that will help, and not hurt, the patient.

The 2014 International Pressure Ulcer Guidelines mentions performing a vascular assessment on every lower extremity ulcer.  That means, at a minimum, we need to check pulses and toe measurements, and perform an ABI. This will assist in identifying the true cause of the wound, whether it be pressure, venous, arterial, or mixed venous/arterial.

What’s this about an ABI?

An ABI is considered the gold standard of tests that can be easily performed at bedside – all you need is a blood pressure cuff and a hand-held Doppler. It is also the most useful test to assess lower extremity arterial perfusion, and compares the systolic blood pressure of the ankle to that of the arm (brachial). When should you perform ABI?

  • When pulses aren’t clearly palpable or are weak
  • On all patients with lower extremity ulcers
  • When the ulcer is not healing
  • Always before starting compression therapy

Compression therapy is the standard of care for the treatment of venous stasis ulcers.  ABI results will help identify significant arterial disease and determine the amount of compression (if any) that can be applied safely. You never want to compress a lower extremity that has significant arterial flow compromise, for fear of cutting off all blood flow and causing harm to your patient.

Blood flow assessment is a must

Earlier, we used the example of a patient who has a possible “pressure ulcer.” When we are not sure of the type of wound we are treating, we need to ask some serious questions:

  • Could there be arterial blood flow compromise that will make healing problematic or even unrealistic?
  • Is there venous disease complicating the clinical picture that could benefit from appropriate levels of compression?
  • Or is this strictly a pressure ulcer where the treatment plan will require off-loading interventions first and foremost?

The bottom line

When assessing a lower extremity ulcer, it is vital to determine the assessment of blood flow.  Without the information obtained from an ABI, your care plan can be inappropriate, your goal setting can be unrealistic, and your patient could be harmed.

What do you think?

We want to know about your experiences with this topic. When do you typically obtain an ABI in practice? In long-term care settings, how often do you obtain ABI measurements? If you’re not obtaining ABIs, what are you using? Please share your experiences below.

 

Wet-to-Dry Dressings: Here We Go Again

October 15th, 2015

 

Wet-to-Dry dressingsIn the modern world of wound care, we’ve seen drastic improvements in treatment options over the years. So it’s always a surprise when we hear that there are still orders being submitted these days for outdated practices. In this case, we’re talking about those dreaded wet-to-dry dressings.

Why is this still happening – even though the disadvantages to this approach are well-documented? Could it simply be due to a lack of education? Or maybe it’s due to the unavailability of other wound care products that have been shown to yield much better (and safer) outcomes. Whatever the reason, we’re here to double-down on this: no more wet-to-dry dressings.

What is Wet-to-Dry?

Wet-to-dry is a form of mechanical debridement, and is substandard for wound care.  Here’s how it works:

  • A moist saline gauze is placed onto the wound bed.
  • The dressing is allowed to dry and adhere to the tissue in the wound bed.
  • Once the gauze is dry, the clinician forcefully removes the gauze.
  • Any dead tissue that has adhered to the dry gauze will then be removed from wound bed.
  • These steps are to be repeated every 4 to 6 hours.

 A Reality Check

Although this is technically the way wet-to-dry dressings are applied, most often clinicians will modify it by moistening the gauze prior to removal. This is so that it won’t stick to the wound bed and cause bleeding and trauma, or remove healthy tissue along with it.  The problem is that, while well-intentioned, the moistening of the gauze before removal, which spares the patient pain, defeats the original purpose (mechanical debridement). In addition, the prescribing clinician’s orders are not being followed.

To further complicate matters, some professionals with prescriptive authority write for this dressing but do not understand it is for debridement.  For example, a Physician’s Assistant once explained that he thought this type of dressing meant that the wound bed would be kept moist and covered with a dry secondary dressing.  So in many cases, we have wet-to-dry orders being written by someone who doesn’t understand what they’re ordering, and we have clinicians implementing these orders incorrectly.

The 2014 International Pressure Ulcer Guidelines clearly state that wet-to-dry dressings can be painful and may remove healthy tissue.  It also states that they are being used less frequently. In fact, research shows that this procedure is associated with slower healing rates and are costly in professional time due to the need for frequent wound dressing changes.

We Have Solutions

So, what is the answer to this ongoing problem for wound care practitioners?  It’s all about education, and everyone can help by:

  1. Sharing information. Proper educational resources and information regarding this issue need to be shared with not only nursing staff, but also with those who write the orders.
  2. Making a plan. Talk to your medical director and plan a short educational program to present alternatives for those with prescriptive authority.
  3. Asking for change. Ask for a facility policy change from your medical director that states wet-to-dry dressing orders are no longer acceptable.
  4. Talking about it. Keep the discussion going and enlist help from all levels of the organization.
  5. Learning from others. There are plenty of success stories out there from facilities that have planned for and implemented change involving key stake holders. Know that changes can be made, and don’t get discouraged if it doesn’t happen quickly. Remember, your patients are counting on you.

What do you think?

Do you work in a facility that has eliminated wet-to-dry dressings?  How did this change in policy take place, and do you have tips for others who are dealing with this problem? We would love to hear about your experiences having to do with this topic. Please leave your comments below.

 

The Battle of Wound Healing: Dry vs. Moist

October 8th, 2015

The truth about moist wound healing, related cost savings, and the risks of keeping wounds dry.

Do Wounds BreatheWhen you were a kid, you probably had your share of cuts, scrapes and other childhood wounds that required a good old-fashioned bandage. And somewhere along the way you were most likely told to “… take the bandage off to let it breathe.” This advice, which essentially is what we now call dry wound healing, surely came from a parent, well-intentioned friend, or perhaps even a health professional.

Today, we know better. Thanks to lots of research and a better understanding of wound treatments, we know that in most cases, moist wound healing is the better way to go.

History of Moist Wound Healing

In the early ‘60s, while parents, caregivers and clinicians were commonly telling patients to just “let it breathe,” British-born pioneer Dr. George Winter decided to conduct a little research on the subject. His findings demonstrated that moist wounds healed faster, which flew in the face of conventional wisdom at the time – that dry and scabbed wounds promoted healing.

Winter’s research ultimately changed minds, and led to what is now considered a principle practice: moist wound healing. In fact, his work revealed that wounds heal twice as fast when placed in a moist environment.

Moist Wound Healing Today

While it’s been a long time since Winter’s research served to shift wound care practices away from the dry and scabby kind, there are still a number of uneducated clinicians who continue this outdated approach, ignoring the increased risk of bacterial infection. Some even believe that dry wound care is better because it’s cheaper – saving money on bandages and other supplies.

Not only is this approach short-sighted, it’s incredibly negligent. Responsible clinicians know that when it comes to wounds:

  • Optimum healing occurs when the wound temperature is near normal body temperature.
  • Even a 2°C drop in temperature can delay wound healing for up to four hours.
  • Oxygen is needed for every phase of wound healing.
  • Cooling the wound by leaving it uncovered will cause vasoconstriction and decrease the oxygen available for white blood cells to fight off infection.
  • Uncovered wounds lead to higher risks of infection and prolonged healing rates.

What About the Cost?

Sometimes old-school clinicians argue that dry wound healing is cheaper, and worth the risks involved. This theory doesn’t hold water considering that one single infection will negate any cost savings there might have been, plus this puts patients at risk for sepsis or a number of other preventable complications.

The dressings required to keep a wound covered, warm and moist are actually not expensive, and are considered the standard of care today.  To ignore or reject this approach is foolish, and places practitioners at legal risk should it result in a bad outcome.

But What About Acute Wounds?

There are exceptions to moist wound healing, and this includes the treatment of acute wounds.  According to the Centers for Disease Control and Preventions (CDC), once an incision line is closed and there is no drainage or chance of infection, an acute wound may be left open to air.  When the incision line is re-approximated, epithelialization can be complete within just 72 hours.

The timeframe when acute wounds need to be kept covered is much less than in healing full-thickness chronic wounds, which tend to be open longer and require the production of granulation tissue in order to fill in the deficit, and then epithelial tissue to replace the missing skin on top.

Advocate for Proper Wound Healing

So now that you know the truth about moist wound healing versus the outdated dry wound method, what can you do? Next time you witness a clinician leaving a chronic wound open to air:

  • Take the time to educate them on the principles of modern wound healing.
  • Provide them with copies of any written Standard of Care for wound healing that contains this preferred approach.
  • Encourage them to continue their wound care education – our patients rely on us to know how to help them heal as quickly and safely as possible.
Next time you see a clinician leaving a chronic wound open to air, educate them on modern wound healing.Click To Tweet

Tell Us Your Stories

Have you encountered fellow clinicians who defend dry wound healing when moist healing should be used? Have you had to discuss this issue with colleagues or attempt to educate resistant wound care providers? How did you handle the situation? Please tell us about your experiences by leaving your comments below.

 

WOW in Las Vegas: 2015 Highlights

October 1st, 2015

What happened at the Wild On Wounds Conference? We’ve got your event highlights right here.

WOW_recapIf you traveled to Las Vegas for the Wild On Wounds (WOW) conference Sept. 2-5, then you know the truth: Skin is In. That was the theme for this record-attendance event. Wound care clinical professionals came together in one place for an exciting, information-packed four days that left us all invigorated and ready to treat more wounds.

Nurses, therapists, physicians, students and industry professionals traveled from all over the country to attend this premier wound care convention. We laughed, we learned … we united over our mutual love of skin!

A popular session was Everything You Always Wanted to Know About Nutrition But Didn’t Ask, led by Dr. Nancy Collins. We learned about the important role of nutrition in wound care – and chronic non-healing wounds that can be a result of malnourishment. We were so pleased to hear such positive feedback about this session. Here are some comments from attendees:

“Two things that stood out: Arginine & Glutamine. Not even our dietician has mentioned these in their orders. Good to know that they are essential in healing a chronic wound.”

“Now I understand why increased caloric intake for overweight patients is important in the wound healing process, and I can now share this information to my co-workers, specifically to our CNAs and nurses alike.”

“Dr. Collins was on-point and presented the information in a very creative way. She also illustrated the importance, economical impact, and quality-of-life that medical nutrition has on the patient. Case study presentations were excellent! Very interactive session. It was a wakeup call for all facilities.”

