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The answer to your question regarding whether or not a Stage I pressure ulcer can be measured during a state survey is yes. A survey can evaluate any resident or process that results in proper care being provided to residents in facilities. You need to arm yourself with the same knowledge they have. That means that you need to put into place in your facility a comprehensive pressure ulcer prevention and education plan to prevent facility acquired pressure ulcers. You also need to know how the surveyor will evaluate you. The pertinent regulation F314. Last year CMS provided directives to the surveyors via transmittal #4 which spelled out specific instructions to the surveyors on how to detect and document deficiencies. You can download this document by clicking here.
Hope you find this information helpful.

Joe Degitz, RN

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Absolutely!
Cheryl Nichols Tx Nurse

elw-oklahoma

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Depends on the strength ordered. I would call a pharmacy to see how they make it.

Deborah Harris, BSN, JD, RN, CWCS
Louisville, KY
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I don't think you should use dakin's, because it is active for 1 hour only, also sodium hypochlorite is harmful for cells, try hypertonic salt solution - 5 gr salt for 100 cc water - it shouldn't be sterile!
If the wound is dry - put some hydrogel first - gauze soaked in hypertonic salt solution - every 24 hours.
Catty

Wound Care Specialist
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Dakins is too strong to be used in wounds--it kills the cells that make new tissue. However, if you make a very dilute solution, it works very well, kills all the bacteria but does NOT kill the cells that make the new tissue. I have used this for 11 years with very good success. For a little over $5, you may purchase a 16 fl oz bottle of prepared solution from Century Pharmaceuticals 1-866 DIDAKSOL.
Trish Brooks, RN, MSN, ANP, CWOCN, ET

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Recipes for Dakin's solution can be found using an internet search. Dakins full strength shouldn't be used. Try 1/2 or 1/4 strength or maybe a product with silver in it.

unsigned

Luisa,
At our wound center we can bill for a nurse visit to do a dressing change. When the doctor debrides for instance, we cannot charge for the dressing change. Hope this makes sense. Just thought I would share what we do in our center. Billing is still confusing to me at times. Good luck!

Ohio wound nurse

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Where you live will affect the rate you charge. I suggest you contact other wound care providers in the area or state, or the WOCN and see what the norm is for your area is. (Gee, where are home care nurses making $40-60/hr?!?!?! I'm moving!)

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Try Smith/nephew

DE, RN, BSN

Keep in mind that the normal saline wet to dry dressings are intended for debridement, so if that is not why you are using them, you should stop. Also
for any vascular disease ulcers, you will need compression along with any dressing used in order to heal properly. In order to use compression, you
must first obtain an ABI - Ankle brachial index which should be anywhere over 0.75mm Hg and should be about 1 to tolerate the compression. Even if it
is lower, you should adjust and apply a lower amount of compression. I find a good broad spectrum antibacterial cream like silvadene and xeroform with
gauze wrap and then the compression - you can use 3 or 4 layer or use your own - kerlix, ace and coban providing you know how to administer the proper
amount of pressure. Hope this helps.

Deborah Harris, BSN, JD, RN, CWCS
Louisville, KY

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Sheri,
I have worked with many residents with vascular ulcers. My favorite treatment is to wrap the legs from just behind the toe to 1 inch below the knee with Unna boots. These boots do wonders for these ulcers and offer gentle compression as well. If the wounds seep through try a cut to fit piece of alginate. I change the boots weekly and prn. I can get their legs healed in about three weeks. Depending on other health issues this should work well for you. You might also save yourself some grief with the state survey if you get a non-invasive vascular study done. This will show you how well his circulation is and give you an idea how fast or slow they will heal. Many of these patients eventully develop other problems like heal ulcers which in circulation issues can turn into a stage 4 overnight.
Darlene E. RN, BSN

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How about applying a barrier cream to the periwound, zinc oxide or calmoseptine, etc. prior to applying the tx to the wound?
Cheryl Nichols LVN Tx Nurse

