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Perhaps you are like many health care professionals, and find it difficult to differentiate between venous and arterial ulcers. If so, the following article should help you to learn how to recognize and treat arterial ulcers, also known as ischemic ulcers.

What is an arterial ulcer?
Arterial ulcers are ulcers that occur as a result of a complete or partial blockage of the arteries. Another term for this is arterial insufficiency. Arterial insufficiency occurs as a result of peripheral arterial disease (PAD) and causes decreased perfusion to the tissues distal to an arterial plaque formation.

What causes arterial ulcers?
Arterial ulcers are caused by inadequate circulation, which in turn is caused by arterial insufficiency. The hands and feet most often suffer the consequences of arterial insufficiency. Ulcers may form just at or below the ankle, between the toes, or around bony prominences.

What are the risk factors for the development of arterial ulcers?
There are several health conditions that may place your patient at risk for the development of this type of ulcer, including diabetes, high blood pressure, smoking, obesity, sedentary lifestyle, family history, hyperhomocysteinemia, hypertriglyceridemia, hyperuricemia, and stress. These types of ulcers are more common as a person ages (60’s to 80’s) but may occur earlier in patients with diabetes.
Arterial ulcers are often precipitated by trauma, and a simple bump or scrape to an extremity may be the initial cause. Once formed, these ulcers are slow to heal due to the lack of oxygen and nutrients as a result of PAD.

What are the signs and symptoms of arterial ulcers?
There are several signs and symptoms which should prompt the diagnosis of arterial ulcer. Some of these symptoms are:

• Cool or cold skin
• Reduced or absent pulse in the affected extremity
• Shiny, tight, dry skin
• Skin may be hairless
• Toenails thickened and brittle
• Ulcers small and circular in appearance
• Wound edges smooth
• Wound base is pale in colour
• Minimal fluid drainage (unless wound is infected)

How do I assess arterial ulcers?
Doppler ultrasound may be needed to assess pulses as they may be absent or diminished in the affected limb. You will note that the patient’s skin will feel cool to the touch, worsening as you move down the limb. The patient may experience pain at rest or during ambulation.
Pain at rest is caused by diminished blood flow to the toes or foot that may be relieved somewhat when the foot is placed in the dependant position. When the patient elevates the limb above heart level, the foot may become pale; the leg will appear reddened or dusky when the leg is in the dependent position. Edema may or may not be present, depending on whether the patient positions the leg in a dependent position for comfort.

How are arterial ulcers treated?
Affected limbs should not be elevated. At rest, the limb should remain in a neutral position. Patients should be encouraged to walk. Patients with arterial ulcers should not have their limbs compressed with stockings or bandages.
There are some medications (Trental and Pletal) that may help to increase blood flow in patients with PAD. Patients with chronic heart failure may be unable to take Pletal. Data to support the use of such drugs is not widely available.
Complete occlusion of a vessel may require vascular surgery.
Wound care in arterial ulcers
There are several principles that should be adhered to when caring for arterial ulcers:

• Assess the wound daily for appearance, drainage, increase in size, signs of infection, and moistness
• Document wound appearance and size frequently
• Assess blood flow frequently
• Manage pain appropriately
• Cleanse wounds with normal saline or another non-cytotoxic cleanser
• Moisturize the skin of the affected limb frequently
• Choose the right dressing for the wound in its current state-hydrocolloids, hydrogels, foams, and calcium alginates may be acceptable choices
• Ensure adequate nutritional status
• Be alert to signs of infection and treat aggressively-obtain a wound culture when in doubt as to whether infection is present. The wound should be cleansed with normal saline prior to culturing the wound.

Caring for patients with arterial ulcers can be challenging for you, the health care professional. Following the above principles will help you to identify, assess, and treat arterial ulcers when they occur. Woundeducators.com is dedicated to ensuring that you have the most current knowledge available to treat these wounds with confidence.

