Wound Care Management and Documentation Non-Compliance in Prevention and Care of Wounds

Mapping Intimacies ◽

10.46409/sr.xpuu8046 ◽

2021 ◽

Author(s):

◽

Tobechukwu Unaegbu

Keyword(s):

Best Practices ◽

Care Management ◽

Wound Care ◽

Medical Center ◽

Statistical Significance ◽

Clinical Staff ◽

Project Implementation ◽

Care Policy ◽

Braden Scale ◽

Practice Problem

The incidence of non-compliance and adherence to best practices wound care competence continues to be an issue among the clinical staff of the Veterans Affairs Medical Center (VA). At the VA, there is a practice problem of non-compliance and adherence to best practices wound care competency as evidenced in the electronic medical record (EMR) documentation among the clinical staff. A PICOT question was developed to explore if the establishment of a staff best practices wound care policy focusing on EMR documentation will improve proper wound care management among the clinical staff. The clinical site is a hospital consisting of 40 acute care beds. A new policy adjusted documentation with the use of the Braden scale and the spinal cord impairment monitoring (SCI-PUMT) tools and documentation in the EMR at appropriate times was implemented. A pretest and posttest were conducted to determine the significance of the total documentation using the Braden or SCI-PUMT tools, total accurate documentation using the wound care tools, and the number of multidisciplinary team contacts using the EMR. The results showed no statistically significant improvement with t =1.66, p =.107, t =1.03, p = .310, and t = -0.31, p = .775, respectively. Although the above results did not show any statistical significance after two months of the project implementation, a re-implementation of the project is recommended with the elimination of the barriers encountered during the project implementation

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577 The Collaboration of Burn Outreach and Wound Care Nurses

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.227 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S140-S140

Author(s):

Ekta Vohra

Keyword(s):

Wound Care ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Setting ◽

Basic Knowledge ◽

Definitive Treatment ◽

Knowledge Gap ◽

Burn Wound ◽

Improvement Project ◽

Burn Wounds

Abstract Introduction Certified wound care nurses perform a vital role in skin health and management in the hospital setting. During the certification process, minimal time is spent on burn wound education, despite the fact that wound care nurses are consulted for various wound etiologies; one of those being burns. This construct created a need for collaboration between the burn team and wound care nurses. Although all burns are essentially wounds, the reality is that all wounds are not burns. The management of the burn wound is often different from the management of pressure injuries or surgical wounds. In speaking with the wound care nurses at this large urban academic medical center, a knowledge gap was identified in burn wound care education as well as appropriate and timely consultation of the burn team. Methods This knowledge improvement project focused on educating the wound care nurses in assessment and treatment of burns, and the process for burn service consultation. Burn education was provided through in-person didactic presentations. The lecture included burn wound photos with opportunities to classify the potential depth of burn wounds as well as typical complications. Additionally, it discussed when a burn consult is needed. A basic knowledge retrospective pre-posttest method was utilized. Results An educational plan was tailored to meet the learning needs of the wound care nurses to address the knowledge gap. Post test data results were tracked. Post scores were increased, indicating a successful educational intervention. Also, while providing the education, the burn outreach coordinator identified an opportunity to expand the burn center’s presence among colleagues through collaboration with the wound care nurses. The wound nurses made excellent ambassadors for the mission of the burn service. Conclusions Provision of burn education across disciplines may improve recognition of burn wounds and facilitate definitive treatment.

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Quantifying the Risk of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission From Patient to Healthcare Personnel in the Critical Care Setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.989 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s364-s364

Author(s):

Timileyin Adediran ◽

Anthony Harris ◽

J. Kristie Johnson ◽

Mary-Claire Roghmann ◽

Stephanie Hitchcok ◽

...

Keyword(s):

Patient Care ◽

Wound Care ◽

Medical Center ◽

Glucose Monitoring ◽

Routine Care ◽

Healthcare Personnel ◽

Medication Delivery ◽

Care Activity ◽

The Mean ◽

Specific Care

Background: Healthcare personnel (HCP) acquire MRSA on their gown and gloves during routine care activities for patients who are colonized or infected with MRSA at a rate of ∼15%. Certain care activities (eg, physical exam, care of endotracheal tube, wound care and bathing/hygiene) have been associated with a higher frequency of transmission from the patient to HCP gown and gloves than other activities (ie, administration of oral medicines, glucose monitoring, and manipulation of IV tubing/medication delivery). However, quantification of MRSA contamination and risk to subsequent patients is poorly defined. Objective: We sought to determine the mean MRSA colony-forming units (CFU) found on the gloves and gowns of HCP who acquire MRSA after various care activities involving patients with MRSA. Methods: We conducted a prospective cohort study at the University of Maryland Medical Center from December 2018 to October 2019. We identified patients colonized or infected with MRSA based on culture data from the prior 7 days. HCP performing prespecified care activities on eligible patients were observed. To isolate the risk of each care activity, HCP donned new gloves and gown prior to a specific care activity. Once that care activity was performed, HCP gloves and gown were swabbed prior to the any further care activities. HCP gloves were cultured with an E-swab by swabbing each digit up and down 3 times followed by 2 circles on the palm of their hands. HCP gowns were sampled by swabbing a 15 × 30-cm area along the beltline of the gown and along each inner forearm twice. E-swab liquid was then serially diluted and plated in triplicate on CHROMagar MRSA II (BD, Sparks, MD) to obtain CFU. We calculated the median CFUs and the interquartile range (IQR) for each specific care activity stratified by gown and gloves. Results: In total, 604 HCP–patient care interactions were observed. Table 1 displays the mean MRSA CFUs stratified by gown and gloves for each patient care activity of interest. Conclusions: The quantity of MRSA found on gowns and gloves varies depending on patient care activities. Recognition of differential transmission rates between various activities may allow different approaches to infection prevention, such as the use of personal protective equipment in high- versus low-risk activities and/or the use of more aggressive interventions for high-risk activities.Funding: NoneDisclosures: None

