Wound Care Information Network

 

 

July 16, 2006

 

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 Previous email questions & their replies are listed below. Remember, replies have not been validated for accuracy or truthfulness.

I am looking for a DVD or some type of training for billing on Wound care. Could you please help with where I can get this information? Thank you for the help.

Zane Johnson
I am also interested in any type of inhouse video that we can use as a teaching aid.



Suzette Graafstra
PharmaSave Medical Supply
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You might want to read Gloria Miller's article located here.

Hello- I badly need help on my patient that I am seeing right now. She is 94 year old with a good nutritional status but was assessed to have poor circulation on both lower extremities. The patient was recently diagnosed with osteomyelitis on the LLE bone where there is huge draining wound infected with MRSA and patient now is on antibiotic. I started light therapy and treated patient for 5 days now. Today, when I took out the dressing I noticed black discoloration on the upper region of the wound but I at the same time I noticed more beefy red granulation tissue close the wound edges. I was alarmed and thought that the discoloration might be an adverse effect of the light therapy(IRR) but all the literatures I've seen testifies that there is no known adverse effect of IRR application. Can anyone try to help me explain the back pigmentation/discoloration at the wound bed. Is this bad or good sign? I really appreciate the feedback. Also, since the infection is being managed with antibiotic, do you think the wound will ever heal?( presence of osteomyelitis).

Thanks,

Saturn, PT
Hello Saturn,
I wouldn't mess with this, did you do an ABI and get a vascular consult?
TLH RN WCC

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my experience with osteo is that it does not heal. We just had a case in which there was osteo in the bone, that particular bone was removed and the resident recieved antibiotic therapy for 6 weeks and the wound has healed. Typically if there is vascular issues the wound is very slow if at all to heal and then with osteo I would not expect anything positive. has the physician done vascular studies to see what kind of blood flow you have to the extremities? It almost sounds like looking at amputations to me. (worst case senario).
Sonja Whittredge
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The light may cause some excessive drying and that will tend to look dark. Since you already have red beefy granulation tissue, you may want to stop the light and go with Santyl. This will debride the wound of the dark tissue and may be used until the wound completely heals. You may also like to try Silversorb gel. We have used this and it really works on this type of wound.
DE BSN RN

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There are a few things you did not cover. What are you currently using as a wound dressing and where is the wound and is the patient being turned appropriately. Is the wound on a pressure point?

Are they immobile?

From my experience, it sounds like fresh tissue is starting to grow and you have necrotic tissue at the outer edges. This should be debrided by someone who knows what they’re doing. How deep is the wound? What circumference is the wound? How old is the wound?

There are very effective products available that could improve this situation but without more information, it’s hard to give a suggestion.

Please send more info.

Regards,
D. Peters

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Dear Saturn, Hi my name is Pam Mitchell and I believe because of your patients age surgery is almost out of the question. I do know something even better in her case though, possibly. Maggot therapy! It is non-invasive and works better than any of the treatments I tried, when I had a diabetic ulcers with osteomyelitis. I had ulcers for over two years and had used all kinds of conventional treatments to no avail. I by chance heard about maggot therapy and had to beg my doctors to use it The maggots healed up my ulcers totally (and the osteomyelitis) and I have not had any problems in over four years. These are disinfected maggots raised just for medicinal purposes. They do some amazing things that man cannot do.
1. They eat just the dead infected tissue without touching the good tissue.
2. They excrete enzymes to promote healing
3. They kill all the bacteria
They are extremely cost effective and if insurance does not cover the cost(they should) we at the BTER Foundation offer grants to those who cannot afford the $100.00 for the maggots. It takes approx. three or four treatments. Please consider this for your patient. I believe it is one of the fastest, and greatest treatments out there. Please check out our web site which gives you further info on this and how to order the maggots.

Good Luck,
Pam Mitchell
 

Hello,
My Name is Allison Drake and I am writing to you with a question reguarding computerized documentation of wounds. As a home care agency we are seeing patients with multiple wounds, at times exceeding 15. Do you have any suggestions with computer documentation ?
Drop boxes with anatomical locations?
Measuring wounds every visit vs/ 1 x week?
Documenting healed status?
Referring to wounds as numbers vs. typing the location at every visit.
ie: r hip #!, at the next visit the nurse could type #1 ?

Thank you for your time
Allison Drake MS, RN
When we had our state survey last month, they were happy with just numbering
the wounds. We had a patient with multiple wounds on one extremity, and as
they healed, we just dropped that number off the record.

