Patient Outcomes

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

You might notice the hospital halls seem a little quieter around the holidays, the unit census may be down, and patients may be asking about their discharge plans. The holidays can be a time when patients want to be home (when they're able to).

By Kathy Gallagher, DNP, APRN-FNP, CMC, UMC, BC, WCC, CWS, FACCWS

In 2010, Christiana Care Health System, a 1,000 bed Level I trauma center in Wilmington, Delaware, introduced an acute surgical wound service (ASWS) integration plan in with a single dedicated nurse practitioner, trauma surgeon, and administrative leader. Subsequently, trauma patients with complex wounds experienced decreased morbidity and length of stay. Closely aligned with these numbers, their patient days of negative pressure wound therapy fell from 11+ days in 2010 to 8.2 days in 2018, representing one of the lowest in the nation.

Christine Miller, DPM, DMM, PhD, FACCWS

One of the most difficult aspects of patient care is dealing with non-compliance. How do we help those who refuse to help themselves? This question is very convoluted indeed! The best treatment protocols in the world will be unsuccessful if the patient does not follow the recommendations. Patients with chronic wounds are usually those with multiple comorbidities such as uncontrolled diabetes, autoimmune disease, and uncontrolled hypertension. This complex medical picture is challenging enough for all of us trying to heal them, but add the patients' lack of concern for their own health and it is quite frankly maddening. I find myself often saying, "Help me help you" or "Healing is a team event," although mostly my genuine pleas for partnership fall on deaf ears.

By Christine Miller, DPM, DMM, PhD, FACCWS

One of the gratifying aspects of being a wound care physician is the ability to develop such rich relationships with our patients. The frequent and consistent contact with the same provider lays a strong foundation of open communication and trust. I work in an urban safety net hospital’s ambulatory care center, which sees a high volume of high-acuity patients. It is not uncommon for me to see patients with venous leg ulcerations with concomitant uncontrolled hypertension or diabetic foot ulcerations secondary to uncontrolled blood glucose levels. Patient education is a vital part of my clinical encounters, particularly focusing on the systemic nature of wound healing. I always emphasize that while we are treating your wound, it is the full body well-being that is needed for ultimate success.

Paula Erwin Toth, RN, MSN, FAAN, WOC nurse

Northeast Ohio is now being enveloped by a polar vortex. The subzero temperatures put everyone at risk, but our patients with chronic wounds are especially vulnerable. Neuropathy can desensitize them to the cold and result in frostbite, inadequate shelter and heat, and an inability to go to health care appointments, shop for food, or pick up (or even afford) prescriptions and wound care products. This can have devastating effects.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

Last spring, I encountered that specific type of patient we sometimes meet, the one who has been through the chronic wound care revolving door so many times that he or she sets out on his or her own path and refuses any byways diverting from it.

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 the WoundSource Editors

Biofilm is a complex microbial community containing self- and surface-attached microorganisms that are embedded in an extracellular polymeric substance.^1,2 The extracellular polymeric substance is a primarily polysaccharide protective matrix synthesized and secreted by the microorganisms that attaches the biofilm firmly to a living or non-living surface. This protective covering does not allow the body's immune system to recognize the presence of the microorganism; therefore, the bacteria evade an immune response, avoid detection by standard diagnostic techniques, and avoid destruction by standard treatments.³ Because of the tenacity of the attached biofilm, the microoganisms are able to resist physical forces, such shear, and are able to withstand nutrient and moisture deprivation, altered pH, and the impact of antibiotics and antiseptics. For the purposes of this discussion we break down the formation and actions of biofilms and discuss their impact on wound healing.

By Amanda Steinhauser, LVN, WCC

Everyone has heard the numbers; wound care costs in the United States are reported to be in excess of fifty billion dollars annually. Moreover, more than six million Americans suffer from chronic wounds. According to the American Diabetes Association, over one million Americans are diagnosed with diabetes every year. Despite these jaw-dropping statistics, wound care assessment techniques remain, for the majority, one of the most antiquated parts of health care.

By Janet Wolfson PT, CLWT, CWS, CLT-LANA

I was recently listening to one of my favorite news sources, NPR, enjoying an interview with James E. Ryan, the author of "Wait, What? - and Life's Other Essential Questions". The premise was that asking the right questions can lead to a happier and more successful life. A physician called in to relate that this was something he had been doing in his medical practice. I couldn't have agreed more – the questions I ask my patients (and then listening to their answers) can go a long way toward making an intervention in their health care more successful.