And while it’s impossible to mention all the other educational sessions, demonstrations and presentations that took place, here are more of this year’s highlights:

  • Record attendance – 1100 nurses, therapists, physicians, students and industry professionals
  • Attendees who influence wound care decisions throughout the care continuum
  • 200+ exhibiting partners
  • Interactive, hands-on sessions for Sharp Debridement, Maggot Debridement
  • Fascinating clinical posters and more!

We should also mention the exciting and successful hands-on Topical Wound Management session led by Nancy Morgan RN, BSN, MBA, WOC, WCC, DWC, OMS, C0-Founder of WCEI.  This session focused on topical wound dressing categories and reviewed specific treatment recommendations, giving attendees the opportunity for one-on-one product demos.  This session will be part of the 2016 WCEI one-day seminar tour. Stay tuned for dates and locations.

“This was a great session divided in two parts: lecture and hands-on. Pacing was great, not rushed, and speaker made sure the audience grasped the important points of the topic, giving real-life examples from her bedside clinical experience which solidified information she wanted to impart.”

 “I have enjoyed every session at WOW, but the round-robin table set-up was superb!! Loved it.”

 

What Did You Think?

How was Wild On Wounds for you? We’d love to know what you liked the most about your experience at WOW. What were your favorite moments of the conference? And what types of sessions would you like to see on the agenda for next year? Please leave your ideas and reflections below.

 

Top Wound Measurement Techniques

September 24th, 2015

Measuring WoundsEvery clinician knows that a vital part of wound care is weekly wound assessment. This, of course, tracks healing progress and provides important information that can help with treatment plans and health goals.

But there is more than one measuring technique used to assess wounds, which is why it’s important to not only understand them, but to also make sure that the technique of choice is used consistently and performed accurately. Here is a rundown on some of the most standard measurement types.

Linear Measurement

Linear measurement is the most common, but you might know it simply as the clock method. The name is due to the fact that you measure the greatest length, greatest width, and greatest depth of the wound while referencing the face of an imaginary clock.

In other words, when using the clock method, you would document the longest length of the wound by imagining the face of the clock over the wound bed, and then measure the greatest width. On the feet, the heels are always at 12 o’clock and the toes are always at 6 o’clock. Document all measurements in centimeters, as L x W x D. It’s also important to remember that sometimes the length will be smaller than the width.

When measuring length, keep in mind that:

  • The head is always at 12 o’clock.
  • The feet are always at 6 o’clock.
  • Your ruler should be placed over the wound on the longest length using the clock face.

When measuring width:

  • Measure perpendicular to the length, using the widest width.
  • Place your ruler over the widest aspect of the wound and measure from 3 o’clock to 9 o’clock.

When measuring depth:

  • Place a cotton-tip applicator into the deepest part of the wound bed.
  • Grasp the applicator where it meets the wound margin and place it against the ruler.
  • All wounds must have a depth recorded.
  • For wounds without depth (Stage I and DTIs), record depth as “0 cm.”
  • For wounds that are open but appear to have no depth, record depth as “<0 cm.”

Undermining and Tunneling

As part of the wound assessment routine, you will also need to measure undermining and tunneling. The clock image comes in handy once again as you determine depth and direction of the wound.

To measure undermining:

  • Check for undermining at each location, or “hour,” of the clock.
  • Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator where it meets the wound edge. Then measure against the ruler, and document the results.
  • Using ranges for undermining (for instance, undermining of 1.5 cm noted from 12 – 3 o’clock) tends to be less time-consuming than documenting undermining at each individual hour, and is an acceptable procedure.

To measure tunneling:

  • Insert a cotton-tip applicator into the tunnel. Grasp the applicator at the wound edge (not the wound bed) and measure its depth in centimeters.
  • Document tunneling using the clock as a reference for the location as well.

How Do You Measure Wounds?

There are a variety of methods to measure wounds, and we are interested to know what you use in your clinical setting. Is it the clock method, indicating the greatest length x width? What works best for you, and which method provides you with the greatest consistency in wound measurement? Do all staff participate in wound measurement? Please tell us about your experiences and leave your comments below.

 

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Wound Care: Turning Frequency for At-Risk Patients

September 18th, 2015

What’s the right frequency for turning and repositioning your at-risk patients? Turns out, there’s more than one answer.

Patient Turning FrequencyIf you ask most clinicians what the correct frequency for turning at-risk patients is, the answer is probably going to be an automatic, “Every two hours!” Clinicians seem to have been born with that guideline ingrained in our heads.

But we know that when it comes to proper turning frequency, there is actually quite a bit more involved when finding the best solution.  Some of our patients’ tissue would break down if left in the same position for that length of time. So if two hours isn’t appropriate for some, how do we go about determining the correct turning frequency for at-risk patients?

Official Guidelines Say …

According to the 2014 International Guidelines on the Prevention and Treatment of Pressure Ulcers, turning frequency should be determined by considering your patients tissue tolerance, level of activity and mobility, general medical condition, overall treatment objectives, skin condition and comfort. The frequency of turns should be individualized to your patient, so the standard belief that q 2 hour turns is going to work for all your patents is false.

How do you determine tissue tolerance?

Assessing tissue tolerance allows clinicians to determine how long the skin can tolerate pressure without showing negative impacts in the form of reddened skin. It is done by implementing a step-by-step procedure where the clinician incrementally increases the amount of time the patient is left in the same position until reddened skin is detected, and recording these findings. Once the length of time it takes to see the skin redden is determined, you set the turning frequency to 30 minutes less than that time interval.

For example, if a patient shows reddened skin after 90 minutes, then turning frequency would be each hour. Tissue tolerance results will vary for each patient. The other factors mentioned above (mobility, medical condition, etc.) should also be considered, as they can impact your decisions with turning frequency.

There’s no definitive answer.

What this means for clinicians is that we need to change our thinking about how often our patients should be turned.  The answer to the question “How often do you turn and reposition your patient?” should now be, “At a minimum of 2 q hours and more often if needed.”

What do you think?

Do you currently test for tissue tolerance on your patients?  If so, do you record the results of these trials in the medical record? In Long Term Care, have you had surveyors ask about the method you use to determine turning frequency for your patients? We’d love to hear about your experiences with this topic – please leave your comments below.

 

The Truth About TED Stockings (it might not be what you think)

September 11th, 2015

Photo - TEDs for bedsAnyone with access to the Internet has most likely heard of TED Talks – those powerful but short talks covering the subjects of technology, entertainment and design. But those of us in wound care are way more familiar with another kind of TED, as in … TED stockings.

You and your ambulatory patients know all about these “sporty white stockings,” as they’re sometimes described.  And while they might not get as much attention online as the other TED variety, they are certainly quite popular among physicians, who prescribe them on a regular basis. But do you know what their true purpose and benefits are?

The Truth

We’re sure you’re familiar with that designated area on a patient’s treatment sheet to sign when you put TED stockings on them in the morning, right? And then there’s another spot to sign when the stockings are taken off at bedtime. But guess what? While the stockings are prescribed for a variety of reasons, most clinicians are shocked to hear that they are not actually designed to treat the edema of venous disease.  They simply do not provide enough compression to effectively treat that condition.  So, why are they prescribed?

The Purpose

According to the manufacturer’s instructions, TED stockings are anti-embolism devices designed to prevent DVT’s in patients who are non-ambulatory.  The directions actually tell us to put them on while the patient is in bed. As in … when they go to sleep. At night. Wait, what? So putting them on in the morning and removing them at night (which is what most orders require) is exactly the opposite of what we should be doing.

Putting on TED stockings in the morning and removing them at night is the opposite of what we should be doing.Click To Tweet

The Dilemma

This begs the question: is it important to use products for the indications listed on the product insert?  From both a patient safety and legal standpoint, the answer is, yes!  You are legally responsible for assuring that products are used according to manufacturer’s instructions.

Now some might argue that no harm will come to the patient if the stockings are used incorrectly as described above.  But this brings us back to the reason why they were ordered in the first place.  If they were ordered to prevent DVTs and they are incorrectly removed at night, then major harm could result in the form of an embolism.  If they are ordered to treat the edema of venous disease, then they will prove ineffective, and the patient’s condition will remain untreated.

The Solution

No matter what way you look at this, we need to be aware of the true purpose of TED stockings, as well as the proper way to use them in order to help our patients in the best way we can.  This is why the phrase, “TEDs are for Beds,” has become widely used as a way to remind us of their proper use. They should be worn at bedtime. And that’s the simple truth.

Can You Relate?

We really want to know about your personal experiences with TED stockings. Do you see them ordered and used correctly or incorrectly in your care setting?  If they have not been prescribed according to manufacturer directions, what steps have you taken to correct this situation?  Were your efforts met with resistance? Please describe your experience and leave your comments below.

 

 

 

Palliative Wound Care: Best Practices

August 27th, 2015

Palliative CareFor wound care specialists who work in palliative care, providing proper treatment to patients with advanced, life-limiting illnesses can be a delicate balance. It’s common for such patients to suffer from wounds, and along with that comes pain, odor, infection, discomfort and pain.

As the World Health Organization suggests, palliative care affirms life and views death and dying as part of a normal process:

Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

The bottom line is that our focus must shift from what may be best for the wound to what’s best for our patient. This requires a holistic approach – giving the patient control while facilitating the highest level of independence, dignity, and comfort. Secondary goals may include healing the wound, preventing decline of the wound, providing adequate pain control, preventing infection, managing odor, and controlling exudate.

Dressings & Odor

In palliative care, we often strive to move patients as little as possible due to the discomfort involved. Selecting appropriate dressings to manage the wound or prevent further decline while minimizing repositioning is vital. Managing odor and exudate helps our patients maintain dignity. Here are some main points to consider:

  • Exudate is managed by use of absorptive wound care dressing products including specialty absorptive dressings, alginates and foams.
  • If the odor comes from high bacterial level causing necrotic tissue on the wound bed, debridement may be needed. The preferred method is autolytic debridement due to its gentle nature.
  • Other aids to managing odors include systemic and topical antibiotics, silver dressings, charcoal dressings, topical honey dressings, cadexomer iodine–impregnated dressings, and properly diluted antiseptic solutions along with wound suction devices.

These strategies help enable the patient to socialize with others which is so important to patients and families in palliative care.

Infection Prevention

Preventing wound complications by preventing infection is paramount.  We use basic infection-prevention measures, like good nutrition, wound cleaning, exudate management, and timely dressing changes – if these can be done in accordance with the patient’s wishes.

