Pressure Injury in a Community Population: A Descriptive Study.

PURPOSE: The purpose of this study was to describe present-on-admission pressure injuries (POA-PIs) in community-dwelling adults admitted to acute care. The specific aims of the study were to (1) measure the prevalence of POA-PIs during a 1-year period; (2) determine prehospital location of patients with POA-PIs; and (3) describe demographics, pressure injury (PI) characteristics, risk factors, and posthospital outcome of community-dwelling adults with PIs admitted to hospital. DESIGN: Retrospective descriptive study. SUBJECTS AND SETTING: The study sample was identified from a PI registry, a database maintained for quality improvement, at an 860-bed urban academic medical center in New England. The majority (n = 1022, 76.1%) were admitted to hospital from the community; and the remaining (23.9%) were admitted from long-term care facilities. METHODS: All subjects were assessed by certified wound nurses. Data were extracted electronically from selected standardized electronic health record (EHR) fields, representing variables of interest. Descriptive statistics were analyzed using percentages, means, and medians. RESULTS: The prevalence of patients admitted to acute care with a POA-PI was 7.4%. Community-dwelling subjects with POA-PIs had a mean age of 72.7 ± 15.4 years; 52.4% were male, 80.3% white, 30.9% lived alone, 99.2% were insured, and 30.6% were college educated. They presented with a mean of 1.46 PIs; 37.5% were full thickness. Admission Braden Scale for Pressure Sore Risk scores indicated that 77% were at risk for PI; subscores indicated mobility limitations in 90.8% and inadequate/poor nutrition in 41.3%. Subjects had multiple comorbid conditions (mean 18.4 ± 5.3 admission diagnoses). Only 21.4% were receiving home care services prior to admission. More than half (51.5%) were discharged to a healthcare facility, 33% to home, and 14% died or received hospice care. The 30-day readmission rate was 15.5%. CONCLUSION: The overall prevalence of POA-PIs on hospital admission in this study was higher than previous published reports. The majority arrived from community-dwelling locations. The severity of community-dwelling POA-PIs was higher than known benchmarked hospital-acquired PI severity. This real-world profile of community-dwelling patients with PI suggests that these individuals are considerably vulnerable and underserved by home care services. Opportunities exist for community PI screening, prevention, and intervention.

Exploring the concept of a team approach to wound care: Managing wounds as a team.

Background - The growing prevalence and incidence of nonhealing acute and chronic wounds is a worrying concern. A major challenge is the lack of united services aimed at addressing the complex needs of individuals with wounds. However, the WHO argues that interprofessional collaboration in education and practice is key to providing the best patient care, enhancing clinical and health-related outcomes and strengthening the health system. It is based on this background that the team approach to wound care project was conceptualised. The project was jointly initiated and realised by the Association for the Advancement of Wound Care (AAWC-USA), the Australian Wound Management Association (AWMA) and the European Wound Management Association (EWMA). Aim - The aim of this project was to develop a universal model for the adoption of a team approach to wound care. Objective The overarching objective of this project was to provide recommendations for implementing a team approach to wound care within all clinical settings and through this to develop a model for advocating the team approach toward decision makers in national government levels. Method An integrative literature review was conducted. Using this knowledge, the authors arrived at a consensus on the most appropriate model to adopt and realise a team approach to wound care. Results - Eighty four articles met the inclusion criteria. Following data extraction, it was evident that none of the articles provided a definition for the terms multidisciplinary, interdisciplinary or transdisciplinary in the context of wound care. Given this lack of clarity within the wound care literature, the authors have here developed a Universal Model for the Team Approach to Wound Care to fill this gap in our current understanding. Conclusion - We advocate that the patient should be at the heart of all decision-making, as working with the Universal Model for the Team Approach to Wound Care begins with the needs of the patient. To facilitate this, we suggest use of a wound navigator who acts as an advocate for the patient. Overall, we feel that the guidance provided within this document serves to illuminate the importance of a team approach to wound care, in addition to providing a clear model on how to achieve such an approach to care. We look forward to gathering evidence of the impact of this model of care on clinical and financial outcomes and will continue to share updates over time.

An evaluation of the association for the advancement of wound care venous ulcer guideline and recommendations for further research.

