PreventionThe TRUHEAL Wound Program is evaluating several tools to be included in the prevention recommendations associated with the Program Guidelines. We have developed recommendations for wound prevention by etiology that will align current guidelines, standards, and best practices with the treatment recommendations in the Institute’s Treatment and Documentation protocols. The Advanced Healing Institute recommends that practitioners follow appropriate facility guidelines for wound prevention as well as all applicable state and federal laws and regulations. Please note that the prevention recommendations below are abridged. Complete content is available in the Advanced Healing Institute Wound Treatment Guidelines. Selected Pressure Ulcer Prevention Recommendations
Pressure ulcers develop when excess pressure is not aggressively, quickly, and definitively alleviated for high risk patients with intact skin, or patients with pressure ulcers already developing. Unless the root cause (excess pressure or shear) is properly dealt with, all other interventions will be ineffective. The key to preventing and treating pressure ulcers is to reduce pressure, and the basic standard for reducing pressure is repositioning. Traditionally, caregivers reposition or offload the immobile patient every two hours. This relieves the occluding pressure in capillaries and allows reperfusion of the area. , This standard approach, however, must be individualized for each resident and the specific support surface they are using. Tissue tolerance testing can be used to individualize a patient’s repositioning schedule. In Minnesota, the tissue tolerance test is used to identify those patients at risk for developing a stage 1 ulcer. In this test, the resident is allowed to sit or lie for two hours on a support surface (wheel chair cushion or bed) . If redness occurs at the location of the pressure and persists for more than 45 minutes, the resident did not tolerate that position on that surface. This same resident should then be tested at a shorter time interval (1.5 hours) to determine the acceptability of the shorter interval for turning or repositioning. The testing process continues by reducing the time increments by one half hour with each test until the caregiver establishes a time interval at which the patient does not experience redness for more than 45 minutes at the site of the pressure. In conjunction with fundamental turning and repositioning programs, specific tools are frequently used to aid with the prevention of pressure ulcers. These tools are known as pressure reduction or pressure relief surfaces. Selected Arterial Wound Prevention Recommendations
Medical management of arterial insufficiency is of primary concern in order to facilitate healing of wounds created or exacerbated by arterial insufficiency. In some cases the patient may be a candidate for vascular intervention such as angiography, PTA (percutaneous transluminal angioplasty), or surgical intervention. Methods for management of arterial insufficiency include:
Selected Venous Ulcer Prevention Recommendations
Elimination of edema is a primary means of improving venous wounds. First, consider medical contributors to edema, and then assess requirements for treatment of congestive heart failure, hypothyroidism, malnutrition and pulmonary disease. A stepwise approach to control of edema using appropriate external measures should also be undertaken after accounting for the underlying causes and severity of the condition. Selected Diabetic Wound Prevention Recommendations
Diabetes is a complex medical condition predisposing people to foot ulcers in three ways:
Effective intervention and prevention of diabetic foot wounds requires a coordinated, multidisciplinary care approach. This is likely to include primary care practitioners, and may also include other external resources such as surgical specialists with expertise in diabetic ulcer management, endocrinologists, podiatrists, orthotists, and other specialists as necessary. |