If healing the wound is a patient goal, traditional treatment approaches (including culturing) are appropriate. Be sure to weigh the benefits of treating the infection against the burden a specific treatment could place on the patient. If wound healing isn’t a goal for your patient, formal diagnosis and treatment of a wound infection isn’t necessarily warranted, especially if it won’t yield benefits.

However, in many cases, bacteria in the wound will cause pain, odor, and high levels of exudate, which are problematic and can reduce quality of life. In this case, you may need to take steps to reduce the bacterial load in the wound. Try such traditional methods as debridement, antiseptics, antibiotics, and various antimicrobial dressings and therapies.

Managing Pain

Managing pain is critically important in this patient population. Dressing removal can be the most painful part of wound management, and even the anticipation of a dressing change can cause undue anxiety. The palliative care approach calls for use of long-wear-time dressings to reduce dressing-change frequency. In addition:

  • Using contact layers in the wound bed may help if the dressing is adhering to the wound bed and causing pain on dressing removal.
  • Minimizing unneeded stimuli to the wound is important; topical lidocaine preparations help by numbing the area locally during dressing changes.
  • Pain and anti-anxiety medications may be required.
  • Be sure to wait an appropriate amount of time for pain medication to take effect. With parenteral pain medication, wait at least 15 or 30 minutes. With oral medication, wait at least one hour.

What do you think?

Palliative care requires clinical know-how, along with sensitivity and awareness for all those affected by end-of-life conditions. We’d love to hear about your experiences. Does your care setting have specific wound care policies for palliative care patients? Does the staff understand that choosing a palliative care approach is not giving up on the patient?  What are your biggest challenges when caring for palliative wound care patients? Please leave your comments or stories below.

 

Box_Palliative_Webinar_Rev6

 

Friction vs. Shearing in Wound Care: What’s the Difference?

August 20th, 2015
Example of a stage III pressure ulcer, which can result from friction and shearing.

Example of a stage III pressure ulcer, which can result from friction and shearing.

It’s a common question among wound care providers: what exactly is the difference between friction and shearing? These two conditions are common with limited mobility patients, and often contribute to the development of pressure ulcers. Knowing the answer to this question will help you provide better treatment for your patients – not to mention how you’ll be able to amaze your friends at dinner parties. So in the interest of your patients and social life, we’ve got some answers.

What is friction?

Friction is when two forces rub together, leading to a superficial, partial thickness skin injury that will look clinically like an abrasion.  For instance, a patient in bed might be agitated or restless, and as a result, continuously rub his feet across the sheets. No pressure is involved, it’s just him and his feet regularly sliding against the surface. This constant friction will cause epidermal damage (and upper dermal skin layers), or “sheet burn,” and will be superficial in depth and irregular in shape. But this type of damage is not caused from pressure and therefore won’t be staged.

Friction can be avoided in this example by having the patient assist as much as possible when moving in bed, or using two caregivers and a lift sheet to avoid dragging across the bed.

What is shearing?

Shearing, on the other hand, is what you get when you have friction and then add to it the force of gravity.  Let’s think of that same patient in bed, with his head in a raised position. As the weight of gravity pulls down on the skeleton towards the foot of the bed, his skin might be stuck against the mattress due to friction. As his bones slide down, vessels in between the skin and the bone can become compressed, stretched and/or torn.  This causes a lack of blood flow to the tissue leading to ischemia, and this is how we end up with a full thickness wound.

If pressure is present (and it almost always is with shearing), then it’s called and staged as a full thickness pressure ulcer. This is either a stage III or IV, depending on the depth of tissue destruction, based on NPUAP definitions.  When stage III or stage IV pressure ulcers look oblong or teardrop in shape, have irregular or jagged edges and undermining or tunneling present, this should be a significant clue that shearing forces were present.

The bottom line is this: it is not possible to have shear without friction, but it is possible to have friction without shear. Because shear is a result of that friction and gravity combo mentioned earlier, it can be avoided by keeping the head of the patient bed at a lower angle.

 

 

WOW Conference & Your Money

August 14th, 2015

Wound Care Conference Las VegasThe Lowdown on Tax Deductions and Travel Expenses

One of the most frequently asked questions we get regarding the annual Wild on Wounds (WOW) Conference is, “Can I deduct travel and lodging expenses on my taxes?” The answer is an enthusiastic yes!

As you pack your bags and prepare to head to Las Vegas, Aug 31 – Sept 3, for WOW 2016 – one of the most exciting wound care conferences ever – you can rest assured that as long as your travel is purely related to your practice, you can write off your expenses. Here are the basic guidelines for doing so:

It Must Be Mostly Business

You can write off your travel expenses if attending the WOW Conference benefits your business or contributes to your continuing education. But if you are attending this or any other conference for reasons other than business (like political, financial or social), deductions don’t count. According to Internal Revenue Service (IRS) guidelines, you can’t be gone for more than a week, and at least 75% of your trip needs to be devoted to continued education or business matters.

But Have Some Fun

The IRS is perfectly aware that business travelers like to have fun. Conference attendees commonly extend their education and business trips in order to see the sights or tour local attractions. If you plan to do so, have fun! But you can’t claim your personal expenses as part of your education and business write-offs. So go ahead … enjoy all the extra sites of Vegas, but don’t include those costs in the education and business portion of your expenses.

What About the Extras?

Obviously you’ll be wanting to get some sleep at WOW (after experiencing exciting and jam-packed days filled with amazing sessions). The good news is that those nights in the hotel can be written off, along with your meals – as long as they’re not over-the-top or lavish. And as a side note, if you travel with an associate or employee and pay for their expenses, you can write-off travel costs for them, too. However, you are not allowed to write off expenses for family members.

Keep Good Records

In order to comply with the IRS, keep detailed records of expenditures and accurately calculate deductions. If you are an employee of a company, you can deduct your conference costs that are not reimbursed. Employee spending is considered a “Miscellaneous 2% Expense.”

The Bottom Line

When it comes to tax deductions and travel expenses, it can get a little confusing. We totally understand, which is why we’re not in the tax business! Which means that you’ll need to get help with your conference tax-deductions from a qualified accountant, or visit these IRS website links:

http://www.irs.gov/taxtopics/tc511.html

http://www.irs.gov/publications/p970/ch06.html

http://www.irs.gov/taxtopics/tc513.html

Another Bonus

Don’t forget that you can earn up to 21 Contact Hours (up to 18 contact hours from the main conference, and 3 contact hours pre-conference) by attending WOW.  Find more details here.

Still haven’t registered? There’s still time. Check out the details here.

Speaker Spotlight: Clinical Instructor Gail Hebert

August 7th, 2015

Gail Hebert RN, BS, MS, CWCN, WCC, DWC, OMS

The day-to-day work involved in wound care can be tough. Sometimes you just have to recharge your batteries, which is why WCEI Clinical Instructor Gail Hebert can’t wait to be a part of Wild on Wounds (WOW) 2015 next month. She’ll be among the stellar speakers scheduled for the Sept. 2-5 conference in Las Vegas.

“The great thing about WOW is that you can experience professional excitement again in the company of kindred spirits who have your same passion for wound care,” Hebert says. “And you’ll be excited to return to work, ready to improve wound care practices for your patients.” She will be presenting two sessions at this year’s conference:

  • HOW TO: Medical Device and Moisture Associated Skin Breakdown
  • HOW TO: Skin Tears

A registered nurse for over 35 years, Hebert’s enthusiasm is contagious. With her high-energy style, she will share the latest and greatest in treatments and prevention strategies. She’ll also highlight trends and information published in current literature and used in the field.

“When attendees come to my sessions, they’ll learn how to manage medical device related pressure ulcers so citations and legal issues do not arise from a lack of knowledge or awareness,” Hebert says. She’ll also answer the following questions:

  • What are the latest terminologies used to describe the four most common forms of moisture associated skin damage?
  • Are you in compliance with the 2014 International Guidelines on the prevention of medical device pressure ulcers?
  • How can we drive down the number of medical device related pressure ulcers that our patients experience?

Can’t wait to find out more? Check out this free webinar from WOW 2014, and hear Hebert discuss Palliative Wound Care, including wound odor, excessive bleeding, necrotic tissue, body image and caregiver skills. Use coupon code: BLOG. Valid through 12.31.15.

Still haven’t registered for WOW 2015? It’s not too late – sign up now, and get ready to recharge your batteries. We’ll see you there.

DON’T MISS WOW – Here Are Our Top Five Reasons Why

July 31st, 2015

Not everything that happens in Vegas has to stay in Vegas. At least not when it comes to all the priceless experiences and new takeaways you’ll find at the Wild on Wound (WOW) 2015 National Conference on Sept. 2-5 (not to mention the awesome and graphic wound stories you can share with your friends). After all, if you’re in the wound care field, this is the kind of stuff you live for.

WOW Las VegasWOW in Las Vegas is the continuing education event for all clinicians interested in healing wounds. What’s not to love? Right in the heart of The Entertainment Capital of the World, you’ll get to hone those wound-care skills and learn about the latest and greatest with fellow skin enthusiasts from some of the best speakers, educators and professionals in the industry.

Ready to go? Here are our top five reasons why you won’t be sorry:

  1. The Buzz Report – A WOW conference main attraction, WCEI co-founders Nancy Morgan and Donna Sardina will share all the latest in wound care, including new products, guidelines, resources and tools.  It’s a jam-packed session that, just by itself, is worth the trip.
  2. Stellar Wound Care Skills – You’ll be amazed at how much you learn from our powerful lineup of interactive and advanced how-to sessions, along with plenty of hands-on workshops. You’ll elevate your knowledge of wound care technologies by participating in product training with industry experts. How does Topical Wound Management sound? Or what about Sharp Debridement? Whatever your interest, we’ve got you covered.
  3. Awesome Networking – There is nothing better than meeting other wound care fanatics face-to-face, live and in-person. WOW is the ultimate networking opportunity that allows you to truly engage with others in a meaningful way. You can learn from fellow professionals while basking in the knowledge that entire rooms full of colleagues completely understand what you’re all about.
  4. The Upper Hand – Of course, you’re already good at what you do. But everyone in healthcare today needs to maintain a competitive edge – for your organization, your patients … and yourself. At the WOW conference you’ll grow as a professional in exciting and provocative ways, like reviewing wound cases through dramatic, interactive mock court trials and case studies. Staying ahead of your competitors is a must, and you can do this by learning the latest and greatest in wound care treatments and techniques.
  5. Unforgettable Fun – No doubt about it, wound care is serious business. Whether it’s understanding healthcare reform updates or learning about new treatment guidelines, being the best at what you do is the goal. And giving yourself the gift of this conference is the perfect way to reboot and recharge. But let’s not forget about one of the most important elements of all: having fun. The WOW conference allows plenty of time to relax, laugh, and create new memories with friends. You simply can’t beat that.