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Standardization of Diagnostic Immunohistochemistry: Literature Review and Geisinger Experience

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2014-0074-ra ◽

2014 ◽

Vol 138 (12) ◽

pp. 1564-1577 ◽

Cited By ~ 52

Author(s):

Fan Lin ◽

Zongming Chen

Keyword(s):

Quality Management ◽

Literature Review ◽

Best Practices ◽

Critical Points ◽

Medical Center ◽

Management Program ◽

Review Article ◽

Data Sources ◽

Test Results ◽

Antibody Validation

Context Immunohistochemistry has become an indispensable ancillary technique in anatomic pathology laboratories. Standardization of every step in preanalytic, analytic, and postanalytic phases is crucial to achieve reproducible and reliable immunohistochemistry test results. Objective To standardize immunohistochemistry tests from preanalytic, analytic, to postanalytic phases. Data Sources Literature review and Geisinger (Geisinger Medical Center, Danville, Pennsylvania) experience. Conclusions This review article delineates some critical points in preanalytic, analytic, and postanalytic phases; reiterates some important questions, which may or may not have a consensus at this time; and updates the newly proposed guidelines on antibody validation from the College of American Pathologists Pathology and Laboratory Quality Center. Additionally, the article intends to share Geisinger's experience with (1) testing/optimizing a new antibody and troubleshooting; (2) interpreting and reporting immunohistochemistry assay results; (3) improving and implementing a total immunohistochemistry quality management program; and (4) developing best practices in immunohistochemistry.

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Clinical trials in wound care II: achieving statistical significance

Journal of Wound Care ◽

10.12968/jowc.2002.11.4.26387 ◽

2002 ◽

Vol 11 (4) ◽

pp. 156-160 ◽

Cited By ~ 4

Author(s):

P. Venkatraman ◽

S. Anand ◽

C. Dean ◽

R. Nettleton

Keyword(s):

Clinical Trials ◽

Wound Care ◽

Statistical Significance

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Wound Care Management

Acute Care Surgery and Trauma ◽

10.1201/b19015-36 ◽

2016 ◽

pp. 361-370

Author(s):

Shari Lawson ◽

Wendie Grunberg ◽

Howard T. Wang

Keyword(s):

Care Management ◽

Wound Care

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THE MAGNETIC RESONANCE IMAGING OF THE LUMBAR SPINE IN OUT-PATIENTS WITH LOW BACK PAIN

Journal of Musculoskeletal Research ◽

10.1142/s0218957701000611 ◽

2001 ◽

Vol 05 (04) ◽

pp. 261-267 ◽

Cited By ~ 1

Author(s):

BOHUA CHEN ◽

STEVE LAVENDER ◽

GUNNAR B. J. ANDERSSON

Keyword(s):

Logistic Regression ◽

Medical Center ◽

Lumbar Disc ◽

Statistical Significance ◽

White Collar ◽

Individual Characteristics ◽

Blue Collar ◽

Prior History ◽

Spine Pathology ◽

History Of

This paper aims to estimate the prevalence rates of MRI change in LBP out-patients and to determine the relationship between abnormalities in an MRI and personal and occupational factors. The MRI records were obtained from 200 out-patients with LBP (114 males and 86 females) who received a diagnostic MRI at St. Luke's Medical Center. The mean and standard deviation of this sample's age were 43.8 years and 14.8 years, respectively. Based on the MRI, each lumbar disc was scored as normal or degenerated. Bulging and herniated were also recorded. Each patient completed a short questionnaire that included the measures of height, weight, age, and present occupation and any history of "heavy manual labor". Occupations were grouped into white collar sedentary, white collar professional, blue collar exposed to prolonged sitting and vibration, blue collar exposed to heavy, unemployed or retired, and homemaker. Chi-square tests were used to determine the statistical significance of these trends. A multiple logistic regression was used to develop a predictive model of spine pathology based on a subject's individual characteristics and occupational classification. Normal discs were found in 26% of the patients and degenerated discs in 47.5%. There were bulging/herniated disks in 26.5%. In men who were younger than 29 years, 50% had herniated disks, and 50% were normal. Three fourth of the women in the same age group showed normal discs. Forty-three percent of the subjects reported a history of performing heavy labor. Using the logistic regression model there were two variables predictive of observable MRI pathology: age and prior history of heavy labor. The analysis indicated that an older individual who had a history and heavy labor was more likely to show one or more pathological model discs in an MRI scan.

