Long-Term Care

Cheryl Carver's picture
Terminology

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

It is 2018, and health care professionals around the world are still debating what to call skin damage. I totally immersed myself in wound care because of losing my 47-year-old mother to what was then called "decubitus ulcers." I was young when my mother died, and I wanted to know why and how this could happen. My perspective is different from that of most clinicians because of my personal experience.

My purpose in writing this blog is not only to share my opinion but also to shed a different light on this controversy. There have been many debates at conferences, in the workplace, and on social media forums. After all of these discussions, there doesn't seem to be an easy answer. Based on this dissension, we need not only to establish the correct term but also to make revisions to the staging system itself. Some argue that if you change the term, the definitions automatically change. There have been some revisions, but are they enough?

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Holly Hovan's picture
Geriatric Skin

by Holly M. Hovan, MSN, APRN, ACNS-BC, CWOCN-AP

With a growing population of Americans aged 65 or older, it is important to know what skin changes are normal and abnormal and what we can do in terms of treatment, education, and prevention of skin injuries.

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Cheryl Carver's picture

By Cheryl Carver, LPN, WCC, CWCA, CWCP, DAPWCA, FACCWS, CLTC – Wound Educator

As it stands now, we have 1.6 million nursing home residents in the United States; that number is expected to double by the year 2030. Bringing advanced wound care to the long-term care arena is becoming more common throughout the country. Physician-based wound groups can bring their expertise to the patient's bedside, thereby saving the patient pain during transport to the wound center and lowering costs. However, certain procedures—such as total contact casting and bioengineered skin substitutes—cannot be performed at the bedside because of billing and reimbursement guidelines.

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Cheryl Carver's picture
Documentation Error

By Cheryl Carver, LPN, WCC, CWCA, CWCP, DAPWCA, FACCWS, CLTC – Wound Educator

Most of my experience has been in the hospital wound center setting. However, in the last five years you could say I was converted into the long-term care arena, where I felt I could help most from an education and documentation standpoint. I have trained many physicians on how to best document inside the long-term care setting, because of the federal guidelines and annual surveys. Documentation in long-term care is substantially different from documentation in the hospital, and providers have a higher liability in this setting, given all the wound-related lawsuits. However, the documentation discrepancies can vary. I have given you a few case scenarios in this blog to help define consistent documentation.

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Aletha Tippett MD's picture
Pressure Ulcer Prevention

by Aletha Tippett MD

How do you prevent pressure ulcers? This is an interesting question and one that eludes many. Currently, I am involved in reviewing research proposals to prevent pressure ulcers (injuries). The funny thing is that there is nothing new. Everyone is using the same known techniques, just trying different forms. However, there is a proven way to prevent pressure ulcers and it was done years ago in a Cincinnati nursing home I was working in without any fanfare. The results from this nursing home wound care program were even published.1

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Susan Cleveland's picture
Preventing MASD by Moving

by Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

The long-term care setting has changed over the years: it has become an even more concerning issue because our population is no longer just older adults looking for a place to age, but now includes a wave of acutely ill individuals with multiple comorbidities. And yet despite these changes, skin issues continue to be a problem. Moisture from any source increases the skin’s permeability and decreases the barrier function. The outmost layer of the epidermis, the stratum corneum, is normally slightly acidic and protects the body from pathogens when intact. If the skin is compromised by moisture or moisture with friction, a break in the surface can allow pathogens to enter.

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Susan Cleveland's picture
Long-Term Care Patient

by Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

As a Director of Nursing (DON) in a long-term care facility, do you know where the awareness level of diabetes and its complications is for your staff? Do they realize diabetes doesn’t stop? It is 24/7, 365 days a year. Knowing this reality of diabetes and understanding the disease process may assist with preventing serious health problems such as heart disease, stroke, blindness, kidney disease, and nerve damage that can lead to amputation.

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Holly Hovan's picture
Moisture on Skin

When nurses hear the term moisture, they usually almost always think of urinary or fecal incontinence, or both. There are actually several other reasons why a patient could be moist. Continued moisture breaks down the skin, especially when the pH of the aggravating agent is lower (urine, stomach contents—think fistula, stool). When there is too much moisture in contact with our skin for too long, we become vulnerable to this moisture, and our skin breaks down. Increased moisture places a patient at risk for a pressure injury as the skin is already in a fragile state.

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Holly Hovan's picture
neuropathy testing for sensory perception (Braden Scale)

By Holly Hovan MSN, APRN, CWOCN-AP

As wound care professionals, the Braden Scale is near and dear to our hearts. With that in mind, our evidence-based tool needs to be used correctly in order to yield accurate results. Working with long-term care and geriatric populations opens up a world of multiple pre-existing comorbidities and risk factors that aren’t always explicitly written into the Braden Scale categories. Additionally, the frequency of the Braden Scale may also contribute to a multitude of different scores; the resident behaves differently on different shifts, for example, asleep on night shift but up and about on days. What is the correct way to score them? I believe that a less frequent Braden Scale assessment yields more accurate results. However, we should still complete a Braden Scale on admission, transfer, receiving, and most importantly, with any change in condition.

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Cheryl Carver's picture
long-term care wound education

By Cheryl Carver LPN, WCC, CWCA, CWCP, FACCWS, DAPWCA, CLTC

I tell everyone that long-term care is the toughest arena for a wound consultant. However, it can also be the most rewarding. The focus of this month's blog is to give you an inside look of what really goes on in nursing homes versus other health care settings.

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