Come join us at the WOW Conference in Vegas. You won’t want to leave any new skill, experience or memory behind. Register now, and we’ll see you there!

Speaker Spotlight: Dr. Michael Miller

July 24th, 2015

Anything-but-boring is how you describe this 2015 WOW Conference Speaker

Dr. Michael Miller

Dr. Michael Miller

There are lots of words that you might use to describe Dr. Michael Miller. Some of the usual adjectives on the list include entertaining, colorful, boisterous, and probably most of all … controversial. But after experiencing one of his presentations or even having a simple conversation with him, you would never ever call him boring. And he kind of likes it that way.

“My presentations are sort of like auto accidents,” says Miller, CEO Medical Director for Medical Care Group, Indianapolis. “It’s like you can’t look away. People come just so they can wait for what will come out of my mouth. Some might not agree with what I have to say, but I’m definitely thought-provoking and challenging.”

Miller is a featured speaker at the 2015 WOW Conference, Sept. 2-5 in Las Vegas. He will lead two presentations:

Let’s Assess, Work Up, Dress Up, and Figure Out How To Heal This Wound!
This advanced course goes beyond the basics and will include case studies and typical wound care center simulations. You’ll discuss etiology, work up and dressing choices, while learning how to explain prognosis to patients and work together with them to heal.

Sherlock Miller: Solve the Case
Audience participation is a key to this interactive session. Dr. Miller will facilitate a lively exercise where audience members can strut their stuff and help find solutions to interesting and unusual wound care cases. Together, attendees will bring the patient and the wound to the desired outcome.

“We will definitely have lots of fun,” says Miller. “I’m accused of many things, but boring is never one of them. I invite challenge, and I always ask ‘why.’ And I don’t accept ‘why,’ unless I can understand why the ‘why’ is why.”

Did we mention thought-provoking? This is Miller’s fourth year at WOW, and he looks forward to sharing his unique approach to wound care with others. “Far too many wound care doers start their care with the wound and then spend their time trying to fill it,” he says. “I only look at the etiology and then why it is not healing, which are often two different issues.  In many cases, looking at the wound is the last thing we do.”

A self-described Socratic educator, Miller isn’t interested so much in what an answer to a question is, but how the answer got there in the first place. “There are lots of good specialists out there, but with little concept of what they’re doing,” he says. “And when I ask them why they’re doing something in particular and they answer with, ‘Because we’ve always done it that way,’ it sets my teeth on edge.”

Miller believes that through challenge and logic, specialists can come to recognize and embrace new ways of doing things to achieve better results. Come see Miller and other great speakers at the WOW Conference – check out our full conference schedule here and register now.

Visit Dr. Miller’s Blog at:  http://woundcareadvisor.com/help-me-help-me-help-menext-tuesday/

Wound Care Treatment Outside The Bottle!

July 17th, 2015

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Learn WHY Maggot Debridement Therapy is highly effective in treating non-healing wounds. DIVE into the technical aspects of maggot debridement therapy and how to apply live maggot dressings to mock wounds.

Taught in two sessions, you will get the didactic and the practical hands on. Learn about the history, current status, mechanisms of action, as well as indications and contraindications for maggot and leech therapy.

Dr Sherman Calendar2

 

WOW Conference: Speaker Spotlight

July 13th, 2015

Kathy Schaum at WOW Conference

Kathleen D. Schaum, MS

Kathleen D. Schaum, MS

WOW Conference: Speaker Spotlight
Kathleen D. Schaum, MS
If there’s one thing that WOW Conference speaker Kathleen Schaum knows from past experience, it’s to expect the unexpected. That’s because when she presented last year (on the very last session day, and early in the morning), she figured there might be maybe 10 people in the audience wanting to learn about health care reform. Instead, she spoke to a standing-room-only crowd of hundreds, many of whom lined up in the hall afterwards to ask more questions.
“The uptake from the crowd was unbelievable,” she says. “I could have stood up there for three more hours! Needless to say, there were lots of aha moments that day.”
Schaum is the president and founder of her own reimbursement strategy consulting company, and brings more than 40 years of Medicare reimbursement knowledge and experience to wound care professionals who wish to improve their businesses. Her session, Health Care Reform Update, will provide new information about risk-sharing payment programs in development across the country.
In particular, participants will learn more about how to adjust wound care in order to meet the Triple Aim of health care reform. This includes:

  • Patient-centered care that is evidence-based, providing the best outcomes across a continuum.
  • Processes that provide the lowest “total cost of care.”
  • Programs that provide and measure patient satisfaction.

“Last year at WOW, we discussed changes in health care reform that were predicted for the following three to five years,” says Schaum. “Those changes are already here, and the next year will be astounding for wound care professionals. Quite simply, the future is now, and I’m going to help them get ready!”
As a speaker, one of the things that Schaum looks forward to the most is experiencing the high energy of WOW. She has also noticed the elevated level of motivation among attendees, fellow presenters and organizers. “It’s contagious and very catching,” she says. “It certainly rubbed off on me last year. My speaking style is upbeat, and so it aligned perfectly with the tone of the conference.”
You’ll be able to meet Schaum and experience this must-see Health Care Reform session on Saturday, Sept. 9 (Session 109), from 8:30-9:30 a.m. Interested to find out more? See our conference schedule, find out more about the conference, and register now.

Let’s Go to Conference!

July 7th, 2015

Travel Expenses, Tax Deductions and the WOW Conference

Wound Care Conference 2015So you’re dying to go to Conference, right? You can’t wait to hang out with your wound-care tribe, learn from exciting speakers and hands-on demonstrations, while having a little fun in the process at the Wild on Wounds (WOW) Conference, Sept. 2-5. But what about those travel and lodging expenses – are they tax deductible?

In a word, YES! Isn’t that the best news ever? In fact, if you are traveling to a conference that is purely related to your practice, you may be able to write off your expenses. Here are the basics:

The Conference Matters

If attending the WOW Conference benefits your business or contributes to your continuing education, then you can write off your travel expenses. However, deductions don’t count if you are attending for other reasons, like social, financial or political. According to Internal Revenue Service (IRS) guidelines, you can’t be gone for more than a week, and at least 75% of your trip needs to be devoted to continued education or business matters. But the other 25%? Go have fun.

Separate Business Expenses from Pleasure

Lots of travelers extend their education and business trips to see the sights or tour local attractions, and the IRS knows that. It’s perfectly fine to tack on a day or two at the WOW Conference, but you can’t claim your personal expenses as part of your education and business write-offs. So if you go see the Hoover Dam? Great, but don’t include it in the education and business portion of your expenses.

Track Additional Expenses

So when you go to WOW, at some point (we hope) you’ll want to get some sleep, which means that you can write off your hotel as well as your travel expenses. This includes meals (as long as they’re not “lavish,” so no caviar). You can also deduct 50% of all those other things that you pay for, like tips, taxis, dry-cleaning, printing or faxing. Save your receipts. And if you travel with an associate or employee and pay for their expenses, you can also write-off travel costs for them, too. But no writing off expenses for family members.

Making the Claim and Getting Credit

Here’s the crucial part: you’ll need to keep detailed records of expenditures and accurately calculate deductions. If you are an employee of a company, then you can deduct your conference costs that were not reimbursed. Employee spending is considered a “Miscellaneous 2% Expense.” (is this name correct misc 2% expense?…..or miscellaneous and it would be categorized as an expense?)

Clear as mud? We know how you feel. And because we’re certainly not in the tax business, you’ll need to make sure you get help with your conference tax-deductions from an accountant, or visit these IRS website links:

http://www.irs.gov/taxtopics/tc511.html

http://www.irs.gov/publications/p970/ch06.html

http://www.irs.gov/taxtopics/tc513.html

Also, don’t forget that by attending the conference you can earn up to 21 Contact Hours (up to 18 contact hours from the main conference, and 3 contact hours pre-conference).  Find more details here.

Sharp Debridement Hands-On Session at WOW!

July 3rd, 2015

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Among our most popular hands-on sessions is Sharp Debridement. This session offers a comprehensive presentation of wound bed preparation utilizing conservative sharp debridement. It will also include anatomy and physiology, implications and contraindications, techniques, tools, documentation, legal issues and policy development.
The hands-on lab practicum starts with all debridement instruments and supplies provided and ends with skills performance check-off. Participants will receive documentation of competency in performing conservative sharp debridement upon completion of the session.  Bill_TJ

INSTRUCTORS:
Bill Richlen PT, CWS, WCC, DWC, WCEI Instructor
Teresa Ferrante PTA, WCC

Session 305 HOW TO: Hands-On: Sharp Debridement Saturday September 5, 2015 8:30am – 12:00pm
$150 (lab fee)

This session will sell out. Reserve your seat today!

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Wild on Wounds 2015: Exhibitor Spotlight

June 26th, 2015
Robert Lang

Robert Lange CWCMS, National Accounts Manager

Southwest Technologies, Inc., brings innovative technologies and solutions to the wound care industry

According to Robert Lange, the tagline of Southwest Technologies, Inc. (SWT), isn’t meaningless lip service. Treating the World Well is a statement that drives company philosophy and the actions of its employees.

“We truly want to help caregivers heal patients,” says Lange, National Accounts Manager. “We are always patient-centered, which is why we enjoy being a part of the Wild on Wounds annual conference and sharing our products with such enthusiastic and knowledgeable attendees.”

Lange and other SWT educators will be on-site at the 2015 WOW National Conference in Las Vegas to answer questions, perform hands-on product demonstrations, offer training and product sample give-aways. Located at Booth #434, visitors will have the opportunity to learn about the newest collagen research, and have access to new assessment tools that have been developed to better support practices and make wound care easier.

“As most people in our industry will tell you, evidence-based treatment is in the forefront of wound-care trends,” says Lange. “Caregivers will change the way they approach treatment, and will greater emphasize proven methods over inexpensive solutions in order to gain better results.”