Judi Barton, RN
Performance Improvement Coordinator

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Hello Allison,
For legal purposes you have to document each wound seperately, even on the computer. We use the # system with all wounds added to an anatonomical body. We document treament daily and a full wound assessment weekly with sending a copy to the primary physician as a reference tool. We ask the physician to sign the fax and return it. This becomes his note as well as yours. Sorry no way around documenting multiple wounds in a court of law,
TLH RN WCC DON

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Hi Allison:

Wound Expert is an excellent wound documentation software available for use for a fee. www.woundexpert.com.

Best Regards,
Jamie Pinnock, RN, CWCN
 

I am interested in finding out if you have a policy manual for home health care agencies(Medicare Certified)?

Thank you.

Mary Ann Becker
Sorry, no replies
I formed a keloid on my neck after a bike accident and after about 3 years, I had it removed through surgery. Unfortunately it back a little bigger. A year later I attempted surgery again but this time with a steroid injection immediately after. The keloid came back again. I am considering surgery a third time but this with steroid injections every month and the use of silicon sheets and some creams. Do you think this is a good idea and if so, what products should I buy.
Jude
Cica Care works on scars, why not try it on the keloid. It just may work.
DE BSN Rn
i had a laparotomy on may 12th of this year. incision, approx. 61/2" long with 20 staples.
the cut was made just above the navel, into, & past the navel. i have two sites, one right in the middle of incision, & one staple hole that is still draining & quite bothersome. the doctor seems it is not of concern.
years ago, (16) i had osteomyelitis which resulted from back surgery & much the same way, of the incision not properly healing, so i am fearful of another type of this event. i am 57 yrs. old female. in very good health otherwise, but am very concerned if i should seek another doctor's opinion or just seek out a wound health center? or should i just be putting some sort of antibiotic oitment or what? please advise-------i would be sooooo appreciative.
thank you in advance for any & all information you can give to help me!!

sincerely-----
audrey fisher
aandg01@comcast.net
GET ANOTHER OPINION!
DE BSN RN
I have an adnomial wound they have been treating it.. first wound vac. then wet to dry then dakins, then silver now with Allanzyme this is going on five months. I recently was diagnosed with MRSA. My question is .. today the nurse removed the bandages and they were a neon lime green. Is this a new type of infection? Pseudomonias! Dakins is the treatment of choice.
DE BSN RN

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Neon green is usually a sign of psuedomonas
Robin LPN wound care nurse

What has anyone experienced in the area of Neonatal Wound education?
Smiles-
Michelle
Sorry, no replies
I have a pt - a healthy paraplegic with a clean (cultured) non healing (3 months) wound that started as a skin tear from scraping something in a transfer. I would like to know the best dressing to use to facilitate healing. It is on the buttock just above the crease and is about 1mm deep with minimal exudate. Part of the problem was a breakdown in his gel pad he sits on and that has been replaced. We have tried telfa, bandaids, duoderm with no change.

Susan Anderson MN, FNP-C
 
Try Xenaderm, it doesn't need a dressing but where your wound is you could use a Cov r Site Plus (smith/nephew). Do treatment daily to BID.
DE BSN RN

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Try using 3M Tegaderm Absorbent. It is Tegaderm with an absorbent pad in the center. It holds on great and can be left in place until it falls off. Also allows you to visualize the wound without moving the dressing. Try putting on 3M No-Sting prep first, then use what's left of the prep pad to go around the edges. It makes it hold on better. You can also use if for skin tears. Works great!

Carly RN CWS

What is the reimbursement of transcutaneous oxygen testing in wound care
clinic? Does anyone else have any info about this ?
Transcutaneous oxygen monitoring (TCOM) is reimbursable under certain criteria. The CPT code is the same as other non-invasive vascular testing (93922 or 93923). The criteria for payment varies based on Medicare guidelines (called local coverage determinations) by state. In general, the TCOM test has to be ordered by a physician, be documented as medically necessary (usually done to prove or disprove the efficacy of HBOT or to determine the level of an amputation) and performed correctly (the right amount and placement of leads and positioning of patient).

Hope this helps...if I can be of further assistance, please do not hesitate to contact me.

Sincerely,
Gloria Miller
Chief Financial Officer
Comprehensive Healthcare Solutions, Inc.
(800) 232-5070
 

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