If you are interested in obtaining wound care certification, wound educators.com can be your ticket to success. Contact us today for more information.

Does this sound familiar?

“I have worked in the health care field for 17 years. In the beginning, my career was filled with new experiences and an endless amount of new information to be absorbed. I longed for the day when my confidence level would be such that I knew enough to feel less anxious than I did as a new graduate.
These days, I almost wish that I could recapture the exhilaration of my first job after graduation, when I was excited about all aspects of my job and there was so much to learn and do. I long to feel the excitement about my career that I once did. At this point in my career, I feel as if I need a change, like I am stuck in a rut. I don’t enjoy my job as much as I did in the beginning, and feel as though something is missing. I just haven’t figured out what I want to be when I grow up! I know that something needs to change, but I don’t know what”.

The above quote, from a registered nurse who has been practicing for years in the same area, may sound familiar to you. It is not uncommon for health care professionals, no matter their background, to feel this way. Health care professionals are generally people who enjoy learning and the challenge that learning brings. This quality of curiosity and the enjoyment of learning that makes people choose health care as a profession is the same quality that can lead to boredom and job dissatisfaction.

Once you have identified the need to make a change in your career, what is the next step? Your next logical move is to find an area that interests you. Identifying an area that interests you will help to narrow your focus, and point you in the direction that you need to go.

Specializing in a specific area can allow you to stay in your chosen field, yet broaden your knowledge and open new avenues to you. Becoming certified in an area of interest can bring new career opportunities, higher pay, and can provide greater job satisfaction. Becoming specialized may be just what the doctor ordered to cure career boredom and burnout, and may help you to put the passion back into your career.

Becoming wound care certified may be an option for you if you enjoy the challenge of diagnosis, treatment, and problem solving. Wound care is a field which is growing by leaps and bounds with no signs of letting up, due to an aging population, and advances in treatment that are allowing elderly people to live longer with conditions that may have meant an earlier demise decades ago.

Woundeducators.com can satisfy your need to challenge yourself in your career, providing an opportunity to become certified in one of the fastest-growing specialties today. Becoming a wound care specialist can lead to higher wages, better job opportunities, and a renewed satisfaction in your career. Contact us today, and start your journey towards a new or improved career.

Traditional wound care practice may not be in your patient’s best interest.
Consider the following statistics:

• More than 600,000 individuals suffer from venous ulcers in the US every year
• Costs associated with treatment may exceed $1 billion
• 2-3% of diabetics develop foot ulcers every year-there are nearly 21 million Americans with diabetes
• 15% of diabetics will develop foot ulcers in their lifetime
• Treating diabetic foot ulcers costs more than $100 million per year
• A further 1.5-3 million adults experience pressure ulcers, with 70% of these occurring in the elderly population
• The estimated cost of treating these pressure ulcers is $3.6 billion
  (from Jones, Fennie, & Lenihan, 2007).

Cost aside, these wounds affect quality of life for the patients who experience them, and sometimes render them unable to fully participate in their lives physically and socially. The pain associated with these wounds can be debilitating.

As health care professionals, it is our responsibility to offer our patients wound care management that is based on scientific guidelines and best practice information. Many of the traditional wound care practices have been disproved, and some have been shown to cause harm. An example is the use of cytotoxic agents to cleanse wounds. Dressing wounds with dry gauze is another example of an old standard which has been shown to be ineffective. Using traditional methods to treat wounds can lead to increased pain for the patient, longer healing times, infection, and increased costs.

Hospitals and other agencies are being held to a higher standard of care, and health care professionals and agencies may be held liable for the use of outdated methods of wound care that no longer meet standards as set forth by regulatory agencies. As we are all no doubt aware, Medicare is now “cracking down” and will be holding hospitals and other health care agencies financially responsible for wounds which develop after patients are admitted to a facility.

