Holly M. Hovan, MSN, APRN, GERO-BC, CWOCN-AP

By Holly M. Hovan, MSN, GERO-BC, APRN, CWOCN-AP The third Thursday in November is a highly recognized day within many hospital systems and wound care programs. This day is recognized nationally as World Wide Pressure Injury Prevention Day, highlighted by the National Pressure Injury Advisory Panel (NPIAP). The third Thursday in November is a time to bring awareness to pressure injury prevention, treatment, and research. Each year, we highlight this day a little bit differently, but this year definitely looked much different from years past.

Education is key in sustained positive outcomes and it is the first step in understanding pressure injury prevention, for both patients and staff. It's very difficult to hold people accountable for something that they did not know. Therefore, prevention starts with education. For education to be impactful, it should also be fun. Interactive games, small prizes or candy, and engaged and energetic educators are key to fostering an environment where people will remember what they are taught. The teach-back method and continued follow-up and reinforcement are also essential elements of a successful education plan.

Identifying wound etiology before initiating topical treatment is important. Additionally, correctly documenting wound etiology is significant in health care settings for many reasons. Accurate documentation and appropriate topical treatment are two critical components of a strong wound treatment plan and program. Bedside staff members should be comfortable with describing wounds, tissue types, and differentiating wound etiologies. Training should be provided by the certified wound care clinician, along with follow-up (chart reviews and documentation checks, one-on-one education as needed, and routine competency or education days). Additionally, the wound care clinician should be able to develop an appropriate treatment plan based on wound etiology, by involving additional disciplines as needed to best treat the whole patient.

“Top-down skin injury” is an increasingly common term used to describe superficial cutaneous injury. These injuries result from damage beginning at the skin’s surface or soft tissue. In contrast, “bottom-up” injuries are often the result of ischemia. Top-down injuries are usually caused by mechanical forces, inflammation, or moisture. Medical adhesive-related skin injury (MARSI) is a frequently seen type of top-down skin injury that is almost always preventable. In this blog, I focus on preventing MARSI and describe the different techniques and adhesives (along with adhesive alternatives) available for use.1

By Holly M. Hovan, MSN, GERO-BC, APRN, CWOCN-AP Wound assessment is one of the initial steps in determining the plan of care, changes in treatment, and the choice of key players in wound management. However, wound assessment needs to be accurately understood and documented by frontline staff to paint a true picture of what is happening with the wound.

By Holly Hovan MSN, APRN, ACNS-BC, CWON-AP In patients with end stage renal disease (ESRD), there is a decreased renal clearance that causes an increase in phosphorus, then calcium, in the body. Elevation of these two electrolytes causes the parathyroid gland to secrete additional parathyroid hormone to compensate. This, however, leads to increased movement of phosphorus and calcium throughout the body.

By Holly Hovan MSN, APRN, CWOCN-AP A fistula is an abnormal opening between two areas that typically shouldn't be connected, or with an epithelialized tract. An example is an opening from the bowel to the abdominal wall, termed enteroatmospheric or enterocutaneous (the terms are sometimes used interchangeably) because this fistula is exposed to the atmosphere, or is open from the abdomen to the skin, and typically needs to be pouched or some type of containment of the effluent.

By Holly Hovan MSN, APRN, CWOCN-AP As wound care clinicians, we are aware that part of the process of consulting requires a comprehensive wound assessment, looking at wound characteristics, causative factors, and drainage. As I've previously mentioned, we've all heard the term, "a dry cell is a dead cell." However, not all wounds are dry.

Wound care and healing require an evidenced-based, interprofessional approach, following standards of care, and treating the whole patient, not just the hole in the patient. Often, wound care clinicians are consulted for recommendations on the treatment of chronic or non-healing wounds, as well as other wound, ostomy, and continence issues. Treating a wound and successfully healing a wound require a holistic approach for the best outcomes.

Holly M. Hovan MSN, APRN, ACNS-BC, CWOCN-AP Payne and Martin brought skin tears to the attention of wound and skin specialists and to the wound care community when they reported an incidence rate of 2.23% in individuals aged 55 years and older, living in a long-term care facility. A skin tear is "a wound caused by shear, friction, and/or blunt force resulting in a separation of skin layers." Skin tears may be partial- or full-thickness wounds, develop into chronic wounds without proper treatment and follow-up, and, most importantly, are preventable.