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Team-Centered Wound Care: Making Your Wound Care Safe and Simple Again October 4 th , 2017 Ryan P. Dirks PA-C Founder and CEO

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Page 1: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Team-CenteredWoundCare:MakingYourWoundCareSafe

andSimpleAgainOctober4th,2017

RyanP.DirksPA-CFounderandCEO

Page 2: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

RoadtosuccessDetailedWoundAssessment/RiskAssessment

IndividualizedCarePlanning

Evidence-BasedTreatment

Documentation

Documentation

ExternalSupport

Page 3: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

TOPICS

WOUNDASSESSMENT101

PRESSUREINJURYDOCUMENTATION

KENNEDYULCERS

MEDICALDEVICEPRESSUREINJURY

Page 4: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundAssessment

WashingtonandIdahoHealthCareAssociation

Page 5: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundAssessment• Location• Etiology• Size:Lengthxwidthxdepth• Woundbase• Woundmargins• Drainagecolor• Undermining• Tunneling/sinustracks

Page 6: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundMeasurement

• Measurethegreatestlength(headtotoe)

• Measurethegreatestwidth(sidetoside)

• Describethewoundasthefacetoaclock• Headin12o’clock• Feetare6o’clock• Sidetosideis3o’clockto9o’clock

Page 7: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundMeasurement

• Measuredepth– useacottontippedapplicatortomeasuretheverticaldistancetothedeepestareainthewoundbed.

• Tunneling=channelthatextendsinanydirection

• Undermining=tissuedestructionunderlyingintactskinalongwoundmargins

Page 8: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and
Page 9: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundAssessment

• Location• Etiology• Size:Lengthxwidthxdepth• Woundbase• Woundmargins• Drainagecolor• Undermining• Tunneling/sinustracks

Page 10: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundAssessment

• Woundbaseorwoundbed– identifycolor(s)• Granulatingtissue(red)• Slough(yellow)• Infectedtissue(green)• Necrotictissue(black)• Epithelializing(pink)

• Tissue• Hypergranulation• Muscle,Tendon,Fascia,Bone

Page 11: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and
Page 12: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and
Page 13: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundAssessment

•WoundEdges• Intact• Irregular•Welldefined• Calloused,fibrotic,firm•Macerated,soft• Epibole (”Epiboly”)– rolledunderedges

Page 14: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundAssessment

• Drainage• Serous,Sanguineousserosanguinous,purulent

• Amount• Odor

• Strong• Foul• Musty• Mild• Sweet

• Periwound• Erythema• Induration• Texture• Scartissue• Lesions/Rashes• Edema• Temperature• Color• Ecchymosis• Maceration

Page 15: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

MostCommonChronicWoundEtiologies

• PressureInjury/Ulcer• VenousStasisUlcer• ArterialInsufficiencyUlcer• Diabetic-NeuropathicUlcer

Page 16: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

PressureInjury

Page 17: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

DefinitionofPressureInjury• Localizeddamagetotheskinand/orunderlyingsofttissueusuallyoverabonyprominenceorrelatedtoamedicalorotherdevice.Theinjurycanpresentasintactskinoranopenulcerandmaybepainful.Theinjuryoccursasaresultofintenseand/orprolongedpressureorpressureincombinationwithshear.Thetoleranceofsofttissueforpressureandshearmayalsobeaffectedbymicroclimate,nutrition,perfusion,co-morbiditiesandconditionofthesofttissue.

(NPUAP,2016)

Page 18: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

HighRisk

• Elderlywithhipfractures

• Spinalcordinjuries

• Criticalcare

• >70yearsofage

Page 19: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

PathogenesisofPressureInjury

•“Stuckbetweenarockandahardplace”•Capillaryclosingpressuregenerallyconsideredtobe32mmHg•Venous/lymphaticoutflowceases• Increasedhydrostaticpressurereducesarterialinflow

(Bryant,R.A.&Nix,D.P.,2007)

Page 20: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

PathogenesisofPressureInjury

• Within2-9hoursofsustainedpressuretissueischemiacanoccur.

(Bryant,R.A.&Nix,D.P.,2007)

Page 21: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

SitesforPressureInjuryDevelopment

Page 22: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

PathogenesisofPressureInjury

• INTRINSICFACTORS• NutritionalDebilitation• AdvancedAge• LowBloodPressure• Stress• Smoking• ElevatedBodyTemperatures

• EXTRINSICFACTORS• SHEARING,FRICTION,MOISTURE

Page 23: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

MoistureAssociatedSkinDamage

• NOTapressureinjury

• Topdownmechanismvs.bottomup

Page 24: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and
Page 25: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Howwouldyoustagethese?

