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Wound Care

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by

Leah Hantman

on 9 December 2014

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Transcript of Wound Care

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In elderly patients with pressure ulcers, does the treatment provided by wound care nurses’ decrease the incidence of pressure ulcer formation in comparison to the treatment provided by the primary nurse?

Prevention is Pivotal!
Barriers to wound healing
Optimizing the wound care process could save the health care industry millions of dollars but while the ability to be financially saavy is important the ability to help people recover quicker while minimizing risk of injury and further complications is huge.
Enhance the wound healing process
The Research
Wound Care
Preventing Pressure Ulcers and Turning Practices
UPenn Study conducted in 2013:

Only consulted WOCN after stage 2, primary care nurse responsible for care in stage 1 and 2.

Evidence suggested WOCN present after stage 2 decrease infection rates by 33%.

National Guidelines for Pressure Ulcer Prevention (2013) examined the jobs of a wound care nurse vs primary nurse.

Primary care nurses are responsible for turning patients on a schedule and consulting WOCN.

The average patient is every 4.21 hours in the US instead of every 2 hours.

Elderly patients most at risk after 3 days in the hospital and when skin breaks.


Outcome: wound care nurses aren't involved early enough in the process

Concerns: Pressure ulcer prevention and
the effectiveness of wound care therapy


Ultimate question: How do we prevent pressure ulcers, and if pressure ulcers are present, what combination of care provides for optimal wound healing?

Two Primary Concerns,
One Ultimate Question
The Research
Study 1:
Study 2:
The Research Continued
Study 3:
Evidence-based study published in 2014

Wound care nurses are essential in late stage treatment of pressure ulcers.

The greatest correlation to a decrease in incidence is early prevention.

Uniform education for those working as wound care nurses is lacking.

Education and Prevention are key!
Early Action is Essential!
Conclusion Question 1
Early prevention and turning practices are the best way to avoid lengthy hospital stays and pressure ulcer formation in the elderly.

Evidence suggests that if an ulcer has already developed, a wound care nurse with specialized training can decrease the rate of infection to a larger degree than the primary nurse.

In patients with pressure ulcers what is the optimal method of wound care? How does the traditional method of wet-to-dry dressing compare with newer technologies in wound care such as negative pressure therapy?
Question 2
Question 1
Wet-to-dry
Dressings
Negative Pressure
Wound Therapy
References

Athlin, E., Idvall, E., Jernfält, M. and Johansson, I. (2010), Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses. Journal of Clinical Nursing, 19: 2252–2258. doi: 10.1111/j.1365-2702.2009.02886.x

Australian wound management association. (2014). Wound Care and Treatment of Pressure Ulcers in Clinical Practice. Retrieved from http://www.awma.com.au/ptpu/index.php
Beeckman D., Mathei C., Van Lancker A., Van Houdt S., Vanwalleghem G., Gryson L. (2012) Good Clinical Practice: A National Guideline for the Prevention of Pressure Ulcers KCE Report 193C.

Coleman S., Nixon J., Keen J., Wilson L., McGinnis E., Dealey C., Stubbs N., Farrin A., Dowding D., Schols J.M.G.A., Cuddigan J., Berlowitz D., Jude E., Vowden P., Schoonhoven L., Bader D.L., Gefen A., Oomens C.W.J. & Nelson E.A. (2014) A new pressure ulcer conceptual framework. Journal of Advanced Nursing. doi:10.1111/jan.12405.

Cowan, L., & Stechmiller, J. (2009). Prevalence of wet-to-dry dressings in wound care. The Journal for Prevention and Healing, 22(12), 567-573. Retrieved from www.nursingcenter.com/inc/static?pageid=1053906
Gooyit, M. (n.d.). (2014). A Chemical Biological Strategy to Facilitate Diabetic Wound Healing. ACS Chemical Biology, 437-437.

Gooyit, M. (n.d.). (2014). A Chemical Biological Strategy to Facilitate Diabetic Wound Healing. ACS Chemical Biology, 437-437.

Guy, H. (2012). Using Negative Pressure Therapy in Wound Healing. Nursing Times. Retrieved from http://www.nursingtimes.net/nursing-practice/specialisms/wound-care/using-negative-pressure-therapy-in-wound-healing/5048877.article
Rachel Fields and Leah Hantman
Class participation?