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What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis

BMJ Open ◽

10.1136/bmjopen-2019-030883 ◽

2020 ◽

Vol 10 (3) ◽

pp. e030883 ◽

Cited By ~ 1

Author(s):

Thomas Ludden ◽

Lindsay Shade ◽

Madelyn Welch ◽

Jacqueline Halladay ◽

Katrina E Donahue ◽

...

Keyword(s):

Decision Making ◽

Content Analysis ◽

Best Practices ◽

Research Team ◽

Clinical Staff ◽

Shared Decision ◽

Directed Content Analysis ◽

New Knowledge ◽

Different Types ◽

Knowledge Objects

ObjectiveTo qualitatively analyse different types of dissemination of information during monthly group calls between researchers, providers and clinical staff used to establish best practices for implementing an asthma shared decision-making (SDM) intervention. Evaluating dissemination of information can provide a better understanding of how best practices are shared, informing implementation approaches to improve the uptake of new evidence and overcome barriers.Setting10 primary care practices in North Carolina.ParticipantsProviders and clinical staff participated in monthly group phone calls with researchers to share best practices during implementation of a SDM intervention for asthma patients.DesignThe research team transcribed and coded statements using content analysis into three different knowledge types: Knowledge Position, Knowledge Form and Knowledge Object. Knowledge Objects were further classified using directed content analysis where the research team interpreted the content objects through a classification process of identifying themes or patterns to describe three different types of dissemination of information: (A) Confirmation of Existing Knowledge, (B) Generation of New Knowledge and (C) Spreading of New Knowledge.ResultsAcross the 8 transcripts, 4 Knowledge Positions, 7 Knowledge Forms and 18 types of Knowledge Objects were identified. From the Knowledge Objects, Confirmation of Existing Knowledge occurred during the training of participating practices. The review also identified Generation of New Knowledge by providers and clinical staff raised in these calls. This Generation of New Knowledge was later documented being used by other practices with the identification of Spreading of New Knowledge.ConclusionThe research team described the types of dissemination of information that occurred between researchers, providers and clinical staff during implementation of an asthma SDM intervention. Both Confirmation of Existing Knowledge and Generation of New Knowledge in response to barriers occurred. These exploratory dissemination of information results provide additional mechanisms for evaluating implementation science.Trial registration numberNCT02047929; Post-results

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1255. Comparison in AIDS-Related Mortality Between African Americans and Whites with Human Immunodeficiency Virus During the HAART Era

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1118 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S451-S451

Author(s):

Jennifer Cihlar ◽

Carl Fichtenbaum

Keyword(s):

African Americans ◽

Hiv Infection ◽

Medical Center ◽

Statistical Significance ◽

National Database ◽

Attributable Mortality ◽

Hiv Diagnosis ◽

Cd4 Counts ◽

Standard Data ◽

White Patients

Abstract Background Higher death rates have been reported in African American (AA) compared with non-Hispanic whites with HIV infection. However, there are no published studies of attributable mortality by racial and ethnic groups. We evaluated differences in attributable mortality between AA and whites. Methods We conducted a retrospective review of all persons with HIV infection who received care at the University of Cincinnati Medical Center whose deaths were between 1996 and 2017. We abstracted chart data using a standard data tool and identified all deaths reported to the social security national database. Probable cause of death was assigned using the EuroSida CoDe methodology. Primary endpoint was to compare AIDS vs. non-AIDS-related deaths between AA and whites. Results Initial analysis of 588 deaths are reported through 2007 (44% AA and 53% white). The median age at the time of HIV diagnosis was 37 years for AA patients and 36 years for white patients, while median age at the time of death was 43 years for AA and 42 years for whites (P = ns). 16.9% of AA were women, 2.6% were transgender; 10.3% of whites were women and 1% were transgender (P < 0.02). Risk factors for HIV acquisition included: MSM, 61.3% of whites vs. 46.0% AA; heterosexual contact, 11.7% of whites vs. 13.4% for AA; and injection drug use 16.9% white vs. 18.3% AA (P < 0.0001). African Americans had both lower median CD4 counts at the time of diagnosis and within 3–6 months prior to death (167 and 68 cells/mm3, respectively) as compared with whites (214 and 103 cells/mm3, respectively) (P < 0.0001 for both). There was no statistical significance of having AIDS at entry into the practice between AA and whites (P = 0.79). AIDS-related deaths accounted for a larger percentage of overall deaths within white patients (51%) compared with AA patients (40%) (P = 0.03). Conclusion Our data show that while a greater percent of AIDS-related deaths were found in whites vs. AA in the early HAART era, AA patients typically have lower CD4 counts at the time of diagnosis and within 3–6 months prior to death. Future analyses will examine specific attributable mortality, HIV viremia and changes in causes of death over later HAART era. Understanding factors associated with mortality may inform care models to prevent or delay future deaths. Disclosures All authors: No reported disclosures.

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