I am getting so many questions regarding wound care and the new OASIS C.  For those of you who do not work in home care, it is a pivotal piece of work that is used to determine reimbursement, as well as to track outcomes.  I actually am excited about the document.  I think that it can actually dovetail into developing a wound care plan.  It also emphasizes pressure ulcer prevention, something that many home care agencies fall short of providing.

Anyway, I have two things that might help you to prepare for the changes.  First, I am doing an audio conference on January 21 on the topic of "Wound Care and OASIS C."  I am giving you the link to the information about the one hour event.  If you register, use the coupon code provided to receive a discount.  The link is:  http://goto.mynursingaudio.com/go/9070 and the coupon code is: "BRADLEY"
The second thing that all of you need to be getting your hands on is the new NPUAP International Pressure Ulcer Prevention and Treatment Guidelines.  You will have to purchase these, they are available at www.npuap.org.  I believe that these will become standards of care for every care setting.

Thanks to those of you who are subscribers, your feedback indicates that our online course impacts your practice in very practical ways.  I enjoy getting your emailed success stories and questions.  Keep it up!!    Beth

Maybe it is generational, but I admit that I am a terrible blogger.  What I love to do and do a lot of is see patients and teach clinicians.  I have had a busy summer of teaching and learning.

Honey has long been used as a wound dressing; its s proponents tout it as a great

I am pleased to let you know that the video education found on this site has been approved for CME credit. As with nursing credit, each of the seven segments is individually accredited. If all segments are completed, a physician will earn 10.5 CME's. This education is a great value. I am confident that it will impact any clinician's practice, based on the great feedback that has come from users.

Thanks for coming to Care On Call Education. It is a blast serving you.

Beth

As you learned in a previous post, papain based enzymatic debriders are no longer available for removal of nonviable tissue from wounds.  Several clinicians have told me that they are using “new debridement ointments.” After asking a few questions, I have learned that some manufacturers are marketing their barrier pastes (thick ointments usually used to protect skin from moisture or to heal skin injury caused by incontinence or moisture) as debriders.  If you have viewed video 5, your brain is already working this one out.  Let me help those of you who aren’t familiar with our education.  Part of debridement is adding moisture to soften the nonviable tissue.  The moisture itself does not debride, but it does help to make the macrophages’ jobs easier. A barrier ointment or paste is not a debrider.  It may help facilitate the debridement process along by adding a little moisture, but that‘s really all.  Remember in video 4 when we discuss autolytic debridement you learned that occlusive dressings not only call in moisture, but also increase the numbers of macrophages in the wound.  And macrophages actually secrete enzymes that debride nonviable tissue. 
It is so important to critically evaluate wound care products so that you can understand what they do and why they do it.  Then you will achieve the outcomes your patients deserve in a cost effective manner. 

Here's the Hx: Ruffy is a 13ish year old dog who started as a stray found in the woods as a puppy. She lives outside and eats Ol Roy dog food. Her last vet appt was when she was spayed 12 years ago; we do drive by rabies clinics and internet worm medicine. On Dec 30 my husband discovered drainage with a foul odor on Ruffy's neck just below the collar. After cleaning it with some homemade Dakins with a drop of dish soap, I found an abcess. For those of you horse lovers, you would recognize it as the result of the bite of a certain, nasty fly that actually injects its egg under the dermis of the victim (gross!) and an abcess results from the whole process.
Assessment and course: The large amt of exudate had a foul odor, the wound opening was approx 1.8 cm with dead space/undermining about the volume of a golf ball. It was not painful, Ruffy didn't act sick, and she did not feel feverish. I treated it with BID irrigations of the Dakins/dish soap mixture and filled in the dead space with AMD gauze. Exudate became serosanguinous within a couple of days, decreased irrigations to once a day. By Jan 5, the undermining was gone, depth less than 1 cm.
What's the point of this? I was amazed at the rate of Ruffy's wound improvement. As I wondered what accounted for it, I thought of two reasons. First, Ruffy does not have the comorbidities that most of my patients have. We often forget to consider the host's potential to heal effectively and quickly. Second, I was reminded that clinicians often rush to apply advanced technologies and dressings to wounds that have not been appropriately treated with good basic wound care. I believe that in 2009 the big news in chronic wound management is going to be appropriate cleansing and management of biofilms.
So, the lesson that I learned from my dog was that my passion for excellent comprehensive basic wound management has value, and the information on this website is useful. I hope that it will help you make your patients' lives better. And no, I am not advocating dish soap to cleanse wounds.
Best wishes for a pleasant 2009, Beth

I want to make sure that you are aware that the FDA has notified manufacturers of topical papain debridement products that production of these products must cease by November 24 and distribution must cease by sometime in January. These products will become unavailable to patients as supplies are depleted. Where does this leave clinicians needing to effect debridement in acute and chronic wounds?

I’ve recently begun a new consulting job, a combination of clinician education and patient consults. I realized again a common pattern among clinicians who are trying to get non-progressing wounds to move. Often a dressing is chosen because of a recollection that it helped another patient. While the choice may be a lucky one and make a difference, I strongly advocate that dressings be selected based on the wound context.

Hello,
What do you do after that wound that you have been coaxing along finally covers with that last bit of new skin? I usually do the chicken dance over the difficult ones, I’m sure you know what it’s like to get a hard to heal wound to that end point. But what next? Often for clinics and home care agencies, it is discharge. For LTC’s you get them off of your wound rounds list. I want to ask you to think about a few things before you break ties with your patients who cross the finish line.

Hi there,

I hope that you are enjoying learning from our videos! Remember that the companion print materials are AS IMPORTANT as the videos, so I hope that you will take the time to download and print them before you view each segment. We are only a few weeks past launch, but are getting nice feedback, thanks.