Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving,...
Transcript of Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving,...
![Page 1: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/1.jpg)
Wound Care in LTC facilities
L. Gurvich APN, M.S., MPH, CWS.L. Gurvich APN, M.S., MPH, CWS.
Chicago 2009
![Page 2: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/2.jpg)
Purpose
Wound Care expertise (CWS) “Bringing” Wound Center to NH Emphasizing prevention as a core value Emphasizing prevention as a core value Instant staff in-service and education
![Page 3: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/3.jpg)
Program Benefits
Higher RUG score for MDS Longer LOS for Medicare patients Constant supervision of patient care Constant supervision of patient care Goal is “0 tags“ on PH inspections
![Page 4: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/4.jpg)
Program Benefits
Defensive documentation against “tags” Reduction in risk of lawsuits Avoiding hospital visits and admissions Avoiding hospital visits and admissions Cost
![Page 5: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/5.jpg)
How it works?
Weekly rounds with wound team E&M wounds of all etiology, abscess.. Bed side sharp clinical debridements Bed side sharp clinical debridements Prescribing treatment orders, care plan F/U visits, on-call 24/06
![Page 6: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/6.jpg)
How it works?
Goal: Restoring natural path of healing Treating the cause of problem: Vascular assessment: Doppler,… Vascular assessment: Doppler,… Pressure Offloading: surfaces, pillows…
![Page 7: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/7.jpg)
Wound care is not just skin care
Nutrition: Alb,(prealb) Vit’s, G-Tube Infection: tissue C/S, Antibiotics
systemic and topicalsystemic and topical Multidiscipline : PT, OT, Dietary, PCP,
CNA’s
![Page 8: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/8.jpg)
Before we start
Care based on written order from PCP Order should be placed in patient chart. Informed consent for wound Informed consent for wound
evaluation, debridement andphotography signed by patient or POA.
For first time telephone consent is O.K
![Page 9: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/9.jpg)
Expectations:
Carrying out treatment orders Following the treatment plan Report about any significant change in Report about any significant change in
Pt condition or treatment plan Update PCP and families about progress
![Page 10: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/10.jpg)
Treatment cart
Container for sharps instruments Disposable tray for each Pt
![Page 11: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/11.jpg)
Treatment tray
Biohazard Red bag
![Page 12: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/12.jpg)
Documentation
Printed consultation notes after eachvisit.
Notes placed in Pt’s chart Notes placed in Pt’s chart Notes as a source for care plan Narrative notes reflecting wound care
progress / specialist site visits
![Page 13: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/13.jpg)
Debridement
before after
![Page 14: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/14.jpg)
Debridement
before after
![Page 15: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/15.jpg)
Debridement
•
after
![Page 16: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/16.jpg)
Debridement of R Hip decubitus ulcer
![Page 17: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/17.jpg)
Current healing state
![Page 18: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/18.jpg)
Frost bite
![Page 19: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/19.jpg)
Frost bite healing state
![Page 20: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/20.jpg)
Self-trauma / Burn
12-2007
![Page 21: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/21.jpg)
Healed
Healed 11 months later
![Page 22: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/22.jpg)
4 weeks
Heel Decubitus ulcer. 89 Y Female, Dementia, Contractures
11-20074 weeks
12 months Healed 15 months later
![Page 23: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/23.jpg)
Diabetic foot with Osteomyelitis
12-2008 Healed 3 month later
![Page 24: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/24.jpg)
Bilateral Ischium stage IV ulcers
1-16-091-16-09
Healed 9 month later
