Patient Accessibility

By Robert Striks, Special Writer, Encompass HealthCare & Wound Medicine There's a funny scene in the Marx Brothers movie, "Horse Feathers," where Chico tells Harpo how to escape from the room they are locked inside by using a rope. Chico instructs Harpo to tie one end of the rope to the bed and then throw the other end of the rope out the window. "Tie on the bed, throw the rope out the window," he repeats. Haplessly, Harpo takes the tie he was wearing around his neck, places it on the bed and then throws the entire escape rope out the window.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA It is hard to read a newspaper (my preferred news source) or an online news site without discovering false information. I recently read an NPR article about how to vet news yourself and how to recognize this.1 The vulnerability I felt made me think about protecting my decisions from this reporting and even more, how I can help my patients weed out fake reports.

By Diana L. Gallagher MS, RN, CWOCN, CFCN Last month, the news shared two important stories that were closely linked. Walmart announced the closing of 102 Walmart Express stores as part of their overall restructuring and statistical analyses revealed the states with the highest levels of obesity. These two stories prompted discussions about food deserts and their tie to obesity.

By Margaret Heale, RN, MSc, CWOCN "Must Love Dogs (Cats, Lizards, Snakes, Birds, AND Arachnids)." This is a line that needs to be next to all job advertisements for home health care staff. You see, I am a dog lover, not because I love dogs but because I have a way of being able to adapt in order to survive. I work in home care as a clinical nurse specialist and have slowly learned to love dogs ever since I was reported to my manager for mentioning I didn't like them much. Shortly after this I was told not to visit a patient whose cat I had shooed away from my wound dressing field. While discussing this with a colleague, she told me of the bird that had landed on her head that morning just as she was probing the patient's foot wound with a Q-tip. Maybe everybody has had experiences like mine, but maybe not, so I would like to put mine to paper to entertain you in this season of good cheer.

By Thomas E. Serena MD, FACS, FACHM, FAPWCA Fans of folk singer John Prine will recognize the homey lyrics describing his views on organ donation. Sitting at my desk a few weeks ago with John Prine twanging in my headphones, I began to slog through the new Noridan Local Coverage Determination (LCD) on hyperbaric oxygen therapy (HBOT). It should not have come as a surprise that the Centers for Medicare & Medicaid Services (CMS) is planning prepayment review for HBOT services. We have been struggling for months in New Jersey, Michigan and Illinois with preauthorization. What is frightening is that a large number of the denials we have seen are completely nonsensical, bureaucratically driven, and dangerous: a patient with osteoradionecrosis of the jaw, for example, was denied because she didn't have 30 days of standard of care; or perhaps the CMS keyword search engine selected out a proscribed adjective!

em>By Rob Striks, Special Writer Encompass HealthCare and Wound Medicine One of the most heartbreaking scenes in Forrest Gump is when Lieutenant Dan is coming to grips with the loss of his legs. Robbed of his perceived destiny of dying proudly in battle like his ancestors, and with the weight of his world collapsing down on him, an exhausted Lt. Dan Taylor sighs, "What am I going to do now?"

By Karen Zulkowski DNS, RN, CWS All medical personnel strive to provide care based on the strongest available evidence. Yet how many of us provide culturally competent care? Culturally competent care is defined as having specific cognitive and effective skills that are essential for building culturally-relevant relationships between patients and providers.1 We may know about local customs but in today’s global world our patients may be from a different area of the world. So how would you react if your Asian patient wanted to use non-traditional medicine or your patient of the Sikh faith refused to remove their underpants prior to surgery?

It all started with a phone call at close to midnight on a Saturday night from my physician’s phoneline app. It was an established wound care patient calling me to state that his negative pressure therapy device went awry. He was requesting advice to resolve the issue. Out of these growing concerns, he stated that if there was no solution, he would be immediately reporting to our hospital emergency room, which was not his preference in such a situation. In response, I simply informed the patient it was safe to turn off the device and that I would make a home visit to him at 5 o’clock the next morning. With a sigh of relief, he agreed to the plan.

Refractory wounds comprise a significant worldwide health problem, affecting 5 to 7 million people per year in the United States alone, as discussed in previous blogs. Wounds that fail to heal not only impact quality of life, but also impose a significant physical, psychosocial, and financial burden. Additionally, individuals with refractory wounds often experience significant morbidity, and sometimes mortality. Wound infections and amputations are common in this population, and chronic conditions often exist as well.