Posts Tagged ‘Assessment Skills’

Wound Care: Turning Frequency for At-Risk Patients

Friday, September 18th, 2015

What’s the right frequency for turning and repositioning your at-risk patients? Turns out, there’s more than one answer.

Patient Turning FrequencyIf you ask most clinicians what the correct frequency for turning at-risk patients is, the answer is probably going to be an automatic, “Every two hours!” Clinicians seem to have been born with that guideline ingrained in our heads.

But we know that when it comes to proper turning frequency, there is actually quite a bit more involved when finding the best solution.  Some of our patients’ tissue would break down if left in the same position for that length of time. So if two hours isn’t appropriate for some, how do we go about determining the correct turning frequency for at-risk patients?

Official Guidelines Say …

According to the 2014 International Guidelines on the Prevention and Treatment of Pressure Ulcers, turning frequency should be determined by considering your patients tissue tolerance, level of activity and mobility, general medical condition, overall treatment objectives, skin condition and comfort. The frequency of turns should be individualized to your patient, so the standard belief that q 2 hour turns is going to work for all your patents is false.

How do you determine tissue tolerance?

Assessing tissue tolerance allows clinicians to determine how long the skin can tolerate pressure without showing negative impacts in the form of reddened skin. It is done by implementing a step-by-step procedure where the clinician incrementally increases the amount of time the patient is left in the same position until reddened skin is detected, and recording these findings. Once the length of time it takes to see the skin redden is determined, you set the turning frequency to 30 minutes less than that time interval.

For example, if a patient shows reddened skin after 90 minutes, then turning frequency would be each hour. Tissue tolerance results will vary for each patient. The other factors mentioned above (mobility, medical condition, etc.) should also be considered, as they can impact your decisions with turning frequency.

There’s no definitive answer.

What this means for clinicians is that we need to change our thinking about how often our patients should be turned.  The answer to the question “How often do you turn and reposition your patient?” should now be, “At a minimum of 2 q hours and more often if needed.”

What do you think?

Do you currently test for tissue tolerance on your patients?  If so, do you record the results of these trials in the medical record? In Long Term Care, have you had surveyors ask about the method you use to determine turning frequency for your patients? We’d love to hear about your experiences with this topic – please leave your comments below.


Wild On Wounds Exhibitor Showcase Vendor Spotlight

Thursday, May 28th, 2015


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:

Register for WOW today and stop by the MPM booth #224



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

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!



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

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.


Awareness and Assessment Skills

Saturday, December 18th, 2010


I saw this video recently on YouTube and it got me thinking about assessment skills when it comes to wounds. As Wound Care Certified Professionals, we are held to a higher standard and our biggest skill and tool is our assessment skill set. The video above is a fun video and if your awareness is top notch you may have seen the Moonwalking Bear during the first segment of the video. However, if you didn’t see the Moonwalking Bear, you may have seen it in the second segment.

Didn’t see it? Stop reading here and take another looksie at the video. It was easy to miss. Thats my point. What are you missing in your wound assessments? Are we so busy, just ‘changing the bandage’ and getting to the end of our day to miss what may be happening with our patients? I know you may be saying, that we are forced to move quickly because we have so many patients on our case load or to see during the course of our day. It doesn’t take long to miss something that may be vital to the outcome of our wound care.

Test Your Pressure Ulcer Staging Skills

Saturday, July 18th, 2009

Test Your Pressure Ulcer Staging Skills

Recently, we have been posting some Assessment skills related articles and WCEI co-founder, Donna Sardina RN, uploaded a slide presentation to Test Your Pressure Ulcer Staging Skills.

Go ahead and click on over to see how you do. Warning: The Presentation contains graphic photos

For more information about becoming Wound Care Certified, check out for upcoming class schedules

How good are your assessment skills? What is going on with this wound?

Monday, July 6th, 2009

So how good are your assessment skills? If you were presented with a patient that had this wound that is shown in the picture below, do you think your assessment skills are up for the challenge? As wound care certified professionals, we have been taught to assess patients head to toe. But on first sight, can you tell what is going on? Do you have that inclination of what may be happening before going through an series of questioning or tests?

So what do we have here? What say you? Your comments are welcome below.



For more information on wound care certification, please visit

Provided the feedback we recieve, we may start to do this from week to week as part of an assessment series. Your comments and suggestions are helpful and welcomed.

What Caused the wound in the first place?

Thursday, May 7th, 2009


So you think your assessment skills are top notch? You say you can differentiate the types of wounds you encounter daily? What about the causes of these wounds?

As a wound care certified nurse, therapist, or physician, we should be looking at more than just the wound. Understanding the cause of the wound may just lead to the answer of how to treat the wound. I know that sounds like a novel idea but how often does the cause just keep chronically repeat itself ?

A combination of compliance and repetitive cause may be an issue but we as professionals need to look past the wound and pay attention to the cause. Eliminating the cause or at least minimizing the effects of causation can make a difference in the long term result of healing the wound.

As always, fine tuning your wound assessment skills is a good idea.

If you would like to take your assessment skills to the next level, consider becoming Wound Care Certified and utilize that knowledge to better care for your patients.