ABSTRACT
PURPOSE: The purpose of this quality improvement project was to provide a standardized, repeatable, and easy-to-use process for selecting a support surface for prevention or treatment of pressure injuries (PIs). PARTICIPANTS AND SETTING: The Wound, Ostomy, and Continence Nurses Society Support Surface Algorithm was chosen to guide clinicians in selection of an appropriate support surface. These clinicians provide services to approximately 465,000 patients across the nation annually. APPROACH: This quality improvement project aimed to establish clinician knowledge and comfort levels when recommending a support surface and providing a standardized way to identify the appropriate support surface once a patient had been identified as at risk. The support surface algorithm was incorporated into our agency's electronic medical record (EMR); we chose this interactive algorithm to facilitate support surface selection among clinicians with no specialized expertise in PI treatment or prevention. OUTCOMES: Clinicians reported an increase in knowledge and comfort levels in the ability to select an appropriate support surface following implementation of the clinical decision support tool. Benchmarking data illustrated a decrease in the year over year aggregate (September 2018 to September 2021) trending for the Centers for Medicare & Medicaid Services quality outcome measures surrounding potentially avoidable events related to PIs. IMPLICATIONS FOR PRACTICE: Implementing the support surface algorithm assisted clinicians with support surface selection, elevated and standardized clinician practice, and reduced potentially avoidable events. As a result of this project, the Wound, Ostomy, and Continence Nurses Society Support Surface Algorithm Tool has been fully integrated into our EMR and is a standardized part of our clinical assessment.
Subject(s)
Home Care Services , Ostomy , Aged , Humans , United States , Quality Improvement , Medicare , AlgorithmsABSTRACT
BACKGROUND: The management of chronic (nonhealing) wounds with epibole is challenging and costly, especially when the problem is not promptly identified or the patient is intolerant to conventional treatments. CASE DESCRIPTION: We describe the use of a polymeric membrane dressing (PMD) in 3 patients with chronic (nonhealing) wounds and epibole who were unable to be treated with traditional interventions such as silver nitrate or sharp debridement. Patient 1 was a 51 year-old male with a right foot stasis ulcer with 60% fibrin/slough to the wound bed, patient 2 was a 58-year-old female with a stage 4 pressure injury of the left hip with undermining, and patient 3 was a 62-year-old female with a dehisced abdominal surgical wound. CONCLUSION: The use of PMD, when applied using a specific technique, proved to be effective for resolving epibole in 3 patients with nonhealing wounds of differing etiologies. Based on these experiences, we postulate that topical therapy using a PMD may provide an effective alternative means for resolving epibole and promoting wound healing in patients unable to undergo surgical excision or chemical cauterization.
Subject(s)
Bandages/standards , Combined Modality Therapy/instrumentation , Epithelial Cells/metabolism , Treatment Outcome , Wound Healing , Administration, Topical , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/therapeutic use , Combined Modality Therapy/methods , Epithelial Cells/drug effects , Female , Humans , Male , Middle Aged , Pressure Ulcer/physiopathology , Pressure Ulcer/therapy , Surgical Wound Dehiscence/physiopathology , Surgical Wound Dehiscence/therapy , Varicose Ulcer/physiopathology , Varicose Ulcer/therapy , Wound Infection/prevention & control , Wound Infection/therapyABSTRACT
Many nurses have limited experience with ostomy management. We sought to provide a standardized approach to ostomy education and management to support nurses in early identification of stomal and peristomal complications, pouching problems, and provide standardized solutions for managing ostomy care in general while improving utilization of formulary products. This article describes development and testing of an ostomy algorithm tool.
Subject(s)
Algorithms , Home Care Services/standards , Ostomy/nursing , Quality Improvement/statistics & numerical data , Adult , Aged , Aged, 80 and over , Colostomy/adverse effects , Colostomy/nursing , Education, Nursing, Continuing/methods , Education, Nursing, Continuing/standards , Education, Nursing, Continuing/statistics & numerical data , Evidence-Based Nursing/methods , Evidence-Based Nursing/statistics & numerical data , Home Care Services/statistics & numerical data , Humans , Ileostomy/adverse effects , Ileostomy/nursing , Middle Aged , Nurses/psychology , Nurses/statistics & numerical data , Ostomy/statistics & numerical data , Pennsylvania , Pilot Projects , Program Evaluation/methods , Program Evaluation/statistics & numerical data , Self Efficacy , Skin/injuries , Skin Care/nursing , Skin Care/statistics & numerical data , Surgical Stomas/adverse effects , Surgical Stomas/statistics & numerical data , WorkforceABSTRACT
BACKGROUND: The management of malignant malodorous wounds within the oral cavity can be challenging due to limited availability of dressings that are safe, efficacious, and ingestible. CASE DESCRIPTION: An 80-year-old woman with squamous cell carcinoma of the oral cavity was admitted to home care with complaints and distress related to extreme malodor. CONCLUSION: Manuka honey proved a safe, effective, palliative treatment to reduce odor and inflammation in wounds secondary to squamous cell carcinoma of the oral cavity in this patient.