Lange says the SWT products that include Elasto-gel™, Gold Dust®, Stimulen® and NectaCare® will positively support the continuum of care for the patient and care-giver throughout all healthcare settings.  He says the company’s proven technologies backed by evidence-based research make care plans less cumbersome. “Our products are easy to use, help support positive outcomes, and are truly cost-effective,” he says. “They meet the needs of the patient, caregivers and wound characteristics, including types and etiologies.”

Lange, who has been trained and certified as a Wound Care Market Specialist (CWCMS®) by the Wound Care Education Institute®, says the WOW conference is really special. “It’s the perfect combination of high energy and knowledge-based programming.” He says that when attendees truly want to learn and interact with exhibitors, the better the experience is for everyone.

“The open forum allows for attendees to get all their questions answered, and to learn more about specific topics that are so crucial in our industry,” Lange says. This will be SWT’s fifth WOW Conference.

Wild on Wounds is the annual conference dedicated to continuing education for all clinicians interested in healing wounds. Click here for complete details and to register online.

 

Top Five Reasons to Attend WOW in Las Vegas

June 23rd, 2015

Let’s face it, not everyone gets excited about wound care. Not everyone can study graphic wound photos while eating lunch with friends. But for those of us who can – for those of us who want to learn and study the healing of wounds – well, we get each other in a way that’s hard to describe.

That’s why attending the Wild on Wound (WOW) 2015 National Conference in Las Vegas, Sept. 2-5, is so valuable. This annual event is dedicated to continuing education for all clinicians interested in healing wounds. You’ll get to hang out with like-minded skin enthusiasts, get your hands dirty, so to speak, and get better at doing that unique thing you do.

And if that’s not enough reason to get yourself to Vegas, then check out our Top Five Reasons why you should go:

Catch a BUZZ. The Buzz Report, a highlight of every WOW conference, features speakers and WCEI co-founders Nancy Morgan and Donna Sardina. You’ll find out what’s hot in wound care, including new products, guidelines, resources and tools.  It’s an information-packed session that, just by itself, is worth the trip.

Improve your skills. You’ll impress your friends and amaze even yourself with how elevated your clinical skills will be, thanks to a powerful lineup of interactive and advanced how-to sessions, along with plenty of hands-on workshops. You’ll get to participate in product training with industry experts that will advance your knowledge of wound care technologies. How does Sharp Debridement sound? Or what about Topical Wound Management? Whatever your interest, we’ve got you covered.

Meet your people. Sure, online interaction is great, but nothing – and we mean nothing – beats meeting new friends and talented colleagues face-to-face and in person. WOW provides the kind of networking opportunities that allow you to truly engage with others in a meaningful way. You can learn from fellow professionals and take comfort in knowing that other people get you and understand what you’re all about.

Be the best you can be. You’re good at what you do, no doubt about it. But all of us in health care need to maintain a competitive edge – for your organization, and for your patients. At the WOW conference you’ll be able to do amazing things, like review challenging wound cases through dramatic, interactive mock court trials and case studies. Staying ahead of your competitors is crucial, and learning the latest and greatest in would care treatments and techniques is imperative in our industry.

Have fun. Wound care is serious business. Whether it’s staying abreast of healthcare reform changes or learning about new treatment guidelines, being the best at what we do is paramount. And giving yourself the gift of this conference and everything it offers is a tangible way to revitalize, reenergize and find your wound care mojo. But we also know how important it is to enjoy the company of others and let your hair down, so to speak. The WOW conference affords attendees plenty of time to laugh, meet new people and enjoy each other in an unparalleled way.

Wound Care is ever an ever-changing industry, and it’s not easy to keep up with all the new information that’s out there on your own. Come join us at the WOW conference, revel in the company of other wound care clinicians, and enjoy the inspiration and passion of colleagues and industry leaders. We can’t wait to see you there.

Wild On Wounds Exhibitor Showcase Vendor Spotlight

May 28th, 2015

Scott_Miller_MPM

MPM Medical Inc. brings to you industry experts for 2 days during the WOW conference in Las Vegas on September 2-5, 2015. They will answer your questions, perform product demonstrations and provide hands on product training.  All of their sales representatives have been trained and certified as Wound Care Market Specialists (CWCMS®) by the Wound Care Education Institute®.  They offer a comprehensive line of hydrogels with lidocaine, foam dressings, moisture barriers, antifungals, calcium alginates, waterproof composite dressings, woundgard bordered gauze pad dressings, multilayer composite dressings, cleansers, saturated gauze pads and collagen and super absorbent dressings.

MPM has published a number of practical reference pieces including a definitive Wound Management Guide, Wound Care Wall Charts and clinical studies.  For information on these educational pieces visit their website at: www.mpmmedicalinc.com

Register for WOW today and stop by the MPM booth #224

WOW_link_button

 

What Will You Gain by Attending WOW?  You Will…

  • Discover what is new in wound care which is essential to your practice
  • Elevate your clinical skills with interactive, advanced, how-to sessions and hands-on workshops
  • Participate in product training with industry experts to advance your knowledge of wound care technologies
  • AND MORE…

Full Conference Registration Includes:

  • Access to educational sessions over 3.5 days
  • Access to product experts during the exhibitor showcase
  • Lunch on each registered day
  • Poolside get-together with a robust buffet
  • FREE cyber cafe to check emails, complete onsite evaluations, etc.
  • Complimentary collectible event T-shirt
  • And more!

WOW2015_600x155_FREE-TICKET_BANNER

REGISTER BY MAY 1ST – PAY BY JUNE 1ST

April 28th, 2015

RegisterNowPay_LaterHeaderSave $100 when you register by May 1, 2015  
You’ll get first choice of conference sessions and…
You don’t pay until June 1st!

Industry and Clinical experts will provide training and product demonstrations and will help answer your “hard to heal” wound questions. Join us in Las Vegas, September 2 – 5, 2015 and network with hundreds of passionate wound care clinicians with the same goal in mind, to advance their wound care knowledge.

About WOW

Wild On Wounds is a national conference dedicated to clinicians who want to enhance their knowledge and learn current standards of care in skin and wound care. Attend lecture sessions, participate in hands-on workshops and learn all the new products and technologies from industry experts.

Full Conference Registration Includes:
  • Access to educational sessions over 3.5 days
  • Access to product experts during the exhibitor showcase
  • Lunch on each registered day
  • Poolside get-together with a robust buffet dinner
  • FREE cyber cafe to check emails, complete onsite evaluations, etc.
  • Complimentary collectible event T-shirt
  • And more!

register now    send a brochure

Wild On Wounds Conference Early Registration Savings

April 17th, 2015

Only_14_days

When you register early, you save $100 and you will have first choice in selecting all conference sessions. The early discount rate expires May 1, 2015.  Register today!

Industry and clinical experts will provide training, product demonstrations and will help answer your “hard to heal” wound questions.

Join us in Las Vegas, September 2-5, 2015 and network with hundreds of passionate wound care clinicians with the same goal in mind, to advance their wound care knowledge.

About WOW

Wild On Wounds is a national conference dedicated to clinicians who want to enhance their knowledge and learn current standards of care in skin and wound care. Attend lecture sessions, participate in hands-on workshops and learn all the new products and technologies from industry experts.

Full Conference Registration Includes:

  • Access to educational sessions over 3.5 days
  • Access to product experts during the exhibitor showcase
  • Lunch on each registered day
  • Poolside get-together with a robust buffet
  • FREE cyber cafe to check emails, complete onsite evaluations, etc
  • Complimentary collectible event T-shirt
  • And more!

course_header2WCEI2015_WCC_BUTTON_rev

WOUND CARE CERTIFICATION – This Wound Care Certified (WCC®) course offers an evidence-based approach to wound management and current standards of practice to keep clinicians legally defensible at bedside.

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DIABETIC WOUND CERTIFICATION – This Diabetic Wound Certified (DWC®) course takes you through the science of the disease process, focuses on limb salvage and prevention, and covers the unique needs of a diabetic patient.

WCEI2015_OMS_BUTTON_revOSTOMY CERTIFICATION – This Ostomy Management Specialist (OMS) course will take you through the anatomy and physiology of the systems involved in fecal/urinary diversions. The course includes hands-on workshops and online pre-course modules.

 

CLICK HERE FOR COURSE DETAILS

 

You Be The Judge…and Jury!

April 6th, 2015

The Verdict Is In_HeaderJ_Melendez_175x236

You Be The Judge…and The Jury!

Julia Melendez RN, BSN, JD, CWOCN
Ever wondered what it’s like to be in the courtroom defending the wound care you provided?  So what happens and how does it all work?
This session will feature a mock trial demonstration portraying pitfalls encountered in the courtroom. Brush up on your acting skills. We will be selecting participants from the audience to be the players in this lawsuit.

SESSION #403: You Be The Judge…and Jury (Interactive)  

Come join us at the Wild On Wounds National Conference September 2-5, 2015 in Las Vegas, where you will learn the current standards of care in skin and wound management. Choose from a variety of essential to advanced educational sessions which include hands-on workshops, “learn it today and do it tomorrow” training, and interactive sessions.

Spend 3+ days with onside industry experts who will provide answers to your challenging wound healing questions, one-on-one product demonstrations, and hands-on training.

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Save $100

if you register by May 1, 2015

 

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Wound Care Certification

This course offers an evidence-based approach to wound management and current standards of practice to keep clinicians legally defensible at bedside.

 

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Diabetic Wound Certification

This course takes you through the science of the disease process, focuses on limb salvage and prevention, and covers the unique needs of a diabetic patient.

 

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Ostomy Management Specialist Certification

This course will take you through the anatomy and physiology of the systems involved in fecal/urinary diversions. The course includes hands-on workshops and online pre-course modules.

 

To register for a course visit  www.wcei.net

 

Wild On Wounds National Conference Registration is Open!

March 18th, 2015

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We as clinicians are responsible for the care of our patients’ skin …   SKIN IS IN!

Come join us at the Wild On Wounds National Conference September 2 – 5, 2015 in Las Vegas where you will learn the current standards of care in skin and wound management.  Choose from a variety of essential to advanced educational sessions which include hands-on workshops, “learn it today and do it tomorrow” training, and interactive sessions.

Spend 3+ days with onsite industry experts who will provide answers to your challenging wound healing questions, one-on-one product demonstrations and hands-on training.