All of these are good reasons why health care professionals must take it upon themselves to learn all the latest evidence based practices as regards wound care management. Treatment methods are ever-changing and complex as new studies bring forth new information in this area. Keeping abreast of new developments in wound care can be challenging, but ultimately is worthwhile as patient satisfaction, healing time and experience of pain will all be optimized. Individuals and organizations who invest in education in evidence-based management of wounds will reap the benefits of lower financial costs as well as the satisfaction of knowing that they are providing their patients with the most current, up-to-date management practices available.

At woundeducators.com, we are committed to bringing you the latest information in wound care management, based on research and current evidence based practice. Our online courses in wound care management will support you or your employees in providing the best care for your patients, helping to improve patient satisfaction and decrease costs. Visit WoundEducators.com to learn how we can help you achieve excellence in wound care.

Can you tell the difference between perineal dermatitis and a pressure ulcer? Distinguishing between the two conditions can be tricky!

Perineal Dermatitis
Perineal dermatitis can be defined as moisture-associated skin damage and is often the result of urine or fecal incontinence (or both). Patients who wear incontinence pads or briefs may be at higher risk for the condition, as these garments hold moisture against the skin, increasing surface temperature and humidity. These conditions can lead to maceration of the skin.

Perineal dermatitis may show itself as an area of redness on the skin. You may also see scaling of the skin. Papule and vesicle formation may take place. Weeping vesicles may contribute to skin damage. Keeping patients clean and dry is the key to prevention of this condition.

Irritant-Associated Dermatitis
This type of dermatitis is thought to be caused by the skin’s prolonged contact with urine and/or stool, which may result in the release of inflammatory cytokines. Signs and symptoms include:

• redness, which may spread to skin folds of the buttocks and inner thighs
• edema
• blistering
• skin erosion
• weeping
• itching and/or pain in the area

Allergic Contact Dermatitis
This condition may be caused by residue from laundry detergent in patients who wear washable incontinence products. It can also occur from contact with an allergen from a cream or ointment applied to the skin. It may appear rather quickly and spread rapidly. Skin will have a similar appearance to that of irritant-associated dermatitis; however, the key to treating this type of dermatitis is to discover the cause and remove the causative agent.

• Treating perineal dermatitis includes treating incontinence and protecting the skin from further irritation. Frequent cleansing of the skin with mild soap and water and applying a barrier cream to protect the skin from moisture are sound treatments which should improve the patient’s skin quickly and effectively. If the area becomes infected with yeast or bacteria, use of an appropriate antifungal or antibiotic will be necessary.

Pressure Ulcers
A pressure ulcer is a localized area of injury to the skin, usually over a bony prominence, as a result of pressure by itself or in combination with friction or shear. Stage I or II ulcers can form in the same areas as perineal dermatitis, making an accurate diagnosis difficult. Stage I pressure ulcers usually involve an area of nonblanchable redness over a bony prominence. The skin is intact in Stage I ulcers. Stage II ulcers present as a shallow open area in which the wound bed is pink or red. There is no slough. Alternately, stage II ulcers may present as intact or open serum-filled blisters. In pressure ulcers, pressure and not moisture is the defining element.

Care of the patient with a pressure ulcer involves employing methods to relieve pressure and allow healing of the ulcer by:

• using pressure-reducing beds, chairs, and other equipment
• providing optimal nutrition for wound healing
• turning and frequent repositioning to relieve pressure
• treating pain

Of course, both of these conditions can occur together. Patients who develop perineal dermatitis are at higher risk of developing a pressure ulcer to the same area, as the skin is already compromised. Prevention of both of the conditions is key to management, and instituting appropriate and rapid treatment once one of these conditions is recognized will produce the best patient outcome.

At woundeducators.com, we are committed to providing you with quality, up-to-date information which will allow you to care for your patients utilizing the best available information. Obtaining wound care certification will allow you to quickly identify and treat any condition that our patients may present with, and will ensure they receive the best treatment possible. Contact us today to find out how you can begin your journey to becoming certified as a wound care specialist.