![Page 25: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/25.jpg)
Documentation
Aq/Admit Date
TunnelingColor
IV Pressure/ Vascul/Skin alterUlcers Location SacralStage/ Type
Size LxWxD in CmUndermining 2cm at 12 o'clock
4 cm at 6 o'clockP/R/B/Y/Br
Exudate Amount modExudate Type serGranulation Amount/Type ##Necrosis/Eschhar Am #Slough/Fibrin Amount #
ErythemaOdor
Dressing Instruction Dressing InstructionFrequency QD And PRNClean with
Cover withAnchorage and
Slough/Fibrin Amount #Periwound Mac/ Red/Indurated
Signs of Infection minimalExposed Tend/Mus/Bone BTM
2cmMin/ Foul/Necrotic
Changes since last visitImproved/Worsed/Unchanged
Topical ApplicationN.Saline/WCleanser
ACE band/ Take off HS
Santyl + Adaptic4x4
![Page 26: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/26.jpg)
Date
Braden Scale
SensoryPerception 2 Bed Moisture(
1
Walking Activity 1 Bed Mobility 3
Nutrition 3 Friction and Shear 2
Risk factors contributing to wound healing
Braden Scale < 18 x
Age 65 or older x Dementia Malnutrition Vasculitis
Agitation Def- Feet Medications xVenousStas
Anemia Diarrhea MSUnderweightAnemia Diarrhea MS t
Arthritis Edema Multi S. DisWeightLoss
CAD Frail PVD
Cancer & Chemother Fracture/Cast Obese Others
Chewing difficulties x Hemodialysis Pain xNo improved for 2-4weeks
Confusion Hospice Parkinson
COPD/Resp Fal Immun-suppr Renal Insuf
Contractures Steroids Sepsis
CVA A.Immune Dis Skin Path
Dysphagia Immobility
Diabetes Incont Urine SCI x
Dehydration Incont Fecal Spasticity
Depression Liver Dis Tobacco Use
![Page 27: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/27.jpg)
Preventive Measures Recommended or Already inplace
Daily Skin Check Foam Wedge/ Positioning Pillows
Sitting in w/c only for meal time x Restorative Program x
2 hrs Turning schedule G Tube
Stage Appropriate Mattress Foley
Heel Protectors x Colostomy x
W/Ch Cushion Texas Cath
![Page 28: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/28.jpg)
Conclusion
• Comprehensive wound care program• High healing rate• In-service, staff education• High cost- effectiveness• High cost- effectiveness
![Page 29: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/29.jpg)
After conclusion
Treat a whole patient and
notnot
a hole in the patient
![Page 30: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/30.jpg)
About the Author
• Leon Gurvich: is an Adult Nurse Practitioner• Master of Public Health ( MPH)• Board certified Wound Specialist (CWS )• 15 years of Nursing experience• 15 years of Nursing experience• 10 years of Wound care practice
![Page 31: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/31.jpg)
Publications and research
• Poster Presentations in Symposium on AdvancedWound Care in 2006, 2007, 2009 with main topics: Limbpreserving, Maggots treatment, Growth factors therapy
• Publications : Article “Double impact”: Synergism in• Publications : Article “Double impact”: Synergism inusing Negative Pressure Wound Therapy with alternatedapplications of Autologous Platelet-Derived GrowthFactors in treating post acute surgical wounds. Caseseries.” “WOUNDS” Journal, May 2009.
![Page 32: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/32.jpg)
Appendix: supply recommendations:
Nursing home in house stock: Hydrogel ( SAF Gel or Integrity)
Non adhesive :Adaptic Non adhesive :Adaptic ACE bandage 4 and 6 inch Tubigrip sizes: D, E, F Collagens/ Alginates
![Page 33: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/33.jpg)
Appendix: supply recommendations
Collagens: Fibracol,Prizma, Promogran,Puracol
Alginates: Aquacel,Ag, Maxsorb None adhesive: Adaptic, Aquaphore Ointments & Creams:Hydogel, Baza, A+D SkinLotion: Ammonium Lactate12%, Eucerin, Enzymatic: Santyl, Xenaderm
![Page 34: Wound Care in LTC facilitiesWound Care in 2006, 2007, 2009 with main topics: Limb preserving, Maggots treatment, Growth factors therapy • Publications: Article “Double impact”:](https://reader036.fdocuments.in/reader036/viewer/2022071015/5fce2178a4338a627d3de50a/html5/thumbnails/34.jpg)
Appendix: supply recommendations
Compression: Profore and Profore Lite, Unnaboot, ACE bandage 4’’ and 6”, Tubigrip orMedigrip sized C, D, EAntiseptic solution: Iodine solution, Dakin’s Antiseptic solution: Iodine solution, Dakin’s½ str solution
Silver based products: Silvadene cream,Silvasorb gel, Acticoat absorbent and Acticoat -7
Antimicrobial: Iodoflex, Iodosorb, Bactroban,Triple antibiotics, Bacitratcin . Iodoform Tape.