Patient Outcomes

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 Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN January is the month for committing to new goals and resolutions for the year ahead. Several years ago I made a New Year's resolution to stop making New Year's resolutions. Like most New Year's resolutions I have not had much success in keeping it. Therefore I am sharing a few resolutions.

Margaret Heale, RN, MSc, CWOCN "Personalized medicine" is apparently a new concept that has evolved from taking good family histories, then adding a genetic testing component. The idea is to help assess the risk of specific traits that may be evident, and confirm with genetic testing so people can make lifestyle changes that reduce risk. It has attracted a huge amount of attention over the past few years.

by Lydia A Meyers RN, MSN, CWCN At the start of December, I was looking at graduation from my Master's Degree program and the completion of my final paper. A capstone to the Master's program is much like the dissertation to the doctoral program. My journey has been long and along the way I have increased my base of knowledge. What I have learned on this journey will enhance my practical knowledge of wound care and patient care. I learned that health care must change, and we must look hard at how we are doing business and be willing to challenge the status quo. Health care needs highly knowledgeable leaders to assure patients receive quality care by being good stewards of the money given to promote that care. The provider must be educated to assure the patient's wishes are followed first and always.

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.

Advanced wound care technologies have come a long way in treating chronic wounds. However, diabetic foot ulcers (DFUs) can be challenging, and not every patient should have identical treatment. Utilizing a patient-centered approach is necessary for selecting appropriate treatments and achieving best possible outcomes. Understanding the specific patient’s needs and understanding the pathophysiology of diabetic wound chronicity are key elements in DFU management. The primary goal should be wound closure, while also preventing recurrence. To achieve both goals, clinicians must incorporate ongoing education and clinical support. Health care professionals should keep up on latest evidence-based research and practices to select the best advanced treatment for each patient.

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS Patients who come in with venous insufficiency ulcers and lower extremity arterial disease (LEAD) should be evaluated for compromised vascular status and the use of compression. The purpose of the ankle-brachial index (ABI) test is to support the diagnosis of vascular disease by providing an objective indicator of arterial perfusion to a lower extremity.

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.

Hospital-acquired pressure ulcers (HAPUs) pose a challenge for acute and post-acute care environments and are listed as hospital-acquired conditions (HACs) by the Centers for Medicare & Medicaid Services (CMS). Other HACs include central line–associated blood stream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Although CLABSIs and CAUTIs have seen a decrease in prevalence over the past decade, the HAPU is the only HAC that has not. In my recent WoundSource webinar, I discussed the topic of building a pressure ulcer prevention program within hospitals. The webinar is still available for viewing on WoundSource.com.

Naltrexone is an opioid antagonist originally approved by the FDA in the early 1980s for the treatment of heroin addiction. The high dose of 50mg was used, but caused people to become too sick with withdrawal effects, thus falling out of use as few people would take it. What has since been developed in 1986 is low dose naltrexone (LDN), in the 1.5 to 4.5mg range. This low dose has demonstrated some benefit in helping with autoimmune disease. There have been few published studies of limited research showing remarkable results with multiple sclerosis, scleroderma, Crohn's, HIV, fibromyalgia and Parkinson's disease.