Help c wound care and dressing choices

Chaya, ASN, RN · Jan 8, 2004

That't pretty scary Todd. If I recall correctly improper wound care is one of the biggies that NH's get sued for. There should be a clear written plan for each pt/resident's wound care acc. to facility policy for that type of wound and if there is any deviation from this it should be really well documented!documented.

gwenith, BSN, RN · Jan 8, 2004

Toss there are some websites listed over in the Australasian forum and one day when I have a chance I will make a wound care sticky for this forum

CWOCN · Jan 12, 2004

Dressing choices should be based on drainage--the amount and character. How well is the dressing supporting the wound? How much drainage is left on the dressing you just took off? You want a moist healing environment, you want the wound to be clean. Wounds want to be clean, moist, protected. Know the different dressing categories, what they are for and go from there. I agree that there should be some protocol for the wound care that is being done. It should not be left to anyone's whim. Try Cathy Thomas Hess book Wound Care. It gives an overview of the product categories, trade names, what they do, etc. That should be a good start.

Jewelrmn · Jan 18, 2004

I know how you feel, this is an age old problem! The solution is to train all nurses in the art of wound care, so that we are all singing from the same song sheet. However, we do not live in an ideal world do we? Assessment processes which are designed to guide nurses through wound management will help continuity of care. Having a well formulated assessment form takes some of the subjectivity out of the assessment process. Formulating review dates to the care plan also helps, as any dressing needs time to work as we all know.

My theory is though, that you treat the patient not the wound, and if you can get all your team to take this philosophy on board, you may get somewhere. Hopefully.

Good luck

gwenith, BSN, RN · Jan 18, 2004

At one time I actually developed a wound care assessment sheet which included patient assement - it was developed utilising the pressure area assement scales as most of the factors that cause pressure areas i.e. cachexia will also operate to delay healing - gave up though and are now happy if people describe the wound correctly.

ROSIEK · Mar 24, 2006

I'm finding out that there is a whole lot that wasn't taught in school and judging from what I am seeing at work in the NH, I am not alone. It seems everytime I do a dressing change, the nurse before me has done it their own way. One day I will see a wet/dry and the next there will be a foam pad on the same wound. What is more confusing is that each nurse has their own rational for why they did that type of dressing.
Can someone suggest a good resource I can study to learn about this subject?

Search for books by Cathy Thomas Hess and Sharon Baronowski and Elizabeth Ayello. I know this is an old message from you but others will have the same concerns.

suebird3 · Mar 24, 2006

Many times the MD will order a "standard" dressing at our facility, but we had utilized a Wound Care Consultant until I learned about the various dressings. Does your facility have access to one?

Here, Public Aide will only cover certain items, too.

Suebird

ROSIEK · Mar 24, 2006

I'm finding out that there is a whole lot that wasn't taught in school and judging from what I am seeing at work in the NH, I am not alone. It seems everytime I do a dressing change, the nurse before me has done it their own way. One day I will see a wet/dry and the next there will be a foam pad on the same wound. What is more confusing is that each nurse has their own rational for why they did that type of dressing.
Can someone suggest a good resource I can study to learn about this subject?

The wound bed preparation platform addresses these issues. In order to close a wound you must first remove the barriers.

Necrotic tissue

Bacterial Burden

Unmanaged Moisture

Choose a dressing based on what the bARRIERS ARE.

mcdonaldgirl · Apr 4, 2006

Todd....why 2 or 3 nurses using 2 or 3 different dressings? Aren't they following the Doctor's order?

"Mac"

fipsez · Nov 14, 2007

Why not make a simple grid system of "types of wounds" or "partial thickness/full thickness wound" and the suggested wound care approach based on the patient's goal (prevent infection, palliative care only, complete healing), including dressing categories. There should be a procedure for "if wounds are > 25% necrotic" and a "debridement approach". Also add a column for special interventions such as "pressure relief", "compression therapy", monitor albumin, etc. As the wound changes, so will your dressing selection. An approach like "red, yellow, black wound color" approach may be the way to go to help with contingency plans when the wound changes. Many wound care supply companies have these formats in their literature that you can use as a template to make the project go quicker and smoother.