Take advantage of the early discount rate and receive a $100 discount off the standard $550 rate when you register by May 1, 2015.

FULL CONFERENCE REGISTRATION INCLUDES:

  • Access to educational sessions over 3 ½ days
  • Access to product experts during the exhibitor showcase
  • Lunch on each registered day
  • Poolside get-together with a robust buffet
  • Free cyber café with internet access to check emails and more
  • Complimentary collectible event T-shirt
  • And MORE!

register now  send a brochure

 

 

 

 

 

Questions? call 1-888-318-8536 or email diana@wcei.net

 

 

Really, How Important is that Monofilament Test?

January 26th, 2015

Neuropathy is one of the most common risk factors for lower extremity complications in our diabetic patients. With sensory neuropathy the patient has a loss of protective sensation that leads to a decrease in the ability for our diabetic patient to sense pain and temperature changes. This loss of protective sensation puts the patient at an increased risk for plantar foot injury. Unfortunately the patient may not feel the injury until significant complications have occurred.

The American Diabetes Association set up guidelines for us as healthcare professionals, these guidelines recommend screening in diabetic patients for neuropathy to check for loss of protective sensation on an annual basis, one way this can be done by doing the Semmes Weinstein Monofilament test. If the patient is found to have decreased sensation and is found to be at high risk the monofilament test should then be done quarterly.

The Semmes Weinstein 10g Monofilament is a test that checks for protective sensation in the diabetic foot.  It uses a 5.07 monofilament that exerts 10 grams of force when bowed into a C-shape against the skin for one second.  We don’t apply the filament directly to the ulcer site, callous, scar or necrotic tissue. Ask the patient to close their eyes during the exam and tell them to reply “yes” when the monofilament is felt, repeat without touching skin occasionally to be sure of patients response. Be sure to use random order on successive tests.

Areas to be tested include the dorsal midfoot, plantar aspect of the foot including pulp (fleshy mass on the distal plantar aspect) of the first, third, and fifth digits, the first, third and fifth metatarsal heads, the medial and lateral midfoot and at the calcaneus.  Record the results on the screening form, noting a “+” for sensation felt and a “-” for no sensation felt. The patient is said to have an “insensate foot” if they fail on retesting at just one or more sites on either foot.

Those patients who cannot feel the application of the monofilament to designated sites on the plantar surface of their feet have lost their “protective sensation”. Without this protective sensation the diabetic is now at increased for injury or ulceration. Neuropathy is usually noted in the first and third toes and then progresses to the first and third metatarsal heads.

Injury is much more likely to occur in the diabetic insensate foot at these areas and interventions must be implemented to protect the diabetic foot that is at risk for ulceration. Patient education and good “shoe fit assessment” will be part of our plan of care to protect the diabetic neuropathic patients foot.

 

What is Charcot foot?

January 1st, 2015

What is Charcot Arthropathy? Charcot foot, as it is commonly referred to, is a chronic progressive disease of the bone and joints found in the feet and ankles of Charcot_Footour diabetic patients with peripheral neuropathy.

What leads to this Charcot foot? Having long standing diabetes for greater than 10 years is one contributing factor. Having autonomic neuropathy leads to abnormal bone formation and having sensory neuropathy causes the insensate foot, or foot without sensation and thus susceptible to trauma, this is another contributing factor. These bones in the affected foot collapse and fracture becoming malformed without any major trauma. One common malformation you see related to Charcot foot is the “rocker bottom” where there is a “bulge” on the bottom of the foot where the bones have collapsed.

Your patient with Charcot foot will present with a painless, warm, reddened and swollen foot. You may see dependent rubor, bounding pedal pulses, and feel or hear crackling of the bones when moving the foot. If a patient were to continue to bear weight on the Charcot foot there is a high chance for ulceration that could potentially lead to infection and/or amputation.offloading_devices

Continued, on-going weight-bearing can result in a permanently deformed foot that is more prone to ulceration and breakdown. Prompt treatment is necessary using total contact casting, where no weight bearing will occur on the affected foot for 8-12 weeks. Our job as wound care clinicians is good foot assessment with prompt identification and treatment of this acute Charcot foot to prevent foot deformity and further complications in the diabetic patient.

 

Diabetic Patient Education

December 29th, 2014

Patient education plays a vital role in positive outcomes for our diabetic patient. Diabetic patients need to understand the importance of proper foot care and importance of good blood glucose control to maintain the integrity of their feet.

So what do our patients need to know? They need to work closely with their physician and the dietician to be sure their blood glucose levels are properly controlled. foot_mirror_between_toesThe ADA recommends an A1c below 7%.  They need to know how important it is to check their feet daily to catch any problems early. We as clinicians need to teach them how to do this and what to look for. Teach your diabetic patients to inspect their feet everyday. They can do this by having family members or caregivers check their feet, or they can use a mirror and do it themselves.

Explain to your patients what exactly they are looking for; cuts, sores, red spots, swelling, infected toenails, blisters, calluses, cracks, excessive dryness or any other abnormality. They should check all surfaces of the feet and toes carefully, at the same time each and every day. Explain to your patients to call their physician right away if they notice any abnormalities or any open areas. Other problems the diabetic patient should be aware of with their feet and report to their physician include tingling or burning sensation, pain in the feet, cracks in the skin, a change in the shape of their foot, or lack of sensation – they might not feel warm, cold, or touch. The patient should be aware that any of the above could potentially lead to diabetic foot ulcers.

Instruct your patients to wash their feet every day, but not soak their feet. Use warm, NOT hot water – be sure they check the water temperature with a thermometer or shoe_fittheir elbow. Dry feet well, especially between toes. Apply lotion on the tops and bottoms of their feet but not between toes. Trim toenails each week and as needed after bath / shower, trim nails straight across with clippers, smooth edges with emery board.

Wear socks and shoes at all times, the diabetic patient should never be barefoot, even indoors. Have them check their shoes prior to wearing, be sure there are no objects inside and the lining is smooth.  Instruct them to wear shoes that protect their feet; athletic shoes or walking shoes that are leather are best, be sure they fit their feet appropriately and accommodate the foot width and any foot deformities.

For our diabetic patients, glucose control is a key factor in keeping them healthy, but patient education and understanding of proper foot inspection and what findings to report to their physician are just as important for the well being of our diabetic patient.

Free Webinar “How-To: Diabetic Foot Exam Made Easy”. Use Promo Code: DFOOT  through 12/31/15.

Venous, Arterial or Mixed Ulcer…How Do I Know For Sure?

December 15th, 2014

Your patient has a lower extremity wound. You aren’t sure what exactly you are dealing with. You know you need to do that ABI to be sure, but while you are waiting to have that done some of your wound assessment findings will help clue you in as well.

Let’s start with the venous ulcer, typically found on the medial lower leg, medial malleolus and superior to the medial malleolus. Seldom will you see them on the foot or Venous_Arterialabove the knee. They tend to be irregular in shape, are superficial, have a red wound bed, have moderate to heavy amount of exudate and the patient may have no pain or a moderate level of pain. Surrounding skin can be warm to the touch, edematous, scaly, weepy and you may see hemosiderin staining present. Your ABI will be the definitive answer and will come back at 0.9.

The arterial ulcer is typically found on the lateral malleolus, over the phalangeal heads, between the toes, tips of toes and areas that are subject to trauma and rubbing. They tend to be regular in shape, round punched out in appearance. Deep pale wound beds with necrotic tissue present are common in the arterial patient. There will typically be minimal amounts of exudate, and the patient will have complaints of extreme pain. The pain typically starts out as intermittent claudication or cramping in the lower extremities and then continues to progress.  Surrounding skin will be cool to the touch, pale, cyanotic, hairless on ankle and foot with thickened toenails. The ABI will come back abnormal and low at 0.5, indicating significant arterial disease.

Unfortunately sometimes the answer isn’t so clear, the patient with a lower extremity ulcer may present with signs and symptoms of both arterial and venous issues. You may see a full thickness wound, irregular in shape with minimal exudate on a cool pale lower extremity. What then? Then we go back to the gold standard of bedside tests, our ABI to determine what we are dealing with for sure.  Here most likely the patients ABI will fall somewhere between 0.6-0.8, this reading is indicative of a “mixed” lower extremity ulcer.

Our assessment skills can help guide us in differentiating these lower extremity wounds, but it is important to remember that not every ulcer always follows the rules. For example you may have a venous ulcer on the lateral side, it would not be unheard of. This is why ultimately the ABI is the gold standard of care and must be done to rule out arterial disease.  We always need to do a full comprehensive assessment, and one that includes the ankle brachial index (ABI) for our patients with lower extremity wounds.

Click Here for a FREE Webinar “Pressure Ulcers – Choosing The Right Treatment”  use coupon code: ULCER through 12/31/15.

 

Tips for Trimming Those Diabetic Toenails

December 8th, 2014

Make sure you have the proper tools. A set of toenail nippers, nail file, and orange stick are typically used.  Always follow your facility or healthcare’s settings policy for nail clip blog imagesinfection control. Single use disposable equipment is favorable.
Nails are easiest to trim after they have soaked for 10 minutes in a footbath to soften them. It is important to remember and educate our patients that the soaking of a diabetic patients feet should only be done by a healthcare professional. You can save some time by cleaning under the patient’s toenails with an orange stick wiping on a clean washcloth in between each toe while the feet are soaking.
After soaking and washing of the feet are completed, dry the patient’s feet completely. Wash your hands and put on new gloves to trim the toenails. Use your dominant hand to hold the nipper. Start with the small toe and work your way medial toward the great toe. Squeeze the nipper to make small nips to cut along the curve of the toenail. Be careful not to cut the skin. Use your index finger to block any flying nail fragments. Nippers are used like a pair of scissors – make small cuts, never cut the nail in one clip all the way across the nail. Never use two hands on the nipper. The nail is trimmed in small clips in a systematic manner. The nail should be cut level with the tips of the toes, never cut so short or to break the seal between the nail and the nail bed. The shape of the nail should be cut straight across and an emery board should be used to slightly round the edges. When filing nails always use long strokes in one direction, avoid using a back and forth sawing motion.
When all toes have been trimmed and filed, remove gloves and wash hands. Apply clean gloves and apply lotion to the top of the foot and to the bottom of the feet, rubbing lotion in well, wipe excess lotion off with a towel. Put patients socks and shoes back on as needed. Wash your hands again and smile, you are done!

