...The Significance of Having a Multidisciplinary Team 3 Abstract The growing prevalence and hospital acquired pressure ulcers is an immediate concern. The major challenge is the A major challenge is the lack of knowledge and skills in wound identification, management, treatment and prevention. This, along with other factors, creates poor patient care and vast costs to the pertinent facilities. The solution is to have interprofessional collaboration. The utilization of current advanced practice nursing staff as a resource for floor nurses and other involved healthcare workers is a must. This would obtain certification in wound care and be responsible for the ongoing continued education for wound prevention, monitoring and maintenance. The staff will be educated and trained at quarterly intervals on wound identification, staging, prevention, maintenance and monitoring. Key words: wound care, evaluation, pressure ulcers, multidisciplinary, specialist, evidence The Significance of Having a Multidisciplinary Team 4 Problem Identified The Centers for Medicare & Medicaid Services (CMS) declared in October of 2008 that it will no longer provide reimbursement for hospital acquired pressure ulcers (HAPUs) because it is a preventable occurrence (CMS, 2014). Even though the percentages of occurrences have declined since then, HAPUs continue to cause financial strain on institutions (estimated $9.1- $11.6 billion dollars loss annually)...
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...venous leg ulcer is a chronic wound as it takes longer than six weeks to heal. It is caused by venous hypertension which is high blood pressure exerted in the veins of the legs which causes damage to the skin. Fluid can leak from the veins and pool under the skin causing swelling and thickening, this then leads to the skin breaking down to form an ulcer. Before a venous ulcer can be treated it is important to rule out peripheral arterial disease being the cause of the ulcer. Symptoms of peripheral arterial disease include pain in limb when exercising or walking, intermittent claudication, skin changes such as hair loss, cold to touch, oedema and ulceration. An arterial leg ulcer is caused by poor blood flow in the arteries and due to the current treatment of venous ulcers which is bandaging. This would reduce blood flow further and cause more damage making the ulcer worse. Having a history of varicose veins and a lack of mobility increases the chance of developing venous leg ulcers . According to SIGN (2010) when assessing a patient for the first time with a venous ulcer it is important to obtain their medical history in case of previous varicose veins and deep vein thrombosis as well as their mobility. Knowing these factors will contribute to managing the patients treatment, care and help with the rate of improvement. The framework model used to assess leg ulcers is the leg ulcer care pathway which is dived up into four stages 1. Patient...
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...Reduction of Nosocomial Wounds Phillip Cook American Sentinel University Hospital acquired wounds or nosocomial wounds have been a problem to the health systems across America for some time. They can be caused by several factors such as pressure, friction, or shear. In 2008, The Centers for Medicaid and Medicare (CMS) began withholding payment for hospital acquired conditions such as pressure ulcers ("Centers for Medicare," 2012). Hospitals have placed a priority on identifying those patients that are high risk for nosocomial wounds as well as protocols for preventing the wounds. Background of the Project Nosocomial wounds are a possibility for any patient that is admitted to the hospital. Patients are admitted to hospitals in various physical conditions and nosocomial wounds are caused by several factors. According to the Mayo Clinic (Mayo Clinic staff, 2011), nosocomial wounds are a result of pressure on the skin that inhibits the blood flow to skin and underlying tissues. This may come as a result of different problems such as: 1. Sustained pressure from the skim being trapped between a boney prominence and a surface such as a wheelchair or a bed. 2. Friction from moist skin being pulled across a surface 3. Shear from two surfaces moving in the opposite direction such as the bed and the patient. This movement damages the tissue making it more vulnerable to sustained pressure. Add to this the compromised nutritional status of the patients and...
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...During clinical patients were at the wound clinic to have their present wounds assessed. The patients at the wound center were both new and returning patients. Each patient is seen by a nurse and either the doctor or nurse practitioner on staff. There were four registered nurses working at the center today each having a different role that they play. The first nurse is responsible for admitting the patient, checking vital signs, going through a brief history. This nurse also is the first person to assess the wound, they will clean the wound and measure the wound for the doctor/NP. The second nurse works as a case manager and does rounding with the doctor. That nurse will write the orders given by the doctor and coordinates with a skilled nursing facility, home health or the primary care provider if need be. The third nurse that see’s the patient is in charge of teaching the patient how to care for the wound to help promote it to heal. They then will eventually discharge the patient once appointment is complete. The fourth nurse worked in the hyperbaric chamber. Although each nurse is designated a different task, they all worked together to help carry out everything needing to be done in a prompt and seemingly fashion, this really showed how...
