Archive for the ‘Education’ Category

What’s Up Down There? Identifying and Treating IAD

Monday, 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.

 

The Winter of 1962

Monday, 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!

 

WHY ABI?

Monday, 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

Monday, 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.

 

 

47 Days to WOW Conference

Monday, August 4th, 2014

It’s not too late to register for WOW!  Don’t pass up the opportunity to network, learn and participate in some of the top wound management sessions. Jennifer talks about two of her sessions and what you can expect in this video.

Jennifer Oakley RN, WCC, CWCA, DWC, OMS, Clinical Instructor

SESSION 406

The Wound Care Quiz Connection
In this session you will have a plethora of wound care information presented in a fun and fast moving quiz format to get you and your colleagues thinking again without overloading you. Join Jennifer, test your knowledge and inspire others.
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SESSION 106
Finding Common Ground…Your Guide to Surviving Wound Care Communication ChallengesIn this session you will learn effective communication techniques that will enable you to effectively deal with the day-to-day challenges you face as a wound care clinician.
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Even our exhibitors and sponsors are getting in on the knowledge.
SESSION 702 
HANDS ON : Use of Collagenase SANTYL Ointment in Wound Bed Preparation

Amy Bruggeman NP, MS, APRN-BC

Proper wound bed preparation is crucial for wound repair to progress normally. The overall goal is to address the necrotic burden and achieve a stable wound with healthy granulation tissue.Debridement helps remove necrotic tissue, which is a key component to wound bed preparation.

This program will review wound bed preparation and the role of debridement. It will analyze evidence based medicine in the treatment of chronic wounds and it will summarize the benefits of Collagenase SANTYL® Ointment in chronic wound debridement.Don’t put it off any longer. Book your sessions today and get your hotel room ready.
See you in Vegas!
 

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Wild on Wounds Productions, Inc.
25828 Pastoral Drive
Plainfield, Illinois 60585

Compression Made Easy Hands-On Lab

Wednesday, June 25th, 2014

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Due to popular demand, this dynamic duo is back to lead the hands on lab during the WOW Wild On Wounds National Conference in Las Vegas, NV on September 17-20, 2014.

Cindy_Michael_speakers

Cindy Broadus
RN, BSHA, LNHA, CLNC, CLNI, CHCRM, WCC, DWC, OMS,
Executive Director, NAWCO
Michael Miller
DO, FACOS, FAPWCA, WCC, CEO Medical Director, Miller Care Group

 

Session 301
HOW TO: Hands-On: Compression Made Easy

Venous disease affects over 15% of the population so its important to learn how to properly apply compression therapy. This session is a one-hour hands-on lab practicum in which you will practice your wrapping skills on each other.  You’ll learn the spiral and figure eight techniques and then use those skills to apply a multi-layered system.

This session is predominantly hands on with minimal didactic, therefore, attending session 200 will be helpful.  This is just one of many hands-on labs being offered.  To download the event brochure  CLICK HERE.  For details and to register online   CLICK HERE.

We hope to see you in Las Vegas!

"Thank you for having this in small groups. It helps to have the one on one attention"

“Thank you for having this in small groups. It helps to have the one on one attention”

I Stage, II Stage, III Stage , IV…. Making Pressure Ulcer Staging a Little Easier

Friday, June 6th, 2014

There has to be a way to get everyone on the same page.  You would think that over the last 6-7 years since the National Pressure Ulcer Advisory Panel (NPUAP) had released the updated staging guidelines we would have gotten better at this.  Not necessarily the case. blog
Lets try to make pressure ulcer staging as simple as possible.  We will take out the all the extra verbiage; you can read that later on.  We will break staging down to some user-friendly terms.  Now remember, we are talking about pressure ulcers, so all of these skin injuries pressure had to be present, sure – friction and shearing can contribute, but pressure must be present. They are usually located over a bony prominence but we know they don’t have to be; they will be located anywhere the skin has had unrelieved pressure.  If they are related to a device they will take on the shape of the device that has caused the injury to the skin.

Stage I.  This is an area of non-blanchable area of erythema (redness) of intact skin.  That’s what it is. Period.  Intact red skin.  Non-blanchable is when we push on the skin it stays red; it doesn’t turn white or blanch.  So, intact, non-blanchable area of erythema, a stage I pressure ulcer.

Stage II.  This is a superficial or shallow open area.  We say it is pink, partial and painful.  The damage is into the dermis here so the tissue we see will always be smooth pink/dark pink, not granulation tissue.  Never will we see any necrotic tissue here; your wound won’t have yellow, black brown colors in it.  It also may be an intact serum (clear fluid) blister. So there you have it; a stage II is a superficial open area with NO necrotic tissue or it can be an intact or ruptured serum filled blister.

Stage III. This stage is easy.  Damage is now into the subcutaneous tissue, but not through the subcutaneous layer.  So this is the start of full thickness tissue injury.  Now here is where we can start see slough, eschar, and granulation tissue in the wound bed.  Tunneling and undermining may also be present in the full thickness pressure ulcer.  In the stage III pressure ulcer we may see healthy subcutaneous tissue, necrotic tissue or granulation tissue.  What we WON’T see in the stage III is muscle, tendon, ligament or bone, ever.

Stage IV.  This is full thickness tissue damage where we now see muscle, tendon, ligament, or bone in the wound bed.  The definition also states “palpable” so if we can feel tendon or bone here, we would stage it as a stage IV.   Cartilage in the wound bed would be included in the stage IV pressure ulcer.  We can have granulation tissue or necrotic tissue present in the wound bed as well.  Undermining and tunneling may be present in a stage IV, but what I MUST see or feel are those underlying structures – muscle, tendon, ligament and / or bone present to say it’s a “stage IV”.