FREE WEBINAR:  Skin and Nail Changes in the Diabetic Foot.  Click Here and use coupon code: NAILS through 12/31/15.

 

 

Debridement Basics. How Many Methods Are There?

December 1st, 2014

beamsDebridement is the removal of necrotic, dead tissue from the wound bed. It also plays a vital role in the tissue management concept of Wound Bed Preparation.  Wound Bed Preparation is the comprehensive approach we use to get our chronic wounds to heal. There are two main categories of debridement:  selective and non- selective debridement.  Selective debridement are methods where only necrotic, non-viable tissue is removed from the wound bed. Non-selective debridement methods remove both necrotic tissue and viable living tissue.

There are 5 major debridement methods. They are known by the acronym BEAMS.  The Selective methods include:  Biological, Enzymatic and Autolytic debridement methods.  The non-selective methods are: Mechanical and Sharp debridement methods.

Biological debridement is also known as maggot debridement using sterile medical maggots to remove necrotic tissue. These sterile maggots debride necrotic tissue by liquefying and digesting it, they also kill and ingest bacteria while stimulating wound healing.

Enzymatic debridement is the use of collagenase ointment (Santyl) once daily to the wound bed. The ointment works from the bottom up to loosen the collagen that holds the necrotic material to the wound bed. It is a faster method than autolytic debridement, but slower than sharp debridement.

Autolytic Debridement is the slowest type of debridement. It uses the body’s own enzymes to assist in breaking down the necrotic tissue. This is achieved by using products that maintain a moist wound environment. This type of debridement is not appropriate for large amounts of necrotic tissue or infected wounds.

Mechanical debridement is a method that uses an external force to separate the necrotic tissue from the wound bed. This may be painful and removes non-viable as well as viable tissue.  Methods include wet to dry dressings, scrubbing, whirlpool and irrigation. Contraindications for mechanical debridement would be epithelializing and granulating wounds.

The fastest method of debridement is Sharp debridement. There are 2 types, Sharp surgical (done by a surgeon, physician or podiatrist) or sharp conservative (done at bedside by a trained clinician). It involves the use of scalpels, scissors, curettes or forceps.  Sharp surgical is a major procedure that sacrifices some viable tissue where sharp conservative is a minor procedure done at the bedside that removes non-viable tissue.

The debridement method used will be chosen on a variety of factors including the wound characteristics, amount of necrotic tissue in wound, efficiency and selectivity of the debridement method itself, pain management for your patient, the cost of the procedure, exudate levels of the wound, presence of or risk of infection, the patients care setting, and the patients overall medical condition all need to be taken into account.

It is also important to remember not every patient with necrotic tissue will always be a candidate for debridement. Be sure that you understand indications and contraindications for each debridement method when you are selecting the method for your patient.

Click Here for FREE WEBINAR – HOW TO: Debridement Options: BEAMS Made Easy use coupon code BEAMS through 12/31/15.

What’s Up Down There? Identifying and Treating IAD

November 24th, 2014

Identifying Incontinence Associated Dermatitis or IAD can be a challenge for wound care clinicians as often it is confused and mislabeled as a pressure ulcer. We need A Questionto get good at identifying the true root cause of what has caused the skin breakdown. This IAD skin damage is damage that occurs from the top layers of the skin down where the pressure ulcer damage starts down deep when vessels are occluded from pressure. IAD is an inflammation of the perineal skin that has come into contact with urine or stool for an extended period of time and this has lead to skin damage.

IAD may present as an area of erythema, blistered, edematous and or a denuded area, but it will be free of necrosis. There may be epidermal loss and the skin damage will always remain partial thickness in nature. The patient may experience pain and complain of itching or burning as well.

Contributing factors for developing IAD include the patients generalized tissue tolerance of the skin, the tissue perfusion and oxygenation. The patient’s perineal environment is another risk factor, how much is moisture present on the skin. The toileting ability of the patient can also increase the risk for developing IAD and any mechanical trauma the skin must endure must also be considered a risk factor as well.

When our patient is at risk for IAD or develops IAD we must put appropriate interventions in place. These include a good skin care regimen with a gentle cleansing of the skin using a mild soap or no rinse soap. We need to use products that will maintain the PH of the skin.  Institute interventions such as patting the skin dry, no rubbing. Moisturize the skin with a product that contains humectant like glycerin, lanolin or mineral oil and use emollients to restore the lipids that have
been lost and apply to the skin when damp. Protect the skin from urine and stool with a moisture barrier ointment that contains zinc oxide, dimethicone or petrolatum or a combination of them.

Institute patient specific interventions for those risk factors that have been identified.  Interventions such as toileting schedules, open systems at night to avoid use of briefs, fecal collection devices, urinary catheters, and low air loss support surfaces may be needed and appropriate. If the IAD is severe topical wound therapy with dressings may be necessary. If candidiasis were suspected further fungal treatment and medical evaluation would be warranted as well.  A good preventive plan of care for the incontinent patient is a must!  For further information Click Here.

 

Cartilage Is Present…Now How Do I Stage It?

November 17th, 2014

In the human body the cartilage is found in joints, rib cage, ear, nose, bronchial tubes, and between the inter-vertebral discs. Most often we as wound clinicians see Printcartilage just below the bridge of the nose or on the ear in our patients with pressure ulcers.

Many clinicians continually question themselves how to stage a wound with visible or palpable cartilage present. After all cartilage does serves the same function as bone, but the word “cartilage” itself is not found in the stage IV definition from the NPUAP.  So how do you stage the pressure ulcer with visible or palpable cartilage?

Well here is your answer: In August of 2012 the National Pressure Advisory Panel released a statement that stated: “Although the presence of visible or palpable cartilage at the base of a pressure ulcer was not included in the stage IV terminology; it is the opinion of the NPUAP that cartilage serves the same anatomical function as bone. Therefore, pressure ulcers that have exposed cartilage should be classified as a Stage IV.”

What that means is any pressure ulcer where you can see or feel cartilage, it will be classified as a stage IV pressure ulcer. There is your answer, simply put: if you have cartilage present in the wound, you stage it as a stage IV pressure ulcer.

For a FREE Webinar called “Pressure Ulcer Staging and Tissue Types”  Click Here or visit http://www.wcei.net/webinars.   Use Coupon Code: BLOG.

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A Stinky Situation: When Wound Odor is a Problem

November 10th, 2014

As healthcare clinicians, in a way, we are lucky.  We become desensitized to things we encounter over and over again, they just don’t bother us like the first time we were shutterstock_193144973exposed. This stands true for those wounds with odor. We almost become immune, yes we are aware the odor is there; but to our noses it is not an issue. The real issue is for our patients and their friends and family. Odor is subjective. Depending on the patient and family members ability, they may be very much aware of the odor. It can be very bothersome to the patient and their loved ones. The patient maybe embarrassed by it, and may try to self-isolate. They may not want to have people around them because of the way their wound smells. This is something as wound care clinicians we need to fix.

The first thing we need to look at is, what is causing the odor? Is it from necrotic tissue that supports the growth of anaerobic bacteria? Is it from a high level of wound exudate? Is there an actual wound infection? Do we have the wrong wound dressing on the patient?

Once we figure out the cause then we need to remove it, whether its debridement of necrotic tissue, managing the high level of exudate with dressings or using Negative Pressure Wound Therapy; we need to find what works.  With an actual wound infection, treating with antimicrobial dressings or antiseptic’s/antibiotic’s are a must to remove the organism causing the infection and the odor. Sometimes just changing the dressing more frequently will help.  Using dressings like those with activated charcoal, or those dressings with medical grade honey in them may help the wound odor. Another option is topical Metronidazole Gel to the wound bed, this may help eliminate wound odor as well.

Just because the odor in the wound bed isn’t offensive to us as wound care clinicians, doesn’t mean it isn’t offensive to others. As a rule, if your patient has odor in the wound bed, consider it a problem that you need to fix.

 

The Winter of 1962

November 3rd, 2014

Why do we do what we do today in wound care? Modern wound management all started back in the 1960’s when Dr. George Winter found that wounds that were kept moist healed twice as fast. By keeping the wound environment moist it mimicked the natural environment of the cells in the body and we had decreased cell death, increased angiogenesis or new blood vessel formation, enhanced autolytic debridement, increased re-epithelialization and the patient had decreased pain. In short better wound healing was occurring with moist healing principles.  Moist_Dry_Wound_Healing

More studies continued and focused on water vapor loss, which lead to heat loss of the wound. The loss of moisture from any surface is accompanied by cooling of that surface, and when the wound loses tissue moisture there is cooling off the wound. Epidermal cells will only migrate over viable tissues; a dry crust or scab impedes the resurfacing process. Our wounds need to be maintained at or near normal body temperature to heal. A drop in temperature in the wound bed of 2°C is sufficient to alter healing and slow or stop healing, and it can take up to 4 hours for that wound to get back to normal healing temperature! As our wound cools off other negative things occur too, vasoconstriction occurs and the wound bed doesn’t get the needed blood and oxygen for our white blood cells to function effectively. This results in the white blood cells not being able to fight off bacteria, and the wound ends up at risk or with an actual infection.

In summary, for wound care, the 1960’s were really the start of something great! Faster healing times and better out comes for my patient! We now practice moist wound healing principles, we know the wound needs to be kept warm and moist, and needs to have a constant supply of oxygen to fight off infection.

Today we accomplish this with dressings that support moist wound healing. We use dressings that have the technology to be left in place for long periods of time and keep the wound bed warm. Long gone are the days of TID dressing changes, remember it takes the wound bed 4 hours to return to normal healing temperature! When it comes to modern day wound care, the 60’s is where we still are at!

 

Diabetic Ulcers – Identification and Treatment

October 27th, 2014
Gail Hebert RN, BS, MS, CWCN, WCC, DWC, OMS, LNHA, Clinical Instructor

Gail Hebert RN, BS, MS, CWCN, WCC, DWC, OMS, LNHA, Clinical Instructor

Don’t miss this energetic webinar brought to you by Wound Care Education Institute®:  Another popular session recorded from the Wild On Wounds National Conference and providing continuing education credit.