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Hi, I am a Practice Nurse in a Health Centre in Devon England. I run a Leg Ulcer Clinic, We never put gauze - soaked or otherwise - directly onto a exuding wound. Have you carried out a full leg assessment and Doppler to ascertain if there is arterial insuffiency? If the ABPI is above 0.8 mmHm then try compression bandaging.For dressings I would use Biatain foam dressing on the exuding venous ulcers and Steripaste or Zipzoc is effective on exuding eczema. Hope this is helpful.. Mary

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Hi,

Have you tried any type of skip preps. 3M makes a very nice skin barrier called No Sting Skin Prep. It is
used to coat the periwound skin. The barrier wipes
protect the surrounding skin from macerating,
shearing, and does not hurt. If a bandage sticks to
the skin prep, the barrier wipe comes off- not skin.
Also, I would recommend changing the dressing more often. A n.s. dressing shouldn't be totally dry. They are used to keep the wound bed moist. I would question if the patient should have a tid treatment or if a different treatment should be initiated.

As far as the patient's pain. One of your roles as a
nurse is as an advocate. It sounds like you have been trying to fulfill this role. If you co-workers will
not listen then I would suggest that you continue up
the chain of command. We need to stand up for our
patients. On your patients behalf-thank you.

Theresa RN
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Sheri,
You are absolutely right that when you take gauze off that is sticking (wet to dry dsg) that it can cause trauma to the tissue. It has been shown that it actually removes good tissue and may leave fibers from the gauze in the wound bed. Wet to dry dressings will eventually not be allowed. Too many physicians use this treatment when it is painful and not done right by nursing staff. You are better to stay away from these type of orders unless you state that it is a moist dressing to be left on. Good luck to you. Cheryl-certified wound nurse
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you are right in your approach and in your analysis of the patients psychology. it is a not-un-heard-of tendency to rush thru a dressing forgetting that the priority is the patient because of whom your skill is
needed. your own time is not the priority.

kumkum

Terri

Terri,
An infection is an infection, no matter the cause. Follow the MDS regs. This will give you a clear understanding of how to count all wounds infected or not. There are also clear guidelines in how to determine an infection. Check APIC for these guidelines. An example would be for a resp. infection, they will give you a list of symptoms, they must have 3 documented or on the MDS or state regs you don't have to count them.
Darlene E RN BSN/wound manager.

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Many of the national wound care conferences offer these classes as a pre-conference workshop...however, it is only a 3-4 hr or 1 day thing...by no means enough to make you competent in my opinion...if you get Ostomy Wound Management, the latest product buying guide (I just got mine in the mail last week) has an education section and I know there is a company in there that offers this class...it is expensive $450 if I remember correctly.

Thanks

April Kuhlman RN CWOCN

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1. In a good practice:
a) Be sure of the correct thing to do before undertaking wound dressing
b) Explain to the patient what you are about to do before starting and seek for their cooperation
c) Use sterile dressing materials
d) Do not rub on the surface of the wound, rather mop
e) Educate patient what to expect next and both should keep up to schedule

2 Documentation of the status of injury on presentation is use as a baseline for measuring progress.

3 Malnutition deprives body of essential nutrients like protein require for the repair of damage tissue and ascobic acid (vitamin C) require for hydroxylation of proline to a stronger hydroxy proline in the structural protein of tissues. Lack of these factors speed up degeneration of tissues and thus formation of pressure sores/bed sores

Ahmed M. Sabo,
Dept. of Human Physiology,

www.convatec.com

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I use a 35cc syringe with a 19 gauge needle for my irrigation. It provides 8 psi for irrigation. Sue, CWS
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Emma,
Go to the AHCPR web site. They have a pressure ulcer guidebook free of charge that give you information on irrigations. I use the little pink "bullets" with normal saline or an angiocath 25 g. for irrigations.
Darlene E, Rn BSN, wound manager.