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Davidaugustyn

Davidaugustyn

WCC
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Davidaugustyn has 9 years experience and specializes in WCC.

Davidaugustyn's Latest Activity

  1. Davidaugustyn

    POLYMEM

    I lost that in formulary also. I use Biatain Foam. May also cleanse with a hibicleanse if you like, to me if it gets to that point I usually use a different treatment anyway.
  2. Davidaugustyn

    Sacral fistula

    Fistulas are the hardest things to deal with. I shutter when I hear of a new admit coming with a fistula...I wish I could give you better advice...Supplies are drained to quickly with them...
  3. Davidaugustyn

    Rehauling the wound care team

    Hello everyone and thank you for having me here. I have enjoyed this forum. First a little background... I have worked in long term care for 10 years, wound care certified for 4. Last year I started working in an LTAC with a wound care team and then was promoted to a wound prevention supervisor. We effectively reduced in nosocomial pressure ulcers from an average of 6 a month to an average of 1 a month over a 9 month period. (5 months high and 4 months low after implementation) I have recently moved on from that the the Director of Nursing position in the SAU adjacent to the hospital. It is an independently run facility but that was sharing the wound care team. As of the new year, we are pulling back wound care strictly to our department. The department does have some issues handling wounds and prevention. My plan is to have floor nurses pick the daily dressing changes back up, where they before never had to do this. We will have a wound nurse that does strictly weeklys, admits, declines, issues, etc. My question is, -Has anyone ever done this and how did they meet the resistance? -Does anyone have any good suggestions? -Turning, as everywhere, is a problem. How have you effectively turned around a non-turning unit? I mostly wanted to start a thread to share a wealth of knowledge. If you have something good, let's here it! Also please let's try to link what we know to best practice and evidenced based effectiveness. Here we go!
  4. Davidaugustyn

    charting advice

    That may be true, and I may be speaking from my LTC experience. Of course we would not skip documenting on it; it is there. But if the origin is unknown, there becomes the opportunity to defend allegations of abuse, depending on the wound. That's all I meant. Not that we wouldn't chart, but that we need to find the origin first or at least have a realistic idea of the cause when oversight comes around.
  5. Davidaugustyn

    Denuded Peristomal Skin

    yeah hollister does have alcohol. I mostly use it for a weeping peristoma. If truly is the key for a a good seal. Ask anyone with a long term difficult stoma. It's just how it's used. Like you said, its not glue. the idea is for the o-ring like seal.
  6. Davidaugustyn

    NCLEX-PN SHUT OFF @ 85 Questions

    I passed my LPN with 85 in 2004
  7. Davidaugustyn

    NCLEX-PN SHUT OFF @ 85 Questions

    Too bad. You failed.
  8. Davidaugustyn

    Infected incision-what would you do?

    How many days old is it? Is it appropriate redness in the inflammatory stage? Lots of times it's just a hope that it doesn't dehisce. I wouldn't use topical antibiotic, not best practice. Really I have not seen much help from the outside on an approximated wound.
  9. Davidaugustyn

    can an LPN become a wound nurse

    I have 3 LPN wound care nurses working in the wound care department that I supervised. They were not certified and the company was hesitant to have them certified because of their degrees. The reason they fell into wound care is because the hospital doesn't like to hire LPNs for the floor. Kindred Healthcare based in Louisville KY has facilities all over the country which greatly hires LPNs. I have worked at 4 different Kindred facilities and each has hired LPNs. One facility had an LPN as a Clinical Manager in fact, overseen by the DON. In our wound care dept, we just make sure an LPN does measurements at least every other week. If I were you, I would see how I could position myself to fall into being needed for a wound care position as the certification is expensive.
  10. Davidaugustyn

    Need advice, preventing shear force/friction

    That's true. Tough situation. I would suggest to him a mattress if he doesn't have one, (something he can't be noncompliant with) and let him be. Those are tough....
  11. Davidaugustyn

    Wound Infections, Best Practice

    Well said mommy.19
  12. Davidaugustyn

    space between incision and vaginal opening.

    I would stick with what I said than. Maybe not silvadene, but a good moisture correct environment and diaper it up.
  13. Davidaugustyn

    Wound Infections, Best Practice

    I'm sorry I was in a mindset when I wrote that. What I should have more clearly stated was that topical antibiotics were useless, and oral antibiotics, unless broad spectrum, have little efficacy due to the way we culture a wound. I do agree with punch biopsy, but only as a means to diagnosing infection. (which I believe can be done with a look and a temp) On that note, Dakins is not best practice either. I have a tendency to speak on the results I see along with the knowledge I've gained. I can see the results with Dakins. (for short periods only) Here is the link to article that sums it up well. http://www.o-wm.com/content/bacterial-swabs-and-chronic-wound-when-how-and-what-do-they-mean I would encourage you to stay minimal with the culturing purulent wounds. It's not a good indicator or the bacterial bioburden. Also purulent drainage is not always an indicator of infection.
  14. Davidaugustyn

    Is this correct practice?

    No Have them pick it back up.
  15. Davidaugustyn

    Conservative Sharp Debridement

    We have 3 WCC nurses at my facility including myself that have taken a "certification" for sharp debridement. (though not acknowledged by the state except as being educated) We cannot technically do sharp debridement. I believe only because PT here does it and can charge for it. If you were going to do this right, you should get PT involved so you can bill. Sorry to say thats how it is. I will still cross-hatch and provide minimal sharps when I think it's necessary. If you still want to have them do it, I would suggest a weekly debridement day and only remove minimally.
  16. Davidaugustyn

    Wound Infections, Best Practice

    OK. I never advise to culture a wound, and that is best practice. A wound is full of bacteria. There's nothing that can be done about that. Unfortunately there my be MRSA or somethings else in the wound that won't be killed with just any ABTX. Doesn't matter though because oral ABTX are practically useless to a wound. Fortunately, you don't need to kill wound bacteria internally as you would pneumonia. (Unless it's getting severe and spreading) Dakin's solution. I'm not one to put bleach in an body cavity, but I have seen some very successful results from a low concentrated dakins (1/16) in reducing signs of infection. I always use dakins for a week or two on excessive green drainage. Silver if not yet severe. I've never really been one for honey. Though I love natural benefits, I find honey better for internal healing where dakins can't go. I use a diluted honey for pink eye in our house. Works every time.