Prevention and treatment of pressure ulcers.

Pressure ulcer prevention and treatment remains a challenge for interprofessional teams in all health care sectors. Evidencebased pressure ulcer guidelines can be simplified with a bedside enabler utilizing the wound bed preparation paradigm. Key steps involve treatment of the cause, addressing patient-centered concerns, and administering local wound care (debridement, infection/ inflammation control, and moisture balance before considering advanced therapies with the edge effect). Optimal outcomes are achievable with a multi-disciplinary approach that supports patients and their circle of care, which is central to every evaluation and course of treatment decisions.

Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool.

BACKGROUND: Peristomal skin problems are common and are treated by a variety of health professionals. Clear and consistent communication among these professionals is therefore particularly important. The Ostomy Skin Tool (OST) is a new assessment instrument for the extent and severity of peristomal skin conditions. Formal tests of reliability and validity are necessary for its use in clinical practice, research, and education. OBJECTIVES: To estimate inter- and intra nurse assessment variability of the OST and validity by comparison to a 'gold standard' (GS) defined by an expert panel. METHODS: Thirty photographs of peristomal skin were presented twice to 20 ostomy care nurses--10 from Denmark (DK) and 10 from Spain (ES)--to determine intra- and inter nurse assessment variability. The same photographs were presented to an international group of experts (dermatologist and ostomy care nurses), to establish a GS for comparison and validation of the results. RESULTS: A high intra-nurse assessment agreement, κ=0·84, was found with no differences in the intra-nurse assessments from the two groups of nurses (DK and ES). The inter-nurse assessment agreement was 'moderate to good', κ=0·54, with the agreement between the experts higher, κ=0·70. A high correlation between the scores from the nurses and the GS were seen in the lower part of the two scales [Discoloration, Erosion, Tissue overgrowth (DET) score<7)]. CONCLUSION: The study supported the validity of the OST. It is suggested that a categorical scale can be used to illustrate the severity of the DET scores.

Nutritional aspects of wound healing.

Proper nutrition is essential to prevent the development of pressure ulcers and to support adequate and timely wound healing. Additionally, research and clinical observation suggest nutrients play a major role in wound healing. How the nutrients Vitamin A, Vitamin C, zinc, calories, protein, and fluids are used in wound healing and recommendations regarding use of supplements are discussed in this article.

Obstacles and opportunities for the multidisciplinary wound care team. A report for the clinical symposium on wound management.

On the last day of the 12th Annual Clinical Symposium on Wound Management, a panel of clinicians from various disciplines, and with diverse experience in wound management, discussed the challenges and rewards of being part of a multidisciplinary team caring for patients with wounds. Panelists included Sharon Baranoski, MSN, RN, CETN; C. Andrew Salzberg, MD; Marlys J. Staley, MS, PT; and David R. Thomas, MD, FACP. Elizabeth A. Ayello, PhD, RN, CS, CETN, was the moderator. An excerpt from this session is published here.

Draft definition of stage I pressure ulcers: inclusion of persons with darkly pigmented skin. NPUAP Task Force on Stage I Definition and Darkly Pigmented Skin.

The National Pressure Ulcer Advisory Panel appointed a task force to review the definition of Stage I pressure ulcers, specifically to assess its adequacy in people with darkly pigmented skin. The process used by the task force to draft a new definition is described in this preliminary report of their work. The proposed definition and initial critique of it are given.

Educational assessment and teaching of older clients with pressure ulcers.

The importance of education in preventing and treating patients with pressure ulcers is evident by the inclusion of recommendations for educational objectives in the clinical guidelines by the Agency for Health Care Policy and Research. Both caregiver and client should be assessed for knowledge of pressure ulcers. Physical changes in vision, hearing, and cognition that might affect educating older clients are described. Strategies suitable for teaching older clients about the prevention and treatment of pressure ulcers are given.

Critique of AHCPR's consumer guide--"treating pressure sores".

The consumer version of the clinical practice guidelines entitled "Treating Pressure Sores" was released by the Agency for Health Care Policy and Research (AHCPR) in December 1994. This review of the patient teaching booklet compares it to existing criteria-evaluating written tools. The AHCPR 1994 Consumer Guide meets almost all the criteria; one area that still needs improvement is the reading level.

A critique of the AHCPR's "Preventing pressure ulcers--a patient's guide" as a written instructional tool.

Preventing Pressure Ulcers--A patient's guide was released by the Agency for Health Care Policy and Research (AHCPR) in May 1992. Using criteria suggested by Falvo (1985), Redman (1988), Ruzicki (1989), and others, the guide was critiqued to determine how it compared to existing criteria for evaluating written tools. The AHCPR guidelines does not meet all the criteria; suggestions for improvement are provided.

Quality of care concepts and nutrition support.

The Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) Agenda for Change has refocused and redefined quality monitoring in health care. The JCAHO has operationalized these new concepts of quality monitoring and evaluation by means of a 10-step process that includes the development of clinical indicators. Theoretical frameworks for the 10-step process were drawn from the work of theorists whose applications of quality-monitoring methods occurred in business and industry. An enhanced understanding of the current JCAHO definitions of quality and processes for quality measurement will help practitioners prepare for future accreditation surveys. A review of quality monitoring and evaluation activities in nutrition support has demonstrated a need for more published accounts to document these important activities.