Taking Consideration: Peer Knowledge as a Factor in Wound Care Decisions

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by Lydia A Meyers RN, MSN, CWCN

In recent months, I have gained insight into a problem that appears to be universal across the continuum of care and across the country as I’ve worked in different facilities and in different capacities. I have found some people accepting of new information and others that feel they know it all and are unwilling to accept information from their professional peers. As those that know me well know, wound care is my passion. The only thing that hurts more than having a peer professional discount information is seeing the impact it can have on a patient and witnessing the resulting suffering - loss of limbs, loss of quality of life and loss of independence - all because the one making the wound care decisions couldn’t see beyond the end of their nose.

A patient threatened with the loss of a limb faces being put in a nursing home, because he/she no longer has the ability to be independent. This costs the Government more money, since the cost of nursing home care is greater than keeping that person at home. How can amputation be better than letting the patient have a life of independence? I cannot say that every limb can be saved, but how many times has the opinions of others been taken into consideration before giving up and saying that amputation is the best approach?

My heart hurts when I see patients condemned to a life of being in bed for months or even years while an amputation wound heals. A patient looking at four walls, having family that does not have time to be there or not having any family in his/her life...where is the quality of life for these patients? My heart further aches knowing wounds can heal well and quickly with the right interventions. Is it better to overuse Government money and decrease the patient’s quality of life than to look to evidence-based care and accept the knowledge of those that have studied hard and long on the subject?

I do not present myself as the know-it-all expert in wound care and I will often seek out information from those who know more than me. No one person knows everything about wound care and it is an ever growing field of study. I just wish practitioners would stop wet-to-dry and wet-to-moist dressing with gauze, the use of Dakin’s Solution on too many wounds, and the use of daily dressing changes when there is research that shows these are not the standards of care.

If I ever need open-heart surgery, I hope I have time to seek the best. I will not choose just any surgeon, but one that specializes in cardiac surgery. I will seek one that keeps up on evidence-based care. I will seek a doctor that participates in ongoing education and studies changes in medicine. I am not saying only the young doctors know it all or that the older doctors have all the experience. Neither is true. It is the doctor that does not let their ego become so big that they think others do not know as much about cardiac care. Every person has strengths and weaknesses and it is the doctor who takes and factors all of the information into their decisions, whether it is self-knowledge or that presented by professional peers that I want to seek for my care.

I will end with a story from my past and hope that some healthcare professionals think about this before making a care decision based on their “knowing it all”:

A patient came into the office after having surgery performed on their foot by another physician. The physician sent the patient for a consultation for an amputation. The surgeon looked at the foot and could not believe what he saw: the patient had negative pressure wound therapy (NPWT) placed on top of her foot. When it was taken off, there were tendons and bones present without the protection of any type of dressing that would keep them moist. There was no way to save these very important tendons and bones. The surgeon very quickly scheduled the patient for hyperbaric oxygen therapy (HBOT), stopped the NPWT and started a moist dressing. The patient had HBOT for three weeks and then surgery scheduled to remove the tendon and place a synthetic graft in the cavity. The HBOT continued for two more weeks and the patient walked out with both feet. This was a patient in her 40s and has a long life ahead of her.

Had this surgeon not had the intelligence to consider all of the information available to inform their decision, and many years of experience of wound care, this story could have ended differently. In addition to his own expertise, the surgeon also relied on his nurse case manager to help guide this patient’s treatment steps and have all the tests scheduled as needed. The surgeon never believed he knew it all and would use those around him when he was not sure what was best to do. This was a surgeon that was aware of new treatments and evidence-based care, and was able to consider the professional knowledge of others. This is a surgeon that took the time to teach others on the wound care team and treated his nurse with respect for having strong knowledge about wound care.

About the Author
Lydia Meyers RN, MSN, CWCN has been a certified wound care nurse for over 15 years with experience working in home healthcare, extended care facilities, hospice care, acute care, LTAC, and wound clinics. Her nursing philosophy to "heal wounds as quickly as possible" is the guiding force behind her educational pursuits, both as a teacher and a student.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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