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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, Sept. 2-5, for WOW 2015 – 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. You can also deduct 50% of all those miscellaneous expenses like tips, taxis, dry-cleaning, printing or faxing, but make sure you save those receipts. 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

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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

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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!

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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

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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.

register nowsend a brochure

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.

 

DWC_tile

 

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.

 

OMS_tile

 

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

banner_Register_Today

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.

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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.

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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

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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.

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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

 

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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 when registering.

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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.

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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.

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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!

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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.

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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.

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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.

 

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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/

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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.

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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
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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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