Wound Ca re AD VISOR Practical issues in wound , skin , and ostomy management Official journal of ® Maggot therapy Treating wounds in intimate areas Wound care in the home Staff education July/August 2014 • Volume 3 • Number 4 ww w.WoundCareAdvisor.com A Publication Advancing Safe Skin throughout the Care Continuum. Through our unique combination of people, process and technology, Hill-Rom can help you achieve positive safe skin outcomes for you and your patients in hospitals, long-term care facilities and in the home. For additional information, please contact us at 800-445-3730 or visit www.hill-rom.com. ©2014 Hill-Rom Services, Inc. ALL RIGHTS RESERVED. ORDER NUMBER 186896 rev 1 22-APR-2014 ENG – US Zinc Number US-PA-0414-0134 staff Group Publisher Gregory P. Osborne Publisher Tyra London Editor-in-Chief Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS editor-in-chief Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Managing Editor Co-Founder, Wound Care Education Institute Cynthia Saver, RN, MS Lake Geneva, WI Editor Kathy E. Goldberg editorial advisory Board Copy Editor Nenette L. Brown, RN, PHN, MSN/FNP, WCC Karen C. Comerford Wound Care Program Coordinator Sheriff’s Medical Services Division Art Director San Diego, CA David Beverage Debra Clair, PhD, APN, RN, WOCN, WCC, DWC Production Manager Wound Care Provider Rachel Bargeron Alliance Community Hospital Alliance, OH Account Managers Susan Schmidt Kulbir Dhillon, NP, WCC Wound Care Specialist Renee Artuso Skilled Wound Care Sacramento, CA PuBlished By Fred Berg HealthCom Media Vice President, Marketing/Business Development 259 Veterans Lane, Doylestown, PA 18901 National Alliance of Wound Care and Ostomy Telephone: 215/489 -7000 Glendale, WI Facsimile: 215/230-6931 Catherine Jackson, RN, MSN, WCC Clinical Nurse Manager Chief Executive Officer Inpatient and Outpatient Wound Care Gregory P. Osborne MacNeal Hospital Executive Vice President, Sales Berwyn, IL Bill Mulderry Jeffrey Jensen, DPM, FACFAS Dean and Professor of Podiatric Medicine & Surgery Web Producer Barry University School of Podiatric Medicine Winston Powell Miami Shores, FL Business Manager Rosalyn S. Jordan, RN, BSN, MSc, CWOCN, WCC Connie Dougherty Director of Clinical Education RecoverCare, LLC Wound Care Advisor (ISSN 2168-4421) is published by Louisville, KY HealthCom Media, 259 Veterans Lane, Doylestown, PA Jeff Kingery, RN 18901. Printed in the USA. Copyright © 2014 by Health - Vice President of Professional Development Com Media. All rights reserved. No part of this publica - RestorixHealth tion may be reproduced, stored, or transmitted in any Tarrytown NY form or by any means, electronic or mechanical, includ - ing photocopy, recording, or any information storage Jeri Lundgren, RN, BSN, PHN, CWS, CWCN and retrieval system, without permission in writing from Vice President of Clinical Consulting the copyright holder. Send communication to Health - Joerns Com Media, 259 Veterans Lane, Doyles town, PA 18901. Charlotte, NC The opinions expressed in the editorial and advertis - Courtney Lyder, ND, GNP, FAAN ing material in this issue are those of the authors Dean and Professor and advertisers and do not necessarily reflect the UCLA School of Nursing opinions or recommendations of the National Al - Los Angeles ® liance of Wound Care and Ostomy ; the Editorial Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Advisory Board members; or the Publisher, Editors, Co-Founder, Wound Care Education Institute and the staff of Wound Care Advisor . Plainfield, IL Steve Norton, CDT, CLT-LANA Editorial Mission: Wound Care Advisor provides Co-founder, Lymphedema & Wound Care Education, LLC multidisciplinary wound care professionals with President, Lymphedema Products, LLC practical, evidence-based information on the Matawan, NJ clinical management of wounds. As the official journal of the National Alliance of Wound Care Bill Richlen, PT, WCC, CWS, DWC and Ostomy ®, we are dedicated to delivering Owner succinct insights and information that our read - Infinitus, LLC ers can immediately apply in practice and use Chippewa Falls, WI to advance their professional growth. Lu Ann Reed, RN, MSN, CRRN, RNC, LNHA, WCC Adjunct Clinical Instructor Wound Care Advisor is written by skin and wound University of Cincinnati care experts and presented in a reader-friendly elec - Cincinnati, OH tronic format. Clinical content is peer reviewed. Stanley A. Rynkiewicz III, RN, MSN, WCC, DWC, CCS The publication attempts to select authors who are Administrator knowledgeable in their fields; however, it does not Deer Meadows Home Health and Support Services, LLC warrant the expertise of any author, nor is it responsi - BHP Services ble for any statements made by any author. Certain Philadelphia, PA statements about the use, dosage, efficacy, and charac - Cheryl Robillard, PT, WCC, CLT teristic of some drugs mentioned here reflect the opin - Clinical Specialist ions or investigational experience of the author. Any Aegis Therapies procedures, medications, or other courses of diagnosis Milwaukee WI or treatment discussed