Unstageable pressure ulcer is a stage we use to classify the pressure ulcer that has enough necrotic tissue present to make the clinician uncertain whether the pressure ulcer is a stage III or stage IV.  So until enough necrotic tissue can be removed we place it in the “unstageable” category.  Once that necrotic tissue is removed and we can evaluate the actual level of tissue destruction in the wound bed, that is when we will stage it and it will either be a stage III or a stage IV.

Suspected Deep Tissue Injury (SDTI).  To be a SDTI the skin must be intact, it must be purple or maroon in color or an INTACT BLOOD filled blister.  Once this intact SDTI pressure ulcer opens up, we would then reclassify it based on our assessment or tissue type in the wound bed.

We need to use the staging definitions set out by the National Pressure Ulcer Advisory Panel (NPUAP) correctly, and all clinicians who assess skin need to have a good understanding of these definitions in order to properly stage pressure ulcers.  What was discussed about above is just a summary, there is more reading we need to do, but this will give us a good place to start with the staging.  We need to start staging consistently across the healthcare continuum; it really just comes down to good wound assessment skills, knowing the tissue type that lies before your eyes and identifying the level of tissue destruction and applying them to the NPUAP staging definitions. Lets get this right!

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

Tuesday, 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!

The blank white buttons with download pictogram            The blank white buttons with download pictogram

 

NAWCO℠ and WCEI® Attend the UOAA National Conference

Monday, August 12th, 2013

A Memorable Experience at the UOAA National Conference! uoaa_collage
What an awesome time we had!

This was a very different type of National Meeting when compared to others we’ve attended in the past. We met hundreds of Ostomates in all ages, from across the US and internationally. This was the first time we attended the United Ostomy Association of America (UOAA) National Conference and we were greeted with a warm welcome from attendees, clinicians and exhibitors.

Many people stopped by the booth to welcome the National Alliance of Wound Care and Ostomy℠ on their latest certification, the Ostomy Management Specialist (OMS℠) into their community with open arms. In fact, over and over attendees were telling us how “there’s nobody trained that can help me”… “there isn’t enough stoma nurses”… “we are so glad you are doing this”.  They were thrilled to learn that the OMS certification would not only include Nurses but also other disciplines such as Physical Therapist, Physical Therapist Assistant, Occupational Therapist, Physicians and Physician Assistant.

Jennifer Oakley (WCEI Instructor) and I spent our time at the booth talking to each attendee and listening to their stories. This really gave us an intimate up-front personal look into their lives. I have to say not many of the stories we heard were positive. In fact many were straight up nightmares of experiences they each had to endure.  Many times Jennifer and I found ourselves holding back the emotion as their stories were so moving.

This just reinforced to me that we need to get out there and spread the knowledge and time is of the essence!    My wheels were spinning on ideas of what we can do to make an impact nationwide.

It was an honor to attend this year’s UOAA national meeting. We want to thank each and every one of you that welcomed us and shared your story. We at WCEI will continue to pay it forward by educating multidisciplinary clinicians in Ostomy Management!

Nancy Morgan RN, BSN, MBA,WCC, DWC, OMS
WCEI Co-Founder

Clinicians Choose WCEI® for Wound Care Training

Friday, August 9th, 2013
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Become Wound Care Certified

Why Do Clinicians Choose WCEI® for their Wound Care Certification Training?

  • Wound Care Education Institute’s Skin and Wound Care Management training course provides continuing education hours for RNs, LPN/LVNs, PTs, PTAs, OTs, NPs, PAs, and MD/DOs.
  • Because it is offered both onsite and online, this comprehensive course meets the lifestyle needs of a wide range of multi-disciplinary clinicians.   Its online availability eliminates the expense of travel, hotel and employee time off.
  • The National Wound Care Certified (WCC®) exam is administered onsite with an exam proctor or at a convenient testing center.
  • WCEI course meets current standards of care and teaches clinicians to be legally defensible at bedside.
  • The pass rate for students that take WCEI® course and then sit for the WCC® exam is 89%-91%. Significantly higher than other courses.
  • WCC is the largest network of Wound Care Certified clinicians nationwide.
  • WCEI works directly with VA, Military, and hospitals that have achieved Magnet recognition along with Long-term, Home Health and Hospice care organizations. WCEI has also partnered with various universities and colleges providing continuing education to health care providers.
  • WCEI has developed state funded educational programs with several organizations in WI, MD, MA, NJ, and RI.  Combined greater than 600 healthcare professionals received state funding to sit for WCEI comprehensive skin and wound management course and WCC exam.
  • WCEI is committed to the success of their alumni and support them throughout their wound care career.  Clinical support is available following certification to assist them in the field.
  • The WCC® certification is a prestigious, highly recognized credential offered only through the National Alliance of Wound Care and Ostomy™. The WCC certification program is accredited by the National Commission of Certifying Agencies (NCCA®), the accreditation body of the Institute for Credentialing Excellence (ICE®). Certification programs that receive NCCA accreditation demonstrate compliance with the NCCA’s Standards for the Accreditation of Certification Programs, which were the first standards for professional certification programs developed by the industry.

Learn more about becoming Wound Care Certified at www.wcei.net

Save $100 on registration for on-site WCC course only. Coupon code: BLOG.  Coupon code must be used at time of purchase/registration. Existing registrations are not eligible. Coupon expires12/31/2013.

Find out about our One Day Wound Care Seminars at www.wcei.net/one-day