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...today. According to the 2014 National Diabetes Statistics Report, “29.1 million people or 9.3% of the population have diabetes.” One of the many conditions resulting from uncontrolled diabetes is foot ulcers. Foot ulcers can lead to an increase hospitalization stay for wound care treatment. The standardized method for treating foot ulcers consist of saline moisture gauze. The newer technology to promote wound healing is Negative Pressure Wound Therapy (NPWT). One type of NPWT is vacuum-assisted closure device. With the rapid growth of diabetes, there comes an...
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...Education on Wound Care for Diabetic Patients Education on Wound Care for Diabetic Patients Abstract Non-compliance of wound care management has increased the risk of infection and amputations. Diabetes wound care management is an important and fundamental aspect when it comes to diabetes teaching and education. Assessment of the feet daily and at a primary care office will provide information such as noncompliance, risks for neuropathy, peripheral vascular disease, macro-vascular disease, and possible amputation. Education provided by health care practitioners to the diabetic population will promote decrease in risk for further complications and the patient to be involved in their own care. Assessment, treatment, and education on wound care management with the involvement of the patient will increase the patient’s quality of life and be very beneficial to both the practitioner and the patient. Keywords: diabetic wound care management, diabetic ulcer care, outpatient diabetes management, diabetic care management Introduction Working in a primary care setting will involve a multitude of disease processes- diabetes mellitus being one of them. Diabetes is a disease that is characterized by high levels of blood glucose with a defect in insulin secretion and cell resistance. Without proper management, diabetes may lead to other issues in health. Examples of such, would be, delay in wound healing, leading to foot ulcerations, which thus increases the risk for amputations...
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...Nurses towards Pressure Ulcers in Long Term Care Facilities that Hinders Prevention & Treatment Takoya Walker College of Costal Georgia Introduction and Background Pressure ulcers (PUs) have post a problem to healthcare for thousands of years. Since at least the 1980s, pressure ulcers have been considered a result of poor quality of care (Lyder & Ayello, 2012). In response to the Institute of Medicine’s landmark report To Err is Human: Building a Safer Health System, the National Quality Forum designated hospital-acquired Stage III or Stage IV PUs as “never events” (considered avoidable health care incidents) (Agency for Healthcare Research and Quality [AHRQ], 2012). Since 2008, the Centers for Medicare & Medicaid Services no longer reimburse providers for treatment of facility acquired Stage III or Stage IV PUs. Populations at risk for PU development include older adults, patients with dementia, and any person with conditions of immobility (Ratliff, Tomaselli, & The Guideline Task Force, 2010). Because an older adult is more likely than a younger person to have impaired mobility and co-morbid health conditions, elders are especially vulnerable for PU development. This is of particular concern given the large population of these individuals in our nursing home facilities. In 1992, the AHRQ developed early guidelines for preventing pressure ulcers. In general, prevention guidelines focus on reducing the amount and time of pressure and shear through...
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...Background: Compression bandaging is required for venous leg ulcers, which is due to damage and loss of skin above the ankle that is the result of a problem with the veins in the leg. Although leg ulcers are not a life-threatening condition, it can have considerable effects, not only on health, but also on the quality of life, self-esteem and healthcare cost. Method: Extended literature review, to extrapolate best available evidence, in order to address the focus question. Computerised and manual searches of previous literature were used; refining searches by means of constantly re-evaluating inclusion and exclusion criteria. Results: Eight (8) articles were decided upon, seven (7) of which were quantitative and one (1) which was qualitative in design. Two main themes emerged from these articles, that of management strategies for leg ulcers and technique of applying compression bandages. Recommendations: Episodes of venous ulceration can be reduced with management strategies, such as graduated compression therapy with comprehensive technique. However, without further education for nurses and patients towards compression therapy, venous ulceration will prolong and management strategies will fail. Conclusion: Knowledge of compression bandaging technique needs to be increased through further training/education. KEY WORDS Compression Therapy • Prevention • Technique • Venous Leg Ulcer • Management INTRODUCTION The primary aim of this extended...