or suggested by authors should not be used by clinicians without evaluations of their Donald A. Wollheim, MD, WCC, DWC, FAPWCA patients’ conditions and possible contraindications or Owner and Clinician, IMPLEXUS Wound Care Service, LLC Watertown, WI danger in use, review of any applicable manufacturer’s prescribing information, and comparison with the rec - Instructor, Wound Care Education Institute ommendations of other authorities. Plainfield, IL Wound Care Advisor • July/August 2014 • Volume 3, Number 4 www.WoundCareAdvisor.com 1 CLICK HERE CLICK HERE TO REGISTER TO DOWNLOAD ONLINE BROCHURE National Conference Basic to Advanced Educational Sessions Including: COMPRESSION “WILD ON WEAR” IS IT PREVENTING SKIN BREAKDOWN CAUSED BY MEDICAL DEVICES MADE REALLY Easy INFECTED? PALLIATIVE HOW DO OH NO! I’VE BEEN WOUND CARE HOW TO: I REALLY SERVED. WHAT DIABETIC HANDS ON SHARP KNOW? BARIATRIC & FOOT ULCER NOW? DEBRIDEMENT SKIN FOLD ASSESSMENT MANAGEMENT Wild On Wounds National Conference Presented By September 17-20, 2014 Rio Hotel, Las Vegas WWW.WOUNDSEMINAR.COM July/August 2014 • Volume 3 • Number 4 CONTENTS ww w.WoundCareAdvisor.com FEATURES 12 Using maggots in wound care: Part 1 By Ronald A. Sherman, MD; Sharon Mendez, RN, CWS; and Catherine McMillan, BA Learn about this simple, effective, low-risk, low-cost wound debridement technique. 32 You want to touch me where ? By Debra Clair, PhD, APRN, WOCN, WCC, DWC page 12 Using intimate touch in wound care DEPARTMENTS 4 From the Editor Device–related pressure ulcers: Avoidable or not? 5 Clinical Notes 8 Best Practices Creating an effective care plan Education vital for successful wound management in the home page 28 20 Apple Bites What you need to know about transparent film dressings 22 Business Consult Creating effective education programs on a shoestring budget Confronting conflict with higher-ups How to love and care for yourself unconditionally 36 Clinician Resources 38 NAWCO News page 32 Wound Care Advisor • July/August 2014 • Volume 3, Number 4 www.WoundCareAdvisor.com 3 From the EDITOR Device–related pressure ulcers: Avoidable or not? medical device–related pressure ul - • Remove or move the device daily to as - cer (MDRPU) is defined as a local - sess skin. A ized injury to the skin or underlying • Avoid placing the device over the site of tissue resulting from sustained pressure a previous or existing pressure ulcer. caused by a medical device, such as a • Educate staff on the correct use of de - brace; splint; cast; respiratory mask or tub - vices and prevention of skin breakdown. ing; tracheostomy tube, collar, or strap; • Be aware of edema under the device feeding tube; or a negative-pressure wound and the potential for skin breakdown. therapy device. The golden rule of pressure • Confirm that the device isn’t placed di - ulcer treatment is to identify the cause of rectly under a patient who’s bedridden pressure and remove it. Unfortunately, many or immobile. of the medical devices are needed to sustain the patient’s life, so they can’t be removed. Of course, even when caregivers focus But does that mean MDRPUs aren’t on prevention, mistakes can happen. Un - avoidable? Yes—and no. Some aren’t fortunately, mistakes are a part of life. But avoidable, but not as many as you might that doesn’t mean we can’t learn from our think. Many result not from the device it - mistakes to better protect our patients. self but from poor device positioning or se - When a mistake occurs, determine what curement. Some result from simple failure happened, correct it, and take steps to pre - to check under the tubing or device. These vent it from happening again. That’s our causes are avoidable. Preventive practices job as clinicians and as patient advocates. include frequently evaluating device posi - tioning and securement. Also, if possible, loosen the device at least once per shift to check for skin problems. Donna Sardina, RN, MHA, WCC, CWCMS, The National Pressure Ulcer Advisory Pan - DWC, OMS el has created four “Best Practices for Pre - Editor-in-Chief vention of Medical Device–Related Pressure Wound Care Advisor Ulcers” posters, which can be downloaded Cofounder, Wound Care Education Institute for free. Besides a general poster, you’ll find Plainfield, Illinois posters for the specialties of critical care, pe - diatrics, and long-term care. Each poster fea - Selected references tures photos of MDRPU-related injuries and Black JM, Cuddigan JE, Walko MA, Didier LA, Lan - prevention strategies such as: der MJ, Kelpe MR. Medical device related pressure ulcers in hospitalized patients. Int Wound J . • Choose the correctly sized medical de - 2010;7(5):358–65. vice for the individual. Fletcher J. Device related pressure ulcers made easy. • Cushion and protect the skin with dress - Wounds UK . 2012;8(2). www.woundsinternational ings in high-risk areas. .com/pdf/content_10472.pdf. Accessed June 23, 2014. 4 www.WoundCareAdvisor.com July/August 2014 • Volume 3, Number 4 • Wound Care Advisor Clinical NOTES cin), a new antibacterial drug used to treat adults with skin infections.