Archive for the ‘Education’ Category

News Flash: Document Education or Risk Facing Pressure Ulcer Citations

Thursday, December 17th, 2015

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

Document Education or Risk Citation

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

What it might look like now

Pressure Ulcer Staging Guide

Click for our FREE Pressure Ulcer Staging Guide

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

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

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

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

What it must look like now

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

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

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

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

No education? Hello, citation!

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

Lesson learned?

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

Test Your Wound IQ

Tuesday, December 1st, 2015

Ready to Test Your Wound IQ? by ProProfs » Testing Software by ProProfs

REGISTER BY MAY 1ST – PAY BY JUNE 1ST

Tuesday, 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

You Be The Judge…and Jury!

Monday, April 6th, 2015

The Verdict Is In_HeaderJ_Melendez_175x236

You Be The Judge…and The Jury!

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

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

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

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

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.

 

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Diabetic Wound Certification

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

 

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Ostomy Management Specialist Certification

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

 

To register for a course visit  www.wcei.net

 

Wild On Wounds National Conference Registration is Open!

Wednesday, 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?

Monday, January 26th, 2015

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

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

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

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

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

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

 

What’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.