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Program Description
This program is designed for Legal Nurse Consultants.
Keywords: wound care, chronic wound, negative pressure wound therapy, interprofessional wound care
Negative pressure wound therapy (NPWT) includes an increasing number of devices to stimulate wound healing by reducing swelling and drainage and creating a local environment that enhances healing. NPWT is a widely accepted modality by the international wound care community. Use – and misuse – of NPWT is on the rise. There are standards of care that must be adhered to if adverse outcomes are to be avoided. Clinicians and legal professionals must be aware of the potential problems and devastating complications related to caring for complex wounds with NPWT. Facility guidelines that do not meet the standard of care for complex wound care with NPWT leave the facility open to adverse events and possible litigation. A team approach is essential to optimize outcomes when NPWT is utilized.
Our presenter, Diane L. Krasner PhD RN CWCN CWS MAPWCA FAAN, is the lead co-editor of Chronic Wound Care: A Clinical Source Book for Healthcare Professionals (4th edition, 2007) www.chronicwoundcarebook.com. She is a Certified Wound Care Nurse (WOCN), Certified Wound Specialist (AAWM) and Master of the American Professional Wound Care Association (APWCA).
FREE articles with webinar
- Explain the rationale for the use of negative pressure wound therapy (NPWT)
- Evaluate the standards of care for the entire healthcare team related to the use of NPWT
- Identify sources for standards of care for NPW
- Recognize common problems related to the use of NPWT that leave facilities open to adverse events and litigation
- Analyze a complex wound case involving NPWT and a wrongful death
As an added bonus, you will receive:
- Six Sticky Wickets of Wound Care
- Chapter 1 from Chronic Wound Care
Presenter
Dr. Diane L. Krasner is a board certified wound specialist with experience in wound, ostomy & incontinence care across the continuum of care. She is a Fellow of the American Academy of Nursing and a Master of the American Professional Wound Care Association. Dr. Krasner is a Wound & Skin Care Consultant in York, Pennsylvania and works part-time at Rest Haven – York as the WOCN / Special Projects Nurse. Krasner graduated from The Johns Hopkins University with degrees in Ancient Near Eastern History and Egyptology. She went on to receive her Bachelors, Masters and PhD from the University of Maryland School of Nursing and a Masters in Adult and Continuing Education from Johns Hopkins School of Continuing Studies. Dr. Krasner was a Johnson & Johnson Medical Post Doctoral Fellow at the Center for Nursing Research at Johns Hopkins University School of Nursing.
Dr. Krasner is the lead co-editor of Chronic Wound Care: A Clinical Source Book for Healthcare Professionals (4th edition, 2007, HMP Communications). She currently serves as the clinical editor of the Kestrel Wound Product Source Book. Krasner is also on the editorial boards of WOUNDS, The International Journal of Wound Care and World Wide Wounds. Since 1992 Dr. Krasner has served on the Board of Directors and as an Officer of several national wound care organizations, including The American Academy of Wound Management, The Association for the Advancement of Wound Care and The National Pressure Ulcer Advisory Panel. Dr. Krasner’s research interests include wound pain, palliative wound care and legal issues related to wound care. She has numerous publications in the wound care literature and lectures nationally and internationally on wound & skin care.
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Moderator: Patricia Iyer MSN RN LNCC
Related Reading
New Pressure Ulcer Guidance for Surveyors Helps Clinicians and Legal Professionals
by Patricia Iyer
In November 2004, The Centers for Medicare and Medicaid Services (CMS) issued guidance to surveyors involved in nursing homes visits. This report can be found here (pdf). Some of the key findings of these changes are summarized below. The author of this article has added bulleted comments in italics. Clinicians, attorneys, expert witnesses, and legal nurse consultants who evaluate pressure ulcer cases are urged to review the complete CMS document for all of the pertinent points. The CMS document concludes with a protocol for surveyors to use to evaluate a pressure ulcer development in a facility. It serves also as a blueprint for evaluating liability.
At the time of the assessment and diagnosis, the clinician is expected to document the clinical basis of the ulcer (e.g. underlying condition contributing to the ulceration, ulcer edges and wound bed, location, shape, condition of surrounding tissues) which permit differentiating the ulcer type, especially if the ulcer has characteristics consistent with a pressure ulcer, but is determined not to be one.
- Look at the initial admission assessment or wound care sheet, if the facility uses one, for the status of skin on admission. It is helpful to set up a table to track each site of breakdown, noting stage, dimensions, drainage, and so on.
The CMS document defines unavoidable pressure ulcers for the first time. “An unavoidable pressure ulcer occurs when the facility staff evaluated the resident’s clinical condition and pressure ulcer risk factors, defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice, monitored and evaluated the impact of interventions, and revised the approaches as appropriate.”
- Documentation in the medical record should support that all of these components were carried out. The reviewer should be aware that documentation may not reflect actual care. One recent study indicated that while nurses may be charting that turning is being done every 2 hours, the actual care provided is much less. A study of 16 California long-term care facilities demonstrated that repositioning was documented as being done every 2 hours in 95% of at risk residents, but were actually being turned every 3 hours in only 23% of residents at risk, as measured by a wireless movement monitor.
