The National Wound Care Strategy Programme (NWCSP) continues to make great progress. I appreciate many of you may have signed up to the stakeholder group and have been questioning our silence, but I can promise you that we have been working very hard behind the scenes to be able to provide you with tangible outcomes following your feedback. We have just finalised the ‘clinical navigation tool’ for all lower limb wounds, which is currently out for consultation with the registered stakeholder group. It is hoped that implementation of the tool will provide a consistent approach for all patients, irrespective of where they live in the UK and who their service provider is. The tool addresses all lower limb wounds, including diabetic foot ulceration, leg ulceration and pressure ulceration on the heel as it has been recognised that one of the fundamental issues is the correct ‘labelling’ of patients … View PDF
Tag: pressure ulcers
Reducing Health Disparities in Pressure Ulcer/Injury (PU/PI) Detection & Management October 7-9, 2021 in Atlanta, Georgia
Join the Association for the Advancement of Wound Care (AAWC) for our Pressure Ulcer Summit (PrU), themed Reducing Health Disparities in Pressure Ulcer/Injury (PU/PI) Detection & Management, on October 7-9, 2021 in Atlanta, Georgia.
– Upon completion of this conference, participants will be able to:
– Describe existing disparities related to pressure ulcer/injury (PU/PI) prevention and care.
– Discuss challenges in providing equitable pressure injury prevention and care.
– Describe characteristics of pressure injury and other damage of persons with dark skin tones.
– Identify at least one method of leveling the playing field for pressure injury detection.
A molecular approach to maggot debridement therapy with Lucilia sericata and its excretions/secretions in wound healing
Chronic wounds caused by underlying physiological causes such as diabetic wounds, pressure ulcers, venous leg ulcers and infected wounds affect a significant portion of the population. In order to treat chronic wounds, a strong debridement, removal of necrotic tissue, elimination of infection and stimulation of granulation tissue are required. Maggot debridement therapy (MDT), which is an alternative treatment method based on history, has been used quite widely. MDT is an efficient, simple, cost-effective and reliable biosurgery method using mostly larvae of Lucilia sericata fly species. Larvae can both physically remove necrotic tissue from the wound site and stimulate wound healing by activating molecular processes in the wound area through the enzymes they secrete. The larvae can stimulate wound healing by activating molecular processes in the wound area through enzymes in their excretions/secretions (ES). Studies have shown that ES has antibacterial, antifungal, anti-inflammatory, angiogenic, proliferative, hemostatic and tissue-regenerating effects both in vivo and in vitro. It is suggested that these effects stimulate wound healing and accelerate wound healing … read more
Pressure Injuries (Pressure Ulcers) and Wound Care
Although the terms decubitus ulcer, pressure sore, and pressure ulcer have often been used interchangeably, the National Pressure Injury Advisory Panel (NPIAP; formerly the National Pressure Ulcer Advisory Panel [NPUAP]) currently considers pressure injury the best term to use, given that open ulceration does not always occur. [1] According to the NPIAP, a pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. It can present as intact skin or an open ulcer and may be painful. It occurs as a result of intense or prolonged pressure or pressure in combination with shear … read more
What is a deep tissue injury?
A deep tissue injury is a unique form of pressure ulcer. The National Pressure Ulcer Advisory Panel defines a deep tissue injury as “A pressure-related injury to subcutaneous tissues under intact skin. Initially, these lesions have the appearance of a deep bruise. These lesions may herald the subsequent development of a Stage III-IV pressure ulcer even with optimal treatment.”(NPAUP, 2005). Why is it important to have yet another stage for pressure ulcers? The answer lies in the fact that, even with proper treatment, deep tissue injuries can deteriorate quickly into your worst nightmare.
The Problem With Deep Tissue Injuries
The problem with deep tissue injuries is that they are not readily apparent. A patient who has fallen at home and lain on the floor for a day may be admitted to the hospital and have every inch of skin examined upon admission, and then develop the tell-tale area of purplish discoloration several days after admission. In many cases, hospitals and other care facilities are being blamed (and payment is being withheld) when patients end up with a gaping hole in their sacrum that takes several months (and several trips to the OR) to heal, if they don’t succumb to their injury … read more
Wound Documentation Standards to Help Avoid Legal Issues
Medical providers, and especially wound care providers, seem to always be under the looming shadow of lawsuits and legal issues. I have written about this before, but it continues to be an issue as I receive requests for legal reviews repeatedly. I have read many charts for legal reviews, and it actually is very straightforward to avoid or mitigate any legal problems.
Important Steps to Take When Documenting a Wound
1. If you have a wound protocol, follow it or document why you didn’t. For example, if your protocol says a bed or chair bound patient on admission is high risk, then treat them as high risk, or document why you didn’t.
2. If you use an assessment tool such as Braden Scale or Norton Scale, be sure you know how to use it properly, and use it per protocol.
3. Document all calls to a physician and the response.
4. If there is a physician order, follow it and document that you adhered to the order.
- For example, if an order says to notify physician if there is blood in the urine and you see blood in the Foley catheter, notify the physician and document that you did notify them and what the response was.