Chronic foot ulcers in patients with diabetes cause substantial morbidity and may lead to amputation of a lower extremity and mortality. Accurate identification of underlying causes and co-morbidities are essential for planning treatment and approaches for optimal healing. In this one-hour recorded session, Gail Hebert will review evidence-based approaches for identification and treatment of chronic neuropathic, neuro-ischemic and ischemic diabetic foot ulcerations.

Wound Care Education Institute is featuring various webinars on topics from this years’ conference.  TO REGISTER CLICK HERE or visit www.wcei.net/webinars.

 

WHY ABI?

October 20th, 2014

What exactly is an ABI?  ABI stands for Ankle Brachial Index. This is a non-invasive bedside tool that compares the systolic blood pressure of the ankle to that of Doppler_BloodPressureCuffthe arm. It is done to rule out Peripheral Arterial Disease in the lower extremities. The ABI is considered the “bedside” gold standard diagnostic test and can be done by any trained clinician in a clinic, hospital, nursing home and/or even the home care setting. All you need is a blood pressure cuff and a hand held Doppler.

Why do we do the Ankle Brachial Index or ABI?  Well, there are several reasons why we include the ABI as part of our assessment for the patient with lower extremity wounds. First of all, in order to heal a wound we have to be sure that our patient has adequate blood flow. The ABI will tell us if the patient has impaired arterial blood flow, and how significant that impairment is.  We also need to know the amount of compression that we can safely apply to the venous patient, in general the lower the patients ABI reading, the lower the amount of compression that can be safely applied.

When do I need to do the ABI? Standards of care and Guidelines dictate when we should be doing the Ankle Brachial Index. Our current standard of practice states to do the ABI: Anytime a patient has a lower extremity ulcer, when foot pulses are not clearly palpable, prior to applying compression wraps / garments or when the lower extremity ulcer is no longer healing.

What does the ABI “number” mean? First we need to be aware that not everyone’s ABI is reliable, in fact patients with diabetes or end-stage renal disease may have incompressible vessels rendering a falsely high ABI score. For these patients we use another diagnostic test called the Toe Brachial toe_cuf_wound_care_education_institutePressure Index (TBPI) instead of the ABI.  For those with ABI readings, in general as the patients ABI score decreases, this signifies that the patient has arterial disease of the lower extremity, and poor blood flow. Any patient with an abnormal reading needs a referral to a vascular specialist. Bedside interpretations of the ABI that we use as wound clinicians are: 1.0 considered a normal reading, an ABI of 0.9 indicate more venous, 0.6-0.8 indicate a mixed etiology (venous and arterial) and less than or equal to 0.5 is indicative of arterial disease of the lower extremity.

We as wound care clinicians are held to certain standards of care and must follow those guidelines established by the experts.  Performing the ABI on patients before applying compression and on patients with lower extremity ulcers is one of them.  As wound clinicians we use the ABI and our clinical assessment to help guide us into determining what type of ulcer we are dealing with so we can make appropriate referrals and develop the best treatment plan for our patients. It’s a step we can’t afford to leave out; our patient’s limb may depend on it.

 

How To: Creating the seal by making the right choices

October 13th, 2014
Joy Hooper RN, WOCN, OMS, WCEI Instructor, Medical Craft, LLC, Tifton, GA

Joy Hooper RN, BSN, CWOCN, OMS

Ostomy Webinar now available through Wound Care Education Institute®:  This popular session is recorded from the Wild On Wounds National Conference and provides ostomy continuing education credit.

Achieving a leak-proof seal between the skin barrier and the abdominal skin surrounding the stoma is the cornerstone of ostomy management. In this session, Joy Hooper will focus on assessment, interventions, and techniques for choosing the right ostomy products for creating dry surfaces, contour management, securement, and peristomal skin protection. 

Wound Care Education Institute is featuring various webinars on topics from this years’ conference.  TO REGISTER CLICK HERE or visit www.wcei.net/webinars.

 

 

Hot Topic at WOW – Nutrition Gems

October 6th, 2014
Dr. Nancy Collins PhD, RD, LD/N, FAPWCA, President/Executive Director Nutrition 411.com

Dr. Nancy Collins PhD, RD, LD/N, FAPWCA, President/Executive Director Nutrition 411.com

Dr. Nancy Collins received an overwhelming positive response from attendees after her lecture on “Nutrition Gems:  Hot topics in Nutrition”. One attendee remarked that she learned more from this one hour lecture than any previous presentation she has heard on this topic.

It was fascinating to hear about the advances in the field from an expert who has helped shape the current landscape yet remembers when her most common intervention when assessing wound patients nutritionally was to order “Milk and graham crackers!”

She covered a new development on the timing of when protein should be ingested based on recent research.
Breaking up protein ingestion at each meal has been shown to make it better available to the body to use verses protein loading at one meal, usually dinner. This can help our patients heal faster by providing the body with the protein it needs to build in that new tissue.

Did you know why Arginine and Glutamine, Conditionally Indispensable Amino Acids, are often need to be supplemented in the diet of our wound care patients?

Because under the stress of a wound, the body may not be able to keep up production of these important nutrients. Without adequate amounts of Arginine and Glutamine in the diet, the signaling pathway to build in new tissue is not activated and wound healing can stall.

Another key point made by Dr. Collins was the need to interpret lab data (Albumin, Pre-Albumin and Transferrin levels) only in conjunction with a full body nutritional assessment. These lab values have been shown to be inaccurate in patients with inflammation occurring in their bodies. Changes in Albumin, Pre-Albumin and Transferrin should not be used to suggest changes in protein status in individuals with acute or chronic inflammatory states. That can and should help all of us to do a better job in conducting a nutritional evaluation of our patients.

Dr. Collin’s passion for nutrition science and her ability to make it relevant to the wound care world was greatly appreciated by all who had the good fortune to attend this lecture.  To learn more about Dr. Collins go to: http://www.drnancycollins.com/

 

Diabetic Foot Ulcer Assessment and Hands On Lab

October 1st, 2014
Donna Sardina RN, MHA, WCC, DWC, OMS

Donna Sardina RN, MHA, WCC, DWC, OMS

Do you know the components of a Diabetic Foot Exam? It is so important that all of us in wound care know the steps to preventing foot ulcers on our diabetic patients.  And that starts with a routinely scheduled comprehensive foot exam.

Donna Sardina took us through all the aspects of a comprehensive exam during the pre-conference session “Diabetic Foot Assessment.”

The key word here is comprehensive. A proper exam involves much more than just a test of sensation using a Semmes Weinstein monofilament or a tuning fork. What about skin color, texture, temperature, foot deformities, nail deformities, glucose control, and critically important perfusion status. Did you know that it is estimated that 50% of amputations in diabetics are a direct result of improper footwear? That statement gets my attention every time I hear it.

In this session we learned how to examine our patient’s footwear for signs of trouble. Included in the handouts was a document “Diabetes: Shoe Fitting Tips” that will be extremely helpful when putting our knowledge into practice. In recognition of the fact that we are not all specialists in the diabetic foot, Donna shared a “Simplified Sixty Second Foot Screen” published by Dr. Sibbald in 2012. It is a validated tool that has just 10 items on it that can be completed in less than 60 seconds. This seminar was empowering to all who attended and gave us the tools we need to make a difference in this at risk population.

DFU_exam

2014 Annual Wild On Wounds, (“WOW”) National Conference Sets Record Attendance

September 26th, 2014

For Immediate Release – PRN Newswire:

2014 Annual Wild on Wounds, (“WOW”) National Conference

Sets Record Attendance

Plainfield IL – September 29, 2014 The Wound Care Education Institute® (WCEI) successfully completed its largest “Wild on Wounds” (WOW) conference in Las Vegas, NV. WOW is fast becoming the largest fall wound care conference in the United States drawing close to 1,000 clinicians, students and industry professionals to the four day event.   Picture1

WOW is specifically designed to advance the skills and knowledge of healthcare professionals specializing in wound care.  The educational sessions and hands-on workshops help them stay on top of ‘today’s standards of care’ and teaches the latest in wound care treatments and technologies.  “I  was  overwhelmed  by  the  outpouring  of  thanks  and  gratitude  from  the attendees,” said Nancy Morgan, Cofounder of WCEI and WOW.

This conference appropriately themed “Skin is in” was held at the Rio Hotel and Convention Center, September 17-20, 2014. Highlights of the conference included:

  • Close to 1,000 practicing nurses, therapist, physicians and industry professionals who influence wound care decisions from all care environments
  • 50+ basic to advanced educational sessions
  •  20 “How-To” and “Hands-On” programs
  • Renowned speakers and industry experts
  • Live certification courses include Skin and Wound Care, Diabetic Wound Care and Ostomy Management
  • Exhibitor partners
  • Clinical poster presentations
  • Wound Care Certified (WCC®) Outstanding Achievement and Scholarship Awards

WOW 2015

Next year’s WOW conference will be held September 2-5, 2015 in Las Vegas, NV.  If you are interested in receiving more details about WOW 2015 email WCEI at info@wcei.net.

 

About the Wound Care Education Institute

WCEI provides healthcare professionals with ongoing education support and comprehensive online and nationwide onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and

OMS™ national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®).   Website: www.wcei.net

Wild On Wounds National Conference Brings Back the Maggots to Las Vegas!

June 3rd, 2014
WOW2014_MAGGOTS_758X290_BANNER
This is just one of the sessions you can enjoy at our
National Wound Conference
Session 305 
HANDS ON:
Maggot Debridement Therapy
Dr. Ronald A. Sherman, M.D., M.Sc., D.T.M.H., Director, BioTherapeutics
We are pleased to welcome back Dr. Sherman, leading expert in maggot therapy and currently Chairman of the Board of Directors of the non-profit BioTherapeutics, Education and Research (BTER) Foundation, which supports patient care, education and research in maggot therapy and the symbiotic medicine.
Taught in two sessions, this course will give you the didactic and the practical hands on education on maggot therapy. Learn about the history, current status, mechanisms of action, as well as indications and contraindications for maggot therapy. Then put all that to use when you actually learn the technical aspects of maggot debridement therapy by applying live maggot dressings to mock wounds.
This session has limited seating and fills up fast so don’t wait.
 REGISTRATION INCLUDES:
  • 3 days filled with wound care education
  • 2 days of vendor showcase exhibits
  • Lunch all 3 days with a lunch speaker on day 3
  • Party poolside with a robust buffet and drinks!
  • Complimentary collectible event T-shirt
  • and MORE!

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