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...OVERVIEW, Pgs3-4. 2. ASSESSMENT PROCESS, Pgs 5-8 3. TREATMENT OPTIONS, Pgs 9-12. 4. EVALUATION, Pgs 13-16 5. CONCLUSION. Pg 17 6. COPY OF PRESCRIPTION, Pg 18 7. REFERENCE SECTION, Pgs 19-23 8. BIBLIOGRAPHY, Pg 24. INTRODUCTION In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of prescribing in the community setting. The author a (trainee nurse prescriber) will display the need for a robust assessment, exploring all areas of health and well-being in order to achieve a safe outcome. The author will further follow current guidelines and be mentored by a senior nurse prescriber throughout the process. The aim of the case study is to display the implications involved in issuing a nurse prescription if deemed appropriate. With regard to writing a prescription as a qualified practioner, the author will adhere to the guidance within the Nursing and Midwifery Council (NMC 2006a) standards for safe prescribing. To protect this patient’s identity and maintain confidentiality, she will be referred to as Mrs X throughout the case study in accordance with the code of conduct (NMC 2008a). GENERAL BACKGROUND Originally, Mrs X had presented to her General Practioner (GP) with signs and symptoms of infection in her ulcer, which had not responded to systemic antibiotics, therefore admission...
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...-Based Practice September 6, 2015 PRESSURE ULCERS An essential part of nursing care of hospitalized patients is skin integrity maintenance. As markers of the values or products of care most affected by the assessment and interventions delivered by nurses, the rate of PUs is being screened thoroughly now than ever before (Manning, 2015). Pressure ulcers (PUs) are preventable, but PU rates persist to increase disturbingly fast, according to an article by Gary and Hampton published in 2015, the incidence of PUs has increased in the US between 1995 and 2008. The purpose of this paper is to review the incidence of PUs and how to prevent its occurrence and nurses’ responsibility. Practice Setting Problem Pressure ulcer occurs when part of the skin and the tissues underneath are impaired as a result of being placed under enough pressure to impair blood supply. Immobility-related pressure ulcers are defined as localized areas of tissue damage that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged time. The most common sites were the sacrum, the heel, the ischium and the trochanter. Pressure is where the weight of the body squeezes the tissues between a bony prominence (such as heel, elbow, sacrum or ischials etc) and a hard surface (such as bed, chair or, in the case of heels, the floor). There are four critical factors contributing to the development of pressure ulcers: pressure; shearing forces; friction and moisture...
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...Pressure ulcers in long term care if occurs and are unavoidable can impose substantial implications of neglect for the facility. Pressure ulcers per federal guidelines comes with a F-Tag according to federal regulations for pressure ulcers entails that residents who become residents and enter a long -term care facility must not develop a pressure ulcer unless it is unavoidable. The guideline further entails those residents in a long -term care facility who have the presence of a pressure ulcer receive adequate and necessary treatment to promote the process of healing and provide preventative measures in the prevention and formation of additional pressure ulcers (CMS.gov). After being selected by IPRO to participate in the Gold Stamp Program, the interventions of the institution has changed to reassess and implement interventions that are geared towards the prevention of potential patients at risk of developing pressure ulcers and healing those nosocomial pressure ulcers that were acquired. Currently, our facility has a total of 11 nosocomial pressure ulcers that were acquired in house. Of those 11 nosocomial pressure ulcers, they can be accounted for as previously healed areas and patients who have risk factors predisposing them to the acquisition of a pressure ulcer, and some were avoidable. The plan to purchase alternating air mattresses from H & R Healthcare will prove beneficial to the facility and will help to heal nosocomial pressure ulcers. Currently, we have 29 patients...