5. If you notice a change in your patient, report it to the proper person. For example: the patient has stopped eating normally, or the patient is acting differently. In an elderly patient this could be the first sign of infection … read more
Managing inflammation by means of polymeric membrane dressings …
… in pressure ulcer prevention
Inflammation is the immediate normal response of the immune system to localised microscopic cell damage that precedes macroscopic tissue damage. Inflammation is triggered by secretion of chemokines that attract immune system cells to the sites of cell damage and facilitate their extravasation through increase in capillary permeability. The increased permeability of capillary walls in the inflammatory state consequently causes fluid leakage from the vasculature and, hence, oedema and associated pain. Polymeric membrane dressings (PolyMem®, Ferris Mfg. Corp.) are multifunctional dressings that focus and control the inflammation and oedema, and reduce pain. The literature reviewed in this article suggests that by having these effects on the inflammatory response, especially in fragile patients, the PolyMem dressing technology may facilitate repair of micro-damage in cell groups, which counteracts the evolution of damage to a macroscopic (tissue) level. Reducing the spread of inflammation and oedema in tissues appears to be a unique feature of PolyMem dressings, which supports repair of cell-scale damage under intact skin and tilts the delicate balance between the counteracting damage build-up and tissue repair mechanisms, thus promoting reversibility and self-healing … read more
Comparing the performance of mechanical wound debridement products …
Background: Mechanical wound debridement is an essential intervention in the treatment of slough pressure ulcers. Therefore, a lot of products are presented in the current local market as effective tools to perform that procedure. There is a need to revise the clinical performance of the available used products in one of the biggest governmental hospitals in Saudi Arabia to support efficient resource utilisation and suggest clinical practice protocols for pressure ulcer treatment. Objectives: The current retrospective cohort study compares the clinical performance of two products regarding mechanical debridement for sloughy sacral and heel pressure ulcer. Methods: The researchers retrospectively cohort the progress of 32 patients with more than 50% slough pressure ulcer, received mechanical debridement by wound care nurse during hospitalisation in the same setting and using the same pressure ulcer treatment protocols, by using either monofilament debridement pads (Debrisoft®; Lohmann and Rauscher) (16 patients) or mechanical debridement by using impregnated sterile gauze monofilaments (UCS™; WelCare Industries S.p.A) for a period of three continuous weeks. The research used PUSH tools as a data collection tool. The Hospital Institutional ReviewBoard approved the study. Results: Both products show the positive progress of pressure ulcer healing status after 3 weeks of application (P<0.01). Also, the progress mean among the monofilament group was significantly higher than the progress mean among the impregnated sterile gauze (P<0.05). Conclusion: The study recommends monofilament debridement pads for mechanical debridement on sloughy (more than 50% of wound bed) pressure ulcers … read more (log in required)
100 Years of Bedsores: How Much Have We Learned?
ABSTRACT Just over 100 years ago, an article was published describing a plan to treat decubitus ulcers that can shed light upon medical progress and current practices. Key prevention and treatment elements included a dedicated ward, staff continuity, frequent position changes and special surfaces, cleanliness, disinfectants, and dressing changes. The necessity of resource allocation and interdisciplinary collaboration was acknowledged. This article sheds light on not only how much we have learned, but also how far we have to go.
A little over 100 years ago, a Decubitus Division was established at Kings County Hospital in Brooklyn, New York, and a management plan was published in an article in The Hospital Bulletin of the Department of Public Charities of the City of New York.1 This facility was established as an almshouse for the poor and today is a major municipal hospital affiliated with SUNY Downstate College of Medicine and a level I trauma center. We can learn much by examining this century-old plan for preventing and treating bedsores. To understand components of the plan, it must be remembered that antibiotics were decades in the future, and Dakin solution was still being developed on the battlefields of Europe.2 This article uses the terms “decubitus ulcer” and “bedsore,” as the terms “pressure ulcer” and “pressure injury” were not yet in the medical vocabulary.
Venous stasis ulcers, arterial ulcers, diabetic neuropathic ulcers, pressure …
Are You Confident of the Diagnosis?
Leg ulcers are skin lesions with full-thickness loss of epidermis and dermis on the lower extremities. Among a wide variety of etiologies for chronic leg ulcers, four common types are venous stasis ulcers, arterial ulcers, diabetic neuropathic ulcers, and pressure ulcers. By definition, chronic leg ulcers last greater than 6 weeks. Acute ulcers such as traumatic wounds undergo normal healing in healthy patients without the need for further treatment. As a result, only chronic leg ulcers will be discussed here.
Patients with venous leg ulcers commonly complain of swelling and aching of the legs that is worse at the end of the day and improves with leg elevation. The medial lower leg is the most common site. The borders of venous ulcers are typically saucer-shaped, initially with a shallow wound base. The surrounding skin often exhibits pitting edema, induration, hemosiderosis, varicosities, lipodermatosclerosis, atrophie blanche, and/or stasis dermatitis read more
Wound Documentation Dos & Don’ts
Scope of Practice and Standards of Practice guide nurses1 and other members of the interprofessional wound care team2 in caring for patients with wounds. Documentation in the medical record is a key aspect of the Standard of Practice and serves to record he care delivered to the patient. Your documentation should follow your facility guideline for documentation. This WoundSource Trending Topic blog considers general wound documentation dos and don’ts and presents 10 tips for success … read more