By Beth Hawkins Bradley RN, MN, CWON
We just can’t resist New Year’s resolutions. This is the time of year when we reflect back on aspects of the year that is ending, and determine to do some things differently in the year that is dawning. If you are reading this, then you likely use negative pressure wound therapy (NPWT) in your clinical practice. If you use this valuable therapy to help your patients’ wounds to heal, then you are aware that NPWT comes with risks. Our friends in the legal profession certainly understand this. Look back at the FDA Safety Alert issued in February 2011 in response to increased injuries among patients receiving NPWT. The FDA concluded that many of the injuries and deaths were related to insufficient observation of wound dressings and lack of patient teaching.
When I went to work for an NPWT company, I assumed responsibilities for education and support of our products. Parts of my duties include overseeing a 24 hour clinical support telephone line. I have been surprised and disturbed by the number of calls from patients who have been placed on NPWT, sent home from a facility or clinic, are seen by home care, but have received no training! In an effort to help you help your patients, below is a list of elements that should be included and documented for patients who are placed on NPWT. Remember: giving your patient a fact sheet or verbal instructions is not enough. Have them quickly return demonstrate or repeat instruction back to you.
- How to plug the device in and ensure that it is receiving power
- Take the power cord along when leaving home for any reason
- How many hours per day the device should be in use
- How to manage the device and dressing if showering is allowed
- How to turn the device on and off
- How to interpret alarms
- Canister change, safe handling and disposal
- How to detect bleeding, assessment of drainage in tubing and canister
- What a normally functioning dressing looks like
- How to detect and troubleshoot leaks (be sure that the patient has materials to patch with!)
- Action plan if a leak cannot be stopped; should the patient call his home health agency, go to an ED, or apply moist gauze dressings?
- Action plan for bleeding
- Emergency action plan
- How to reorder supplies when there is only one week’s stock left
- How to contact clinical support for the device manufacturer
This list seems daunting, but you can accomplish this in a few minutes. As you are applying the dressing, talk to the patient about normal dressing appearance, detecting leaks and patching them. As you are setting up the NPWT device, have the patient or family member turn it on, place the canister, and plug it in. Discuss the other topics listed and reinforce with written patient guides. An efficient way to make sure that you cover both the instruction and documentation necessities is to include these elements in a form, give one copy to the patient and keep a copy in the record. I developed a form of this type; since it is product specific it is not included here. If you contact me I will gladly send it to you.
Thank you for reading this through, and for all of the things that you do to help people heal their wounds. Your efforts make a real difference in the lives of your patients. Best wishes for all success in 2013!
About the Author
Beth Hawkins Bradley, RN, MN, CWON is the director of Clinical Operations at Cardinal Health. She has been certified in the specialty of Wound, Ostomy, Continence nursing since 1990.
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.