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...Low Energy Laser as a Treatment for Refractory Diabetic Leg Ulcers By Wendy Price Wake Forest University Department of Physician Assistant Studies 4/10/2009 I would like to thank everyone at Coy C. Carpenter library help and reference desks. To Ekatrina Zachry who translated the Russian research papers, thank you is the very least I can say for such an excellent job. I would like to tell my girls how proud I am of them and thank them for their patience, pictures, and prayers. You make it all worth the while. I would also like to thank my mother for her support, coming to help with the girls while I have been in school, and her motherly faith in me that never waivers. Most of all I want to thank my husband Clay Price for being an amazing pillar of strength, encouragement, patience, understanding, and love. I know I COULD NOT have done it without you. UA&F Low Energy Laser as a Treatment for Refractory Diabetic Leg and Foot Ulcers ABSTRACT BACKGROUND: Diabetic leg and foot ulcers often lead to immobility, infection, and amputation, cost $7,000 to $40,000 per ulcer, and erode mental health and QOL. Lasers have been effectively utilized in medicine since the 60’s, from various surgical uses to the treatment of diseases. Although low-energy (also called low-power, low-level, and cold) laser therapy for “biostimulation” (or biomodulation) of ulcer healing has been studied extensively, quality data on diabetic wound healing is rare. This review seeks...
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...Review SKIN FUNCTION AND WOUND HEALING PHYSIOLOGY John Timmons is Clinical Manager, Wounds UK and Tissue Viabiliy Nurse, Aberdeen Regular evaluation and the setting of goals is essential to monitor the progress of the patient and their wound.To do this, is important to understand the physiology of the skin and the way normal wound healing progresses in order to plan and provide effective wound management. This article describes the structure and function of the skin and outlines the four normal phases of healing. Wound healing is an exciting and continually developing field, with new technologies and research playing a large part in improving the quality of patient care. The role of the nurse in wound care is all encompassing, stretching from the initial assessment of the wound and the patient, to making the correct decisions about treatment and beyond. Regular evaluation, and the setting of goals is essential to monitor the progress of the patient and the wound. To do this, a baseline knowledge of the functions and anatomy of the skin and wound healing physiology is required. Figure 1. When the skin is breached, it is important to close the defect as quickly as possible, thereby preventing infection from occurring. vital substances (Graham-Brown and Burns, 1998). the nerve endings present in the skin allow the body to detect pain, and changes in temperature, touch and pressure. 8Sensation: Functions of the skin The skin, often referred to as the largest body...
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...those awkward and unique medical conditions. They might be crazy but surprisingly some actually work. Here are ten examples of bizarre and deadly medical remedies in medical history. 1. Maggot Debridement Therapy Maggot debridement therapy, also known as, larva therapy, larval therapy, Maggot Therapy, larvae therapy, biodebridement or biosurgery is a form of biotherapy. The therapy involves live, disinfected fly larvae being introduced onto the non-healing skin and soft tissue wounds on a human being or on an animal. The purpose of this procedure is to clean out the necrotic tissues that are within the wound and also for the purpose of disinfecting the wound. This procedure improves healing of chronic ulcers. In the year 2004, maggots were cleared for medical use in the United States of America for the treatment of non-healing necrotic skin, Neuropathic foot ulcers, traumatic and post-surgical wounds and venous stasis ulcers. The limitations of maggot debridement therapy is that the wound type must be that which...
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... Submission Date | 30.04.2013 | Word Count | | Discuss The Factors Which Influence The Processes Involved In Wound Healing 1. Introduction A wound is defined by its aetiology, anatomical location, acute or chronic stages, and the method of closure by its presenting symptoms and predominant tissue types in the wound bed. Injury to the skin or underlying tissues/ organs caused by surgery, a blow, a cut, chemicals, heat/ cold, friction/ shear force, pressure or as a result of disease, such as leg ulcers or carcinomas, Infectious (bacterial, Virus); Immunologic (Autoimmune disease; Genetic derangement e.g. Sickle cell anaemia); Nutritional (Vitamin deficiency; Oxygen imbalance) and Metabolic imbalance (ATP depletion) breakdowns the protective function of the skin by losing the continuity of epithelium, with or without the loss of underlying connective tissues (i.e. muscle, bone, nerves). Hence, the immune system initiates to recover wounds through complex pathways. Wound healing consists of four stages which are in the order hemostasis...
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