Page 26: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Stage1PressureInjury

Page 27: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Stage1pressureInjury

• Intactskinwithalocalizedareaofnon-blanchable erythema,whichmayappeardifferentlyindarklypigmentedskin.Presenceofblanchable erythemaorchangesinsensation,temperature,orfirmnessmayprecedevisualchanges.Colorchangesdonotincludepurpleormaroondiscoloration;thesemayindicatedeeptissuepressureinjury.

(NPUAP2016)

Page 28: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Howwouldyoustagethese?

Page 29: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Stage2PressureInjury

Page 30: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

STAGE2

Page 31: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Stage2PressureInjury

§ PartialThicknessSkinlosswithexposeddermis§ Woundbedisviable,pinkorred,moist,andmayalsopresentasanintact

orrupturedserum-filledblister.§ Adipose(fat)isnotvisibleanddeepertissuesarenotvisible.

Granulationtissue,sloughandeschararenotpresent.§ Theseinjuriescommonlyresultfromadversemicroclimateandshearin

theskinoverthepelvisandshearintheheel. Thisstageshouldnotbeusedtodescribemoistureassociatedskindamage(MASD)includingincontinenceassociateddermatitis(IAD),intertriginousdermatitis(ITD),medicaladhesiverelatedskininjury(MARSI),ortraumaticwounds(skintears,burns,abrasions).

(NPUAP2016)

Page 32: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Howwouldyoustagethis?

Page 33: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Stage3Pressureinjury

Page 34: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Stage3PressureInjury

§ FullThicknessSkinLoss§ Granulationtissueandadiposetissueoftenvisible§ Sloughand/orescharmaybevisible§ Depthofthetissuedamagevariesdependingonanatomicallocation(nostage3

onnoseandear)§ Underminingandtunnelingmayoccur§ Fascia,Muscleandtendonligaments,cartilage,andbonearenot exposed§ Ifsloughorescharobscurestheextentofthetissuelossthewoundbe

consideredUnstageable.

(NPUAP2016)

Page 35: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

STAGE3

Page 36: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Stage4PressureInjury

Page 37: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Stage4PressureInjury

§ FullThicknessandTissueLossexposedWITHdirectlypalpablefascia,muscle,tendon,ligament,cartilageorboneintheulcer

§ Sloughand/orescharmaybevisible§ underminingand/ortunnelingoftenoccur§ Depthvariesbyanatomicallocation§ Ifsloughorescharobscures----STILLASTAGE4!

(NPUAP2016)

Page 38: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

UnstageablePressureInjury§ Fullthicknessskinandtissuelossinwhichtheextentofthetissue

damagewithintheulcercannotbeconfirmedbecauseitisobscuredbysloughoreschar.

§ Ifsloughorescharisremoved,aStage3orStage4pressureinjurywillberevealed.

§ Stableeschar(i.e.dry,adherent,intactwithouterythemaorfluctuance)onanischemiclimbortheheel(s)shouldnotberemoved.

(NPUAP2016)

Page 39: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

UnstagablePressureInjury

Page 40: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

DeepTissuePressureInjury

Page 41: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

DeepTissueInjury§ Persistentnon-blanchable deepred,maroonorpurplediscoloration§ Intactornon-intactskinorbloodfilledblister§ Painandtemperaturechangeoftencanprecedeaskincolorchange§ Discolorationmayappeardifferentlyindarklypigmentedskin§ DTPIresultsfromintenseand/orprolongedpressureandshearforcesatthebone-muscleinterfaces

§ Canevolverapidlytorevealtheactualextentoftissueinjury,ormayresolvewithouttissueloss.Ifnecrotictissue,subcutaneoustissue,granulationtissue,fascia,muscleorotherunderlyingstructuresarevisible,thisindicatesafullthicknesspressureinjury(Unstageable,Stage3orStage4)

(NPUAP2016)

Page 42: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

DEEPTISSUEPRESSUREINJURY

Page 43: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Trials,TribulationsandInstitutionalRisk

• CentersforMedicare&Medicaidservicesrefusetoreimbursehospitalsforhospitalacquiredwoundsatastage3/4.(2007)• F-Tag314– Facilitymustensurearesidentdoesn’tdeveloppressureinjuriesunlesstheclinicalconditiondemonstratestheywereunavoidable.

