Archive for the ‘Wound and Skin Management’ Category

An overview of peripheral artery disease (PAD) and wound care

Wednesday, April 1st, 2020

Most wound care clinicians see wounds related to peripheral artery disease (PAD) on a frequent if not daily basis.

So let’s learn about PAD’s prevalence, understand the different ways it presents and best practices for managing it.

We spoke with Donald Wollheim, MD, FAPWCA, WCC, DWC, a board-certified surgeon of the American Board of Surgery, to get his insight on PAD.

With 25 years of experience in general/vascular surgery and 13 years as a wound care specialist, educator and case reviewer, Wollheim also is a clinical instructor for our Wound Care Education Institute (WCEI).

“From a wound care clinician’s point of view, it is critical to have good to excellent, oxygenated, arterial blood providing the tissues of the lower extremity to heal any wound of the leg,” Wollheim said.

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Hyperbaric oxygen therapy case: Liability can result from treatment inaction

Wednesday, March 25th, 2020
hyperbaric oxygen therapy

Many of you have worked with wound care patients needing antibiotics and hyperbaric oxygen therapy.

In the 2016 Texas case of Gonzalez v. Padilla, the issue of whether the antibiotics or hyperbaric oxygen therapy were properly prescribed was a core issue in the case.

The patient was struck while riding his motorcycle and was taken to a university-based medical center with a broken lower right leg and a de-gloved heel.

An open external fixation procedure of his compound, comminuted fracture was successfully performed and a “halo type” fixation device was placed around the leg to hold the bones in place as the fracture healed.

The patient was also placed on IV antibiotics, including Gentamicin and Cefazonlin for a period of five days. In addition, he received daily wound care treatments.

The medical center’s records indicated his right leg showed “obvious evidence of continued blood flow … and no obvious necrosis beneath the heel tissue itself.”

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Antimicrobial products: Read labels and do your own research

Wednesday, March 18th, 2020
antimicrobial products

The wound care industry has been inundated with antimicrobial products for years. 

Companies with good intentions try to improve outcomes and move away from antiquated antiseptics, such as Betadine, Dakins and acetic acid, that are not actually approved for use in wounds.

But some products are cytotoxic and lack any solid evidence that they are antimicrobial.

Instead, companies are offering modern products with little or no cytotoxicity available in multiple forms, such as cleansers and dressings. The challenge facing you in this barrage of products is knowing whether they are actually antimicrobial in the wound. 

This blog will arm you with proper ways to analyze these antimicrobial products and increase knowledge about them.

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Meet wound care nurse and WCEI instructor Anita Prinz

Wednesday, March 11th, 2020
wound care nurse

A 10-year veteran of the fashion industry and Wall Street, Anita Prinz, MSN, RN, CWOCN, decided she needed a career change.

Attracted to the nursing profession, Prinz went to nursing school after working in other fields. She earned her bachelor’s degree in nursing in 1995 at Samuel Merritt University in Oakland, Calif.

Soon thereafter, she moved to New York City and worked as a visiting nurse in Manhattan while engaging in a unique mode of travel to visit her patients. “I rode my bicycle to see patients in the late 1990s,” she said.

After seeing numerous wounds in her home care patients and working with exceptional wound care nurses, Prinz said she felt called to learn more about wound care. So she pursued certification as a wound, ostomy and continence nurse.

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What does an allegation of ordinary negligence mean?

Thursday, March 5th, 2020
ordinary negligence

When you are named in a lawsuit alleging professional negligence, a requirement calls for a nurse expert.

The nurse expert is called for both parties (plaintiff and defendant) to establish whether the applicable standard of care in the situation was met or was breached.

The requirement of a nurse expert witness to establish whether the standard of care is met is based on the fact that an allegation of professional nursing negligence involves nursing judgment in the care of a particular patient.

The overall standard of care in a professional negligence case against a nurse is what ordinary, reasonable and prudent nurses would have done in the same or similar circumstances.