Interesting Article:  Perineal skin care for the incontinent patient

Myth # 5-An area of discolored intact skin is most likely a Stage 1 pressure ulcer or a bruise

A deep tissue injury (DTI) is commonly mistaken for a stage 1 pressure ulcer or a bruise. This is a serious error and can have a profound impact on patient outcomes, liability, and reimbursement. 

What is a deep tissue injury (DTI)?
Deeper, full-thickness damage to underlying tissue which may appear as purple areas or dark necrotic tissue should not be confused with Stage 1 pressure ulcers.

The National Pressure Ulcer Advisory Panel (NPUAP) has defined wounds such as these as “A pressure-related injury to subcutaneous tissue under intact skin. Initially, these lesions have the appearance of a deep bruise”(NPUAP, 2002). DTI’s require rapid identification, as they may quickly progress to Stage 3 and 4 pressure ulcers despite aggressive and optimal treatment.

How do DTI’s form?
Fleck (2007) explains that DTI’s form over areas of bony prominence and occur from the inside out. Superficial damage is not seen until later, when tissue undergoes necrosis, reaching the outer layer of skin and resulting in the formation of an external wound. She further stresses that DTI’s can be differentiated from Stage 1 ulcers by their rapid deterioration despite proper care.

What are the legal implications of DTI’s?
DTI’s that are not recognized for what they are can have legal implications due to their ability to deteriorate despite stringent wound management practices. They result in increased costs and hospitalization, not to mention pain and suffering for the patient who develops one of these wounds, putting the health care practitioner and the facility at risk for litigation.

Salcido (2008) discusses the current Medicare changes that are scheduled to take effect October 1, 2008. These changes will have a huge impact on how hospitals are reimbursed. In regards to wound care, pressure ulcers will be considered hospital acquired (and therefore not reimbursed) unless these wounds are documented within 48 hours of admission. The onus is now on us, as healthcare professionals, to ensure that these wounds never develop, and if they do, they should be well documented and aggressively treated. This new policy is forcing us to examine our wound care management practices.

Documentation of DTI’s
Wounds that are suspected as being a DTI should be afforded a full description and the word “DTI” should be mentioned. For those practitioners who work in long-term care with the Minimum Data Set (MDS) documentation system, the word “unstageable” should be used to describe those wounds that are suspicious for DTI. Thorough and ongoing documentation is crucial in respect to DTI’s, as their rapid deterioration may make these wounds particularly tempting targets for litigation.

Education is the key to recognition and management of DTI’s
Understanding the etiology of DTI’s and learning how to differentiate these wounds from bruises, hematomas, and other closed wounds that may have a similar appearance is the key to prevention and treatment of these wounds, which have the potential for significant morbidity for patients, as well as being potentially litigious.

Woundeducators.com strives to provide you, the healthcare professional, with the information you need to recognize and treat DTI’s and other wounds. Our online wound care certification course can give you the tools you need to protect your patient, yourself, and your agency. If you are interested in becoming wound care certified contact us today, and you can be on your way to an exciting new career.

Pressure ulcers have long been an issue for patients immobilized for lengthy periods of time. Although in recent years there has been a greater emphasis and awareness regarding prevention of pressure ulcers, starting in October health care professionals will be held financially responsible for patients who develop pressure ulcers.

What are “never events”?

Never events can be defined as events that should not occur, or preventable adverse events. Along with a long laundry list of circumstances and events such as performing the wrong surgery and blood incompatibility errors, pressure ulcers that develop in patients during the course of their hospital stay will no longer be reimbursed, as set forth in the CMS (Centers for Medicare and Medicaid Services).

Why are pressure ulcers being classified as “never events”?

Pressure ulcers are increasing in hospitalized patients, and patients hospitalized specifically for treatment of pressure ulcers have a higher than average length of stay. Pressure ulcers can lead to extended lengths of stay, infection, pain, loss of function, and even death. As well, the cost of treating pressure ulcers is approximately $11 billion per year.