• Thisplacesmoreemphasisondocumentationandensuringthatappropriateassessments,treatmentplansandwoundcareisreordered• Havinganadvancedprovidertoassessandorderwoundcaretreatmentsisamajorbenefit

Page 44: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WhatisaKennedyTerminalUlcer

• AKennedyTerminalUlcerisapressureulcersomepeopledevelopastheyaredying

Page 45: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Firstdescribed• NPUAP1989.• NamedafteraNPinFortWayneIndiana• Laterfoundtobedescribedin1877”DecubitusAcutus”byDr Jean-MartinCharcot.

• Controversy:isthisasymptomofdeathoracauseofdeath?• LawyerssaycategorizingKTUasunavoidableisirresponsible• 62%ofpatientsinhospicedeveloppressureulcersintheirfinal2weeksoflife

Page 46: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WhatdoesaKUlooklike

• Itusuallypresentsonthesacrumorbuttocks.• Itcanbeshapedlikeapear,butterflyorhorseshoe.• Itcanbered,yellow,blackorpurple.• Thebordersareusuallyirregular• Suddenonset• Commonstatements:“Ohmygoshthatwasnottheretheotherday”

Page 47: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

KENNEDYULCER

Page 48: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

HowdoesaKUprogress

• ItusuallystartsoutasablisteroraStageIIandcanrapidlyprogresstoaStageIIIorIV.• Mayinitiallylooklikeanabrasion.

Page 49: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Cause

• Moreresearchneeded• Skinutilizes25-30%ofthetotalcardiacoutputtomaintainperfusion.• Probablyendoflifeorganfailureofskin.• Usuallypartofmulti-organfailure• Itseemsthatskinoverbonyprominencesinparticularstartstoshoweffectsofpressureofamuchshortertimeframe

Page 50: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

HowaretheydifferentfromotherPI

• TheystartourlargerthatotherPI’s,andmaybemoresuperficialinitially.

• Thendeveloprapidlyinsize,depth,andcolor.

Page 51: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

BestTreatment

• TreatmentisthesameforotherPI.

• Whatyouseeiswhatyoutreat.

Page 52: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

MEDICALDEVICEPRESSUREINJURY

Page 53: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

DEFINITION

• “Pressureulcersthatresultfromtheuseofdevicesdesignedandappliedfordiagnosticortherapeuticpurposes.Theresultantpressureulcergenerallycloselyconformstothepatternorshapeofthedevice.”

EPUAP,NPUAP,andPanPacificPressureUlcerAlliance.“PreventionandTreatmentofPressureUlcers:ClinicalPracticeGuidelines.”SecondEdition2014,page119

Page 54: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

MEDICALDEVICEPRESSUREINJURY

Page 55: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

MEDICALDEVICEPRESSUREINJURY

Page 56: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

INCREASEDRISKWITH:

• Impairedsensation• Moistureunderthedevice• Poorperfusion• Alteredtissuetolerance• Poornutritionalstatus• Edema

Page 57: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Commondevices

• Nasogastrictubes• Feedingtubes• Endotrachealtubes• Tracheostomytubes/collars/straps• Oxygendelivery–Mask• – Nasalcannula

• IV/PICCline/Centrallines• Anti-Embolicstockings• bedpans

Page 58: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

UNAVOIDABLE?

• Whenitismedicallycontraindicatedtoadjust,relocate,orpadunderneathatherapeuticdevice

• Whenalifesustainingvascularaccessorothermedicaldeviceprecludesturningandpositioning

• Whenunderlyingedemaoruncontrollablemoistureunderdevicecompromisestissuetolerancetopressure/shearforces

Page 59: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

STRATEGIESFORPREVENTION

• Properselectionandfittingofdevice• Communicatewithpatientifpossible• Closeobservation• Extensivecareplan• Education• Consistentreassessment/re-evaluation• Teaminvolvement(PT/OT)• Followmanufacturersspecifications• Securedeviceproperly

Page 60: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

RoadtosuccessDetailedWoundAssessment/RiskAssessment

IndividualizedCarePlanning

Evidence-BasedTreatment

Documentation

Documentation

ExternalSupport

Page 61: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

LearnMore!