What do you think?
infection (nosocomial***)
decreased mobility
longer healing rate
poor hand hygeine
compensatory pressure ulcers
poor nutrition: less than body requires
inadequate wound care
delayed diagnosis of wound
lack of pt compliancy
co-morbidities
excess moisture
excess bacterial burden
fluid volume deficit
To create this type of dressing, place a saline-soaked gauze or cotton sponge within a wound with exudate or drainage. As the dressing dries, it pulls exudate out of the wound.
The Benefits
The Negatives
Cheap materials: saline and gauze primarily
More time consuming...
Time= $
Moist environment leads to macerated edges which increase the diameter of the wound
Cross-Contamination
Patients subjective
pain rating was always higher with
wet-to-dry dressing
while satisfaction was lower...

The most widely used wound protocol
Patients perceived nurse to be more interactive with wet-to-dry dressings
NPT involves the controlled application of sub-atmospheric pressure to the local wound environment using a sealed wound dressing connected to a vacuum pump
Found to be more efficient in the healing of complex wounds than wet-to-dry dressings
Insurance is involved, along with
nursing technology
The Benefits
The Negatives
More efficient in healing complex wounds

NPT can also be used in the community setting which means patients can be treated at home, leading to increased quality of life and independence.
Practitioners must be trained to use the specific device
Technology is constantly changing, upgrades = $
Patient education and compliancy needs to be effective in community settings. Study 1: Heidi Guy WON found that those who could not return teach/were not compliant (7% of community wound patients receiving NPT) encountered more severe complications than those being more closely monitored and assisted in the hospital setting.
Study 1:
The Research
Study 2:
The Research
Study 3:
Question 2 Conclusion
WON Heidi Guy examined the healing of complex wounds and found NPT to be a more effective and a more holistic approach to wound healing as it allowed for home treatment and more patient education and involvement.
On the flip-side Heidi noted that because the patient is so much more involved, there is a higher risk for complications with regards to lack of compliancy and knowledge deficits.
Aligning with safety and policy
Reports associated with application of NPT reveal that 21% of treatments are applied incorrectly.

Reports associated with monitoring of NPT
reveal that in 47% of cases frequency of monitoring treatment according to hospital policy was delayed.

Reports associated with NPT issues after Pt. discharge suggest that 7% of Pts./caregivers did not receive adequate education.
NPT was proven to be more effective than wet-to-dry dressing changes based on 3 factors.
1. Mechanism of action and physiology
2. Long term effect, healing time
3. Patient satisfaction
Australian Wound Management Association
Study 3 Mechanism of Action
Stimulation of wound-edge retraction
Negative pressure draws the edges of the wound together
Stimulation of granulation tissue formation
Application of mechanical force slowly stretches the skin and stimulates new cell growth and the formation of granulation tissue
Increased local blood flow
Increased blood flow decreased inflammation and edema and also helps to remove bacteria and exudate from the wound. the reduction in fluid around the wound margins also increases capillary blood flow to the wound bed.
Reduced bacterial burden and load in the wound
The reduction in the number of dressing changes decreases damage to delicate new tissue and decreases the exposure of the wound to nosocomial infection
A study conducted at the Australian Center for Wound Management evaluated the clinical efficacy of diabetic ulcers when treated with wet-to-dry dressings vs. negative pressure wound therapy.

The trial contained 342 participants split between a wet-to-dry group and a negative pressure group.

Each person was then evaluated for 100 days. Complete ulcer closure was defined at 100% re-epithiliazation without drainage or dressings required.

By the end of the 100 days 43.2% of those being treated with the negative wound pressure therapy had complete wound closure when compared with their wet-to-dry dressing counterparts who had a wound closure success rate of 28.9 percent.

Those receiving the negative pressure wound therapy experienced fewer secondary complications with regards to infection and amputation.
Study 3 NPT Effectiveness and Pt. Satisfaction
NPT when applied by a trained or WON specialist nurse is most effective!


EDUCATE yourself as a nurse on the technology and protocol

EDUCATE your patients and their caregivers
The Ultimate Question Answered
Ultimate question, how do we prevent pressure ulcers,
and if pressure ulcers are present, what combination of care provides for optimal wound healing?

Treatment should be holistic and specific to the individual
SAFETY FIRST FOR PATIENT CENTERED CARE
Refer to facility policy and be knowledgeable
about technology being used
Review the physicians order and known when to advocate for your patient and also when to use a Wound-Ostomy Certified Nurse!
Educate yourself and your patient
Practice preventative means and sterility
Ideal world scenario- Pts will be turned q2h by primary nurses and if pressure ulcers occur NPT applied by WOCN
As technology and science advances so does medical treatment
Full transcript