What does the new ruling mean for healthcare professionals and their employers?

Essentially, the CMS ruling means that if a patient is admitted to the hospital without a pressure ulcer, and subsequently develops a pressure ulcer, the hospital will not be paid for that patient’s care.

What effect will this new ruling have on hospitals, long-term care, and home health care?

Obviously, hospitals that have a high incidence rate of development of pressure ulcers will stand to lose a great deal of money; this could greatly impact the financial viability and well-being of the hospital and, by extension, the hospital staff. Considering that the cost of treating a pressure ulcer can be as much as $70,000.00, the need to take steps to prevent pressure ulcers aggressively needs to start now. Facilities that have a program in place to identify and treat patients at risk for the development of pressure ulcers will fare better than those who don’t.

There are some facilities that are exempt from the CMS ruling. These include critical access hospitals, long-term care hospitals, Maryland waiver hospitals, hospitals that treat only cancer, and children’s inpatient hospitals.

You may be wondering how home care will fare under this new ruling. The implications are ominous for home health care practitioners and their employers. There is no provision under the new CMS ruling that states that pressure ulcers must be healed before patients leave the hospital. This means that home care will then bear the financial responsibility for pressure wounds in patients discharged home with pressure ulcers. Additionally, a difficulty that has been identified in the home care setting is the issue of the healthcare provider’s inability to control the patient and the patient’s family in terms of compliance with wound care prevention and treatment recommendations. This is very important in terms of performance monitoring and risk management.

What can healthcare professionals do to ensure they are prepared to meet the challenges of the new guidelines?

Prevention, accurate assessment, and documentation of wounds will become even more crucial as of October of 2008.
The IHI (Institute for Healthcare Improvement) recommends six steps in the prevention of pressure ulcers:

• Assess the skin of all patients upon admission for existing ulcers, and identify those at risk of developing ulcers (i.e. Braden scale)
• Reassess the entire skin daily, observing for development of pressure ulcers or worsening of pre-existing ulcers
• Assess the patient’s risk factors for pressure ulcers daily
• Manage moisture properly
• Optimize the patient’s  nutrition and hydration status
• Minimize pressure and use pressure minimizing tools properly

In order to meet the new challenges set forth by the new CMS ruling on pressure ulcers, healthcare professionals and agencies must aggressively plan and implement ways to prevent pressure ulcers from occurring. One of the most effective ways to manage this is to ensure that all professionals who deal with at-risk patients are trained in the most current evidence based knowledge available. Woundeducators.com can help to accomplish this goal by providing up-to-date information and training in wound care management and wound care certification. Protect yourself and your facility by engaging in online wound management today, and be prepared for tomorrow.

Myth # 4-Common wound care practice is always evidence based practice

Old habits die hard. Sometimes we do things a certain way simply because it is the way it has always been done. This is true even in medicine. We often get stuck in a rut of practicing a certain way through habit, and for no other reason.

Wound care is no exception. Many healthcare professionals continue to treat and dress wounds the way it has been done for years, despite the fact that new research shows this may not be the best treatment modality for the patient. This article will examine three common myths in wound care that have been found to delay wound healing, increase patient discomfort, and that may place you and your employer at risk for negligence.

Betadine and peroxide help wound healing by reducing the bacteria in the wound bed

This has been a common practice in the treatment of wounds for many years; however, it is no longer acceptable practice and continuing to use these agents (and other similar agents) is actually harmful instead of helpful. The Agency for Health Care Research and Policy (2008) states, “Do not use povidone iodine, iodophor, sodium hypochlorite solution, hydrogen peroxide and acetic acid as they have been shown to be cytotoxic. Use normal saline at a pressure between 4 and 15 pounds per square inch (psi).
Using cytotoxic agents to cleanse wounds can increase your patients discomfort, as well as delay wound healing. Dallam et al (2004) reiterate this point: “Do not use cytotoxic solutions, such as Betadine or hydrogen peroxide, to cleanse wounds. They not only deter wound healing, but they may also cause burning and cold to patient discomfort”.

