Study: Pressure injuries at ICU admission predict outcomes

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?

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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Colostomy care for inmates is important to maintain wellness

January 8th, 2020
An inmate with a colostomy holds prison bars

We often talk about ostomy care, including the different ostomy types.  

When I was doing research for this blog, it was surprising how many reported cases exist in which colostomy care was the basis of federal lawsuits filed by inmates in various penal settings throughout the United States.

Other recipients of healthcare not in a penal setting have filed such lawsuits as well.

Simply doing an online case law search for “stoma nursing care” or “ostomy nursing care” yields a number of interesting results.

One prisoner’s colostomy care became an issue in a case he filed against the Missouri Department of Corrections (MDOC) in Crew v. Russell.

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How a wound care app can complement your practice

January 1st, 2020
A doctor uses a wound care app on a tablet at the hospital

More wound care clinicians are using wound care apps when treating their patients.

Some clinicians use them on their own as an adjunct to the requirements of their employers. Others use a specific wound care app because it’s integrated in their employer’s electronic medical record systems.

Use of wound care apps is standard operating procedure and mandated when caring for wound patients.

Whatever category you find yourself in as a wound care clinician, here is a quick overview of three popular wound care apps for clinicians and one for patients.

These will keep you up to date on what’s out there in the world of wound care apps.

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Traumatic open wounds: Let’s define the types

December 25th, 2019
A girl has a Bandaid on her knee covering an open wound.

Learn the difference between the types of open wounds caused by trauma.

Open wound types include abrasions, excoriation, skin tears, avulsions, lacerations and punctures, according to our Skin and Wound Management course workbook.

Traumatic open wounds involve a disruption in the integrity of the skin and underlying tissues caused by mechanical forces. In other words, these wounds are caused by brief but forceful contact with another object or surface.

Differentiating the types of traumatic open wounds involves noting the shape and depth, as well as the nature of the mechanical force that caused it.

Below, we outline six acute, traumatic open wounds that are commonly confused.

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Compression therapy: Why patients might become nonadherent

December 18th, 2019
A woman puts on her compression stockings on an airplane.

Many clinicians encounter patients who follow their plans of care regarding compression therapy without question or delay.

Other clinicians, however, can find themselves dealing with patients who appear unwilling to adhere to their compression plans.

Wound care clinicians may at times scratch their heads and wonder why some patients are nonadherent with their therapy.

Understanding why some patients are nonadherent and taking action to help improve adherence can increase the likelihood of reaching both short- and long-term goals and improve outcomes.

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Adjunctive modalities apply when wound care basics aren’t enough

December 11th, 2019
Clinicians discuss adjunctive modalities to treat a wound.

Have you ever felt like you may have run out of options to heal a wound?

We have all been there in our wound care careers. Before you throw in the towel or pull your hair out in frustration, take a step back and make sure you started the process in the correct manner.

First, ensure you have successfully addressed all the basics of wound healing:

  • Removed the cause
  • Provided moist wound healing
  • Removed the necrotic tissue and epibole
  • Managed the bioburden
  • Ensured adequate tissue perfusion
  • Ensured adequate nutrition

Then review treatments that can accelerate the healing process. You have to build your treatment plan on a solid foundation of basic approaches before considering more expensive, adjunctive modalities. 

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What’s all the fuss about wound dressing change frequency?

December 4th, 2019
A clinician maintains a patient's wound dressing change frequency.

Let’s take a one question wound care quiz.

What is more important for wound dressing change frequency?

  1. Expert application of a dressing
  2. Frequency of the dressing change

The correct answer is the frequency. Now let’s talk about why.

I do not want to take away from the importance of properly applying dressings because that certainly has its own merits. But when it comes down to it, the frequency wins hands down. 

As we teach in class, wound healing is a dynamic process. As the wound progresses through the phases of healing, all kinds of cellular activity is happening.

From the neutrophils and macrophages to the growth factors and fibroblasts, each phase has a job to do for the wound to move to the next phase and ultimately close.

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Is the Kennedy terminal ulcer diagnosis outdated?

November 27th, 2019
A nurse holds the hand of a patient who as a Kennedy terminal ulcer.

The term Kennedy terminal ulcer was identified by Karen Lou Kennedy-Evans.

She and her colleagues came up with the name Kennedy terminal ulcer in 1983 at the Byron Health Center in Fort Wayne, Ind.

The term specifically refers to a pear, butterfly or horseshoe-shaped wound ranging in color from red to yellow to black.

These wounds typically appear over the coccyx and sacral area of patients who are near death.

The wounds also have been noted to occur in other areas of the body, such as the heels, posterior calves, arms and elbows.

Named by Kennedy at the time, she and her colleagues formally presented their subsequent observational research on the topic, which was published in 1989. 

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Retained surgical bodies can lead to serious wounds

November 19th, 2019
A surgeon checks a wound for retained surgical bodies.

Retained surgical bodies in a patient postop is not an unfamiliar occurrence.

One literature review indicated that with more than 28 million operations in the U.S. nationwide, 1,500 estimated cases per year of retained surgical bodies left in patients take place.

In the 2016 case of Thompson v. Mangham Home Care, Inc., who left gauze in a patient’s surgical wound was at issue.

The patient saw her primary care physician for boils/sores on both of her buttocks in 2008.

The primary doctor prescribed antibiotics without success, and the patient was referred to a general surgeon who treated the condition with antibiotics and warm soaks.

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