The establishment of what you as a wound care nurse would have done in a particular case requires, as the court below stated, “highly specialized expert knowledge with respect to which a layman can have no knowledge at all, and the court and jury must be dependent on expert advice.”

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Prior authorization: New rule in effect for pressure reducing support surfaces

Wednesday, February 26th, 2020
prior authorization

Clinicians caring for Medicare beneficiaries who need pressure reducing support surfaces when discharged home are adapting to a new rule.

Those clinicians now need to submit a Prior Authorization Request for Pressure-Reducing Support Surfaces, said Cynthia Broadus, BSHA, RN, CHCRM, LNHA, CLNC, WCC, DWC, OMS, executive director at the National Alliance of Wound Care and Ostomy (NAWCO) in Somonauk, Ill.

The Prior Authorization Request for Pressure Reducing Support Surfaces is a rule established by the Centers for Medicare and Medicaid Services (CMS) that took effect Oct. 21, 2019.

Submitting the preauthorization documentation will identify the need for the pressure reducing support surface and provide the supporting documentation, according to Broadus.

“The authorization must be submitted before the support surface is supplied to the patient and before a claim can be submitted for payment,” she said.

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Your essential guide to wound packing dead space

Wednesday, February 19th, 2020
wound packing

Let’s face it, there is nothing fun, exciting or sexy about this topic.

Wound packing is just a necessary part of performing good wound care treatments in the event your patient has notable depth in their wound. 

However, there is a purpose and a proper way to pack a wound with the goal of promoting healing in the most effective and efficient manner.

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How to prevent and treat wounds in skin folds

Wednesday, February 5th, 2020
skin folds

Wounds in skin folds can be a challenge to prevent and, once present, involve ongoing surveillance and care.

Donald Wollheim, MD, FAPWCA, WCC, DWC, a board-certified surgeon of the American Board of Surgery, shared his insight on best practices for preventing and treating wounds in skin folds if they develop.

As a clinical instructor with our Wound Care Education Institute (WCEI), Wollheim has 25 years of experience in general/vascular surgery and 13 years of experience as a wound care specialist, educator and case reviewer.

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Study: Pressure injuries at ICU admission predict outcomes

Wednesday, January 22nd, 2020
A senior patient holds a nurses' hand in the ICU.

Pressure injuries are a pervasive problem.

They present a real cost for patients physically, psychologically and monetarily. Plus, pressure injuries have an annual financial burden estimated at $11 billion per year in the U.S., especially in the ICU.

A study published in June 2019 by the journal Critical Care Nurse reports pressure injuries present at ICU admission are associated with longer hospital stays. They also have a modest association with higher in-hospital mortality rates.

“I was looking for an unambiguous clinical marker that could predict patient outcomes and mortality in ICU patients,” said William T. McGee, MD, MHA, associate professor of medicine and surgery at the University of Massachusetts Medical School.

He said different modeling tools try to predict outcomes and mortality in ICU patients, but they are not used routinely for all patients at all hospitals.

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Acetic acid and Dakin’s solution: Are they proper wound care today?

Wednesday, January 15th, 2020
Dakin's solution and acetic acid can help minimize bacterial infections

We must ensure we provide wound care treatments based on solid medical rationale and science or clinical evidence. 

This applies to wound care clinicians, especially certified wound care clinicians, and includes all aspects of wound care — even applying Dakin’s solution and acetic acid.

Unfortunately, in my 25 years of wound care experience, I still see many practices that do not meet those criteria. I am guilty too.

Back in the early days of my wound care career, I promoted practices that didn’t meet those criteria because I trusted the clinicians teaching me were doing the right thing. 

However, I began to question things as my knowledge grew. After doing the research, I was shocked to learn some tried-and-true practices weren’t so tried and true after all.

In this blog post, we delve into one of those methods — the use of Dakin’s solution and acetic acid in wound care.

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