Gauze dressings are an effective and cost-efficient way to promote wound healing

Ovington (2001) states that in order for gauze dressings to provide optimal healing, they must be changed frequently or, at the very least, remoistened frequently. This is labor-intensive for health care practitioners or caregivers and not cost effective in today’s health care climate. Most importantly, gauze dressings do not support optimal wound healing. Ovington points out that the use of wet-to-dry dressings is not acceptable, as the debridement that takes place with this method of management is not selective, often removing healthy tissue and causing reinjury to the wound bed, not to mention additional pain for the patient.

Frequent dressing changes with gauze dressings will reduce wound infections

One study has shown that bacteria are capable of penetrating up to 64 layers of dry gauze, thus negating the idea that gauze provides an effective barrier to bacteria. Frequent dressing changes only provide more opportunity for bacteria to enter the wound. In addition, the labor that is involved with 2-3 times a day dressing changes is just not feasible in many cases.

The practices mentioned are not only harmful to the patient, causing delayed wound healing and increased pain, but are also a liability risk for the practitioner and agency who use these methods of wound management. They are no longer considered best practice and are no longer the standard of care.
In these days of rapid change and an explosion in new research and knowledge, how can practitioners be expected to keep up with new standards of care? Online learning at woundeducators.com is one method that can help you stay current with the new guidelines and the knowledge that supports them. We are dedicated to ensuring that practitioners have the most up-to-date information they need to manage wounds in their patients safely and effectively.

Myth # 3-Wound dressings cover a wound and offer little in the way of healing

Choosing the right type of dressing to optimize wound healing and prevent complications is key to wound management. However, the proliferation of wound dressings that have flooded the market in recent years causes confusion among healthcare professionals. How can we, as wound care practitioners, be expected to keep up with new advances and new knowledge in the specialty of wound care management? I hope that the following will shed some light on new advances in wound dressings.

Moist Wound Healing

The old standard of wet-to-dry dressings has been replaced with a myriad of wound dressings that are geared towards treating specific wound care issues, but moist wound healing remains an important concept in wound care management. Moist wound healing is still the gold standard, as it provides and maintains moisture of exposed tissues and does not encourage these fragile tissues to dry out. Research has shown that keeping wound tissues moist has the following benefits:

• Increased rates of healing
• Improved cosmetic results
• Reduced pain for the patient
• Reduced rates of infection
• Reduced associated costs

In general, wound tissues should be moist; that is, not dry and not wet.

Dressings That Absorb Exudate

These dressings are used for wounds that create levels of exudate that are moderate to high. They have the ability to capture and hold fluid, which means that patients will require fewer dressing changes. The advantage of these dressings is that they permit undisturbed wound healing, are less labor intensive for caregivers, and afford increased cost savings. Examples of these types of dressings include foams and calcium alginate dressings.

Dressings That Maintain Hydration

These dressings are used on wounds that have progressed to the formation of granulation tissue, and have begun to fill in with new connective tissue. Wounds of this nature have decreasing levels of exudate, so continuing use of an absorbent dressing could dehydrate the wound tissues, causing delayed healing. These types of dressings actually maintain the natural moisture levels of the wound without active absorption. Examples of dressings that maintain hydration include hydrocolloid and transparent film dressings.

Dressings That Donate Moisture

These dressings are designed for wounds that are already dehydrated and covered by dry, dead tissue. Wounds such as these will not heal unless these tissues are removed. These dressings promote autolytic digestion, or the slow digestion of dead cells by the process of phagocytosis. These dressings maintain a moist environment to facilitate the process of breaking down these dead cells, and to actively add moisture to the wound. These dressings contain water. Examples of these types of dressings are amorphous hydrogels and sheet or water hydrogels.