• www.healu.firmwater.com

Page 62: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Kick-OffTo

Team-CenteredWoundCare

Page 63: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WhatMakesaWinningTeam?

– Focusingonpatientcare–Willingtodiscussideasandchallengeeachotherinapositivewaywhilealwaysmovingtoasolution.–Understandingthattogetherwearebetterthanifweworkedindependently:• Bringingdifferenttreatmentideastogethertofindthebesttreatment• Servingeachothertoprovidecarethatwouldbeextremelydifficultforoneperson(onepersontreats,onepositions,onecharts)• Dailycarecombinedwithweeklyconsultingwithanexpertcanproducefaster/morecompletehealing.

Page 64: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WinningComponentsofWeeklyWoundRounds• ConsistentTeammembers• OrganizedApproach• AccurateWoundAssessments• Evidence-BasedTreatments• InfectionPrevention• ConsistentDocumentation• Routine

Page 65: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

WoundRoundsFlow

Huddle

Position

AssessWoundBedPrep

Dressing

Page 66: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Team-CenteredWoundCare

• 2cohortsofskilledpatientswithallmajortypesofchronicwounds• 311hadstandardnursingcare(internallyled)• 372hadmultidisciplinaryteamledbyanexternalwoundmanagementgroup• 10monthstudy• 3primaryoutcomes

• Daystoheal• Woundrelatedre-hospitalizations• Cost

DeZanzo etal.2011

Page 67: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Internallyvs.ExternallyLedWoundCare

• 115averagetreatmentdays

• 0.21%re-hospitalizations/dayduetowoundcomplications

• $354.26perresidentday(didnotincludeoutsidetransportation)

• 94averagetreatmentdays

• 0.08%/day

• $229.07perresidentday

Page 68: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

• Internalgroupwoundcarecosts$40,678.63• Externallyledcosts$21,449.00

• Woundshealedfaster• Lesswoundrelatedcomplications/hospitalization

• Iwouldventurethatthequalityofcareinothernon-woundrelatedareasincreasedalthoughthiswasnotstudied.Simplybecauseoflesseffortandenergyspentonwoundmanagement.

Page 69: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

• 50+SkilledNursingFacilities• King• Peirce• Skagit• Gray’sHarbor• Thurston

Page 70: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

UnitedWoundHealingWashingtonDataWoundType FacilityAverage NationalAverage

ArterialUlcer 40 81Dermatologic/Rash 24 42DiabeticUlcer 40 83Other 32 57PressureUlcer 33 71SkinTear 15 30SurgicalWound 30 67VenousUlcer 53 69TotalAverageDaysToHeal 35 69TotalWoundsIncluded 1326 266222FacilitiesIncluded 84 803

Page 71: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

IDTTeamMembersPresent• DNS/ADON• DietaryManager/RD• Therapist• SDC• CNA/NAC(newregs)• UnitManager/RCM’s• MDSnurse

IDTSkinReview

Page 72: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Mrs.Jones

• 86yof• Admittedafterrecenthospitalization• Hipfracturerequiringsurgicalintervention• ICUstay

Page 73: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Mrs.Jones

• What’snext?• AdmissiontoDischarge

Page 74: Team -Centered Wound Care: Making Your Wound Care Safe …Stage 2 Pressure Injury § Partial Thickness Skin loss with exposed dermis § Wound bed is viable, pink or red, moist, and

Questions?LearnMore!

• www.healu.firmwater.com


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Chronic Wound Care Guidelinesmultimedia.3m.com/mws/media/618708O/chronic-wound-care-guide… · Chronic Wound Care Guidelines Abridged Version The Wound Healing Society. ... despite

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1 EXCOR ® Wound Care. EXCOR ® Wound care : General information Wound care following antiseptic standards Proper wound care minimise the risk of infection

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Surgical Wound Care Guideline - bestpracticeinsurgery.cabestpracticeinsurgery.ca/.../2018/11/BPS-Wound-Care... · or dehiscence, wound healing, post-operative care, and bandages

360 Degrees of Wound Care - - OHCA - Ohio Health Care ... Degrees of Wound Care... · 360 Degrees of Wound Healing ... Clinical Operations, Northeast Surgical Wound Care (NESWC),

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ORAL WOUND HEALING - nextleveldentistry.net€¦ · Wound healing, or wound repair, is an intricate process in which the mucosa, skin or dermis repairs itself after injury In normal

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