In Wound Care, One Size Does Not Fit All
by Ivy Razmus, RN, PhD, CWOCN
As we continually focus on improving our skills in prevention and management of skin and wounds, we are beginning to understand that one size does not fit all; or, in other words, prevention and management in wound care are dependent on the size and age of the patient. In wound care, one method of care does not fit all types of patients. Although those clinicians who work with younger populations know this to be true based on our personal experience, this can be a problem if purchasing of products for younger patients' skin and wound care is decided without the input of the providers and caregivers who care for them.
Purchasing Issues in Pediatric Wound Care Products
Often health care departments use the 80/20 rule and focus on purchasing products that work for the majority of their patients, who, in a community hospital, are adults. It is possible that adult products are being used for pediatric patients, and, in some cases, they may be effective. However, even within the realm of pediatric care, one type of electrode that has been used successfully in the pediatric patient may not always be effective in the premature infant. There are variations in skin care needs from premature infants to toddlers up to adolescents.
This diversity creates a challenge when convincing purchasing agents that a more effective but also more expensive product should be chosen over a less effective but also less expensive product. Some products that are effective for pre-operative preparation in adults may cause skin damage during the same in the premature infant. Products can also be absorbed into the skin and be harmful to skin cells.
Challenges in Research in Pediatric Patients
There is a lack of information for using evidence-based practice in the selection of appropriate skin and wound care products in pediatric care. This is most likely because infants and children are vulnerable populations and conducting research may be more difficult in the health care setting. For patients who are in the hospital for a prolonged period this can present challenges in obtaining consent. It is also more difficult to conduct research because the parent must consent to participation. Not all staff are able to obtain consent, and time-wise, the patient's parents or designated guardians must be present at the same time, which is not always possible.
There are also limited personnel with the ability to do research in a health care setting unless they partner with an academic institution with resources for Institutional Review Board approval and methods in data collection oversight, processes, data analysis, and dissemination of this information. Consequently, we have limited information beyond case studies about what is most effective for skin and wound care for the wide variety of pediatric patients.
In summary, health care providers for infants and children are limited in their ability to advocate for products that are specific to younger patients because of the lack of wound and skin care intervention studies that would provide an evidence base. Wound care professionals working with children know this to be true because we have limited evidence to support wound care interventions besides our personal experience. Although some adult products can be used successfully in infants and children, they were not developed for use in younger populations, and because of this, they may pose health risks. Future research is needed to support the use of wound and skin care products that are developmentally based.
About the Author
Ivy Razmus, RN, PhD, CWOCN is an Assistant Professor at the University of Detroit Mercy where she is currently teaching in the BSN Nursing program. Her research focus is on pressure injury prevention for pediatric patients including neonatal patients. She has experience as a Manager of Pediatric populations both neonatal and pediatric intensive care; as a quality analyst within a health system focusing on nursing sensitive quality indicators and root cause analysis; and as a CWOCN in the acute, critical and outpatient settings in the adult population.
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.