Dressings That Address The Biochemical Wound Environment

Newer dressings can be particularly useful for wounds that have stalled in the healing process. They function by interacting with the chemical environment of the wound itself, and are considered an “active” dressing because they actually change the environment of the wound. There are several biochemical aspects of a wound that may affect the cells or cellular processes thought to be important in the healing process. Some of these include:

• Local levels of tissue proteases
• Levels of cytokines and growth factors
• Presence and duration of tissue hypoxia
• Reactive oxygen species
• Levels of bacteria (bioburden)

New dressings are currently available (and more are being developed) which will address the biochemical imbalance that occurs in chronic and nonhealing wounds. Three types of dressings are available that seek to correct imbalances in levels of proteolytic enzymes (specifically MMP’s), collagen, and microbes.

As is obvious, rapid changes in knowledge and technology have led to the development of numerous dressings that are specifically targeted towards the treatment of different types and stages of wounds. In this day and age of such rapid development, it is imperative that healthcare professionals stay abreast of the most current and evidence based knowledge available. Woundeducators.com can help you stay current by providing up-to-date information as it becomes available and by making it easy for you to become certified in wound care. Wound care certification provides documentation of a health care practitioner’s knowledge in current dressing availability and use.

Take the first step towards improving your life and the life of the patients that you care for.  Become wound care certified.   Register Today!

Myth # 2 - “Liability for wound treatment is limited to the doctor who writes the order”

As a healthcare professional, it is no longer enough to simply “follow orders”. All professionals who care for patients with wounds are now being held to a standard of care, and may be held liable for providing wound care of substandard quality, regardless of whether they believe they are covered by a physician’s order. Therefore, wound care practitioners need to be aware of these standards in order to protect their patients and avoid legal issues and denial of reimbursement.

Legal issues involving wound care management are generally an issue of negligence, or failure to meet the standard of care.

Malpractice can be defined as failure to meet standards of care that results in harm to another person. Healthcare professionals may be held liable in the event it is determined that standards of care have not been met, and may be guilty of malpractice if a patient under their care is harmed.

What is the standard of care in wound care management?

Standards of care can be defined as the care that any reasonably prudent health care provider would provide in the same or a similar situation. Standards for wound care practice have been determined by several sources:

• Agency for Healthcare Research and Quality- the Agency for Healthcare Research and Quality (AHRQ) has set out guidelines for the prevention and treatment of pressure ulcers.
• Patient Care Partnership-the patient care partnership includes basic patient rights, one of which is safe, quality care
• State nurse practice acts and guidelines-these acts regulate the practice of nurses, and define which treatments and actions may be performed by the nurse in each state
• Employer policies and procedures-policies and procedures are used to establish standards of care, and may be invoked in litigation claims-such claims may reflect either lack of knowledge or blatant disregard for a policy, and may show negligence
• Job descriptions-health care employees who provide care outside their formal job description may be held liable
• Standards of practice-various professions have individual standards of practice, set by the professional organizations

Medicare has determined that, as of October 2008, they will no longer reimburse for mainly preventable conditions, including pressure ulcers!

This ruling means that healthcare professionals must focus not only on preventing pressure ulcers, but also in treating them when they occur using evidence based wound management procedures. This is but one example of how all healthcare professionals are being held to certain standards in wound care management. It is likely that this trend will continue and that, increasingly, professionals who care for patients with wounds will be held responsible for meeting these standards.

Becoming a Certified Wound Care Professional not only guarantees knowledge of the current standards in wound care, but also ensures that the certified wound care practitioner stays current with best practice standards, as maintenance of wound certification requires proof of yearly continuing education as well as periodic retesting.

WoundEducators.com is an excellent way to prepare for certification as a wound care practitioner. As well, our program enables those who take the program to stay current with changes in the industry.

The standards are constantly undergoing change and refinement as new evidence in wound care is uncovered. Our goal at WoundEducators.com is to keep you, the reader, current with new knowledge as it becomes available.