OBJECTIVE: The goals of this study were to analyze the 2010 update of the Association for the Advancement of Wound Care (AAWC) Venous Ulcer Guideline (VUG) and examine recommendations with less than A-level evidence to identify important research questions. DATA SOURCES: The AAWC VUG may be found at http://aawconline.org/professional-resources/resources and at the National Guideline Clearinghouse, http://www.guideline.gov. Supporting references for each recommendation, compiled by the AAWC Guideline Task Force from MEDLINE, CINAHL, and EMBASE databases, may be viewed at the first website. STUDY SELECTION: The literature identified in support of the AAWC VUG recommendations with less than A-level evidence was evaluated and is summarized below. DATA EXTRACTION: Questions requiring further research in venous ulcer (VU) care were developed from recommendations having less than A-level support and that fall under the following topics: diagnosis, documentation, prevention, wound care, adjunctive interventions, and palliation. DATA SYNTHESIS: Practitioners lack strong evidence for several generally accepted recommendations of this synthesis of VU guidelines concerning the following: diagnostic or screening validity of varicosities, timing of biopsies for differential diagnosis, clinic visit frequency, criteria for changing VU care plans, and effective VU preventive parameters. Bedside surgical debridement, several biologic interventions, certain types of grafting, and the comparative efficacy of intravascular surgical procedures also require rigorous examination. Adjunctive interventions to be investigated include systemic pain management, topical biophysical treatments, novel devices, pharmaceuticals, timing, methods and procedures for some surgical interventions. CONCLUSIONS: Better evidence for recommendations with less than A-level support may improve the quality and consistency of VU care, reduce costs, and improve resource use.

Impact of antimicrobial gauze on bacterial colonies in wounds that require packing.

Heavy microbial contamination has been associated with delayed wound healing and infection in both acute and chronic wounds. A prospective, randomized, 5-week controlled, open label, multicenter study was conducted to determine whether using antimicrobial gauze containing polyhexamethylene biguanide in wounds that require packing will result in a greater reduction of bacterial colony counts than using a gauze without polyhexamethylene biguanide (the control). Twenty-one subjects were randomized to the treatment or control dressing. Wounds were evenly distributed with respect to etiology and both study groups had a median baseline wound size of 7 cm2. At baseline, 15 microbial isolates were recovered and counted in treatment group wounds and 12 were recovered in the controls. At Week 1, six isolates were recovered from subjects in the polyhexamethylene biguanide antimicrobial gauze treatment group while 10 were recovered in the control. Change in polymicrobial bioburden was most prominent during the first few weeks of the study in the polyhexamethylene biguanide group. Polymicrobial counts in the treatment group remained reduced for the following three study weeks, returning to baseline at Week 4. In the control group, the number of polymicrobial cultures rose to 60% above baseline at Week 4. Two wounds of subjects randomized to the polyhexamethylene biguanide antimicrobial gauze healed; one wound in the control group healed. Polyhexamethylene biguanide antimicrobial gauze dressing could be an important adjunct to control the polymicrobial bioburden of delayed closure surgical wounds, pressure ulcers, and diabetic foot ulcers. Additional studies seem warranted.

What Do Patients Want? Patient Preference in Wound Care.

Patient preferences are statements made or actions taken by consumers that reflect their desirability of a range of health options. The concept occupies an increasingly prominent place at the center of healthcare reform, and is connected to all aspects of healthcare, including discovery, research, delivery, outcome, and payment. Patient preference research has focused on shared decisions, decisional aids, and clinical practice guideline development, with limited study in acute and chronic wound care populations. The wound care community has focused primarily on patient focused symptoms and quality of life measurement. With increasing recognition of wound care as a medical specialty and as a public health concern that consumes extensive resources, attention to the preferences of end-users with wounds is necessary. This article will provide an overview of related patient-centered concepts and begin to establish a framework for consideration of patient preference in wound care.

Wound Care Nursing: Professional Issues and Opportunities.

As the field of wound care advances and seeks validity as a distinctive healthcare specialty, it becomes imperative to define practice competencies for all related professionals in the arena. As such, the myriad nurses practicing wound care in settings across the continuum should be understood for their unique contribution to the wound care team. Furthermore, the hierarchy of wound care nursing with varying levels of licensure, certification, and scope of practice can be clarified to delineate leadership and reimbursement issues to meet current health care challenges. A review of the role of nursing in wound care from a historical and evolutionary perspective helps to characterize the trend towards advanced practice nursing in the wound care specialty.

A new option in the treatment of skin tears for the institutionalized resident: formulated 2-octylcyanoacrylate topical bandage.

Skin tears are a common phenomenon in elderly institutionalized adults (EIAs). Incidence ranges from 0.92 to 2.5 per person/year. Little supportive literature exists regarding optimal treatment with many regimens reported. A convenience sample of 20 patients with Payne-Martin Category II and III skin tears of less than 8 hours' duration were prospectively evaluated with the use of a formulated 2-octylcyanoacrylate topical bandage. Patients were followed weekly until the tear healed. Complete healing occurred with 1 application of 2-OTB in 90% (18/20) of study subjects; 5% (n = 1) reported transient mild pain (less than 15 seconds), and 90% (n = 19) reported no pain. There were no incidents of cellulitis or infection. Shower and bathing routines were not interrupted. Cost averaged less than $1 per application. Clinician time averaged 1.5 minutes per application. Clinicians reported high satisfaction because repeated dressing changes were eliminated.