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Compression Therapy
Compression therapy is considered the mainstay of venous leg ulcer (VLU) treatment and along with standard care has the potential to heal 50%-75% of VLU. This topic provides an overview on the use of compression therapy in the treatment of VLU with evidence-based recommendations
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Debridement
Debridement is an important step in optimizing a wound or ulcer for functional healing. This evidence-based topic provides clinical, coverage and reimbursement updates on debridement methods in wound management (e.g., surgical, sharp conservative, mechanical, autolytic, enzymatic, larval, hydro-mechanical, etc). Includes indications, contraindications, GRADE recommendations, documentation guidance, links to Medicare coverage determinations by each Medicare Administrative Contractor.
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Offloading Devices
This topic provides a review and updates on offloading devices for diabetic foot ulcers (DFUs), from the clinical, coverage and reimbursement perspectives.
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Wound Culture - Swabs, Biopsies, Needle Aspiration
ABSTRACTCLINICALOverviewWound infection has been regarded as the one of the most important causes of delayed healing of chronic wounds.[1] On the other hand, overuse and inappropriate use of antibiotics and/or topical antimicrobial agents on non-
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Diabetic Foot Ulcers - Classification Systems
Diabetic Foot Ulcer Classifications - Wagner, University of Texas, WIfI, IDSA. Actionable tables with pictures and documentation tips for proper ICD-10 coding
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Diabetic Foot Ulcer - Introduction and Assessment
A diabetic foot ulcer (DFU) can be defined as a full-thickness wound below the ankle, or as a lesion of the foot penetrating through the dermis, in people with type 1 or type 2 diabetes.
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Pressure Ulcers/Injuries - Guidelines and Quality Measures
Pressure ulcer/ pressure injury overview: updates on terminology, evidence-based clinical guidelines, quality measures and resources
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How to Perform An Ankle Brachial Index
DEFINITION
Resting ankle–brachial index (ABI) is the most commonly used test in screening for and detection of PAD in clinical settings. The ankle brachial index (ABI) is the ratio between the blood pressure in the ankles and the blood pressure in the arms. Blockage in the arteries of the legs causes less blood flow to reach the ankles. This reduces the blood pressure in the ankle. The ankle brachial index is lower as peripheral artery disease is worse. The severity of peripher
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Errors and Healthcare
Patient safety is a serious public health issue. Like obesity and motor vehicle crashes, harms caused during care have significant mortality, morbidity, quality-of-life implications, and adversely affect patients in every care setting. This topic provides a snapshot of current patient safety facts, helpful definitions in Patient Safety, factors that lead to errors, liability in Wound and Hyperbaric Oxygen Therapy Programs, and actions that can be implemented to improve Patient Safety and reduce errors.
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How to Select Adequate Compression Therapy Pressure Levels and Products
Compression therapy is essential for patients with venous leg ulcer, lymphedema and other conditions. This topic provides algorithms that illustrate how audible handheld Doppler ultrasound/ waveform analysis or ankle-brachial index can be utilized to determine appropriate pressure levels and types of compression across different clinical scenarios.
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Venous ulcers - Introduction and Assessment
Concise Algorithm for Assessment of Venous Ulcer for use at point-of-care. Comprehensive topic including epidemiology, risk factors, etiology, pathophysiology, history, physical examination, diagnosis, differential diagnoses, documentation and ICD-10 coding. Free Abstract
Summary
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Venous Ulcers - Treatment and Prevention
Venous Leg Ulcers (VLU) are relatively common, affecting 1% of the population in the U.S. This topic discusses treatment and prevention of VLU. Evidence-based management of venous ulcer, including a section for clinicians on patient education. Concise Algorithm for Management of Venous ulcer for use of point-of-care.
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Diabetic Foot Ulcer - Treatment
Diabetic foot ulcer (DFU) management with a concise algorithm which can be used at the point-of-care
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Transcutaneous Oximetry
Application of transcutaneous oximetry in hyperbaric medicine with practical algorithm.
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How to Apply Cellular and/or Tissue Based Products
Practical guidance with step-by-step pictures, protocol and tips on how to apply different types of cellular and/or tissue products (CTPs), also known as skin substitutes
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Pressure Ulcers/Injuries - Introduction and Assessment
Framework for assessment of patients with pressure ulcers/injuries. Includes concise abstract, clinical pathway/algorithm for use at the point-of-care, and comprehensive resources on the condition (e.g. epidemiology, risk factors, etiology, pathophysiology, history, physical examination, diagnosis, differential diagnoses, documentation and ICD-10 coding)
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Pressure Ulcers/Injuries - Classification/Staging
This topic provides pictures and details on two of the most used classification systems for pressure ulcer/injury (PU/PI): the classification created by the National Pressure Ulcer Advisory Panel (NPUAP) and the system adopted by the Centers for Medicare and Medicaid Services (CMS)
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Pressure Ulcers/Injuries - Treatment
Pressure Ulcers/Injuries - evidence-based, always current review on management with a concise algorithm/pathway for use at the point-of-care
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Pressure Ulcers/Injuries - Prevention
Pressure ulcers/injuries (PUs/PIs) pose a large burden to affected individuals, caregivers and healthcare systems. As in any illness or injury, preventing PUs/PIs is better than treating them. This topic presents evidence-based interventions for prevention of PUs/PIs, with best practices and recommendations summarized in a concise table.
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Pressure Ulcers/Injuries -Coordination of Care
Coordination of care for prevention and management of pressure ulcers/injuries - problems and practical solutions
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Patient Education - Venous Leg Ulcers
Venous leg ulcer for patients and caregivers. This illustration-rich topic can be shared by email, or the attached trifold brochure can be printed and handed directly to patients.
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Lymphedema - Introduction and Assessment
Evidence-based review on lymphedema. Framework for assessment of patients with lymphedema. Includes concise abstract and comprehensive resources on the condition (e.g. epidemiology, risk factors, etiology, pathophysiology, history, physical examination, diagnosis, differential diagnoses, documentation and ICD-10 coding)
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Case: How 20 minutes of fun can cost 4 months of disruption
This case illustrates how a seemingly innocent decision in the life of a person at risk for pressure ulcer/injury (PI/PI) can lead to a new episode of PU/PI
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Case: When Pressure Ulcer/Injury Happens...
This case illustrates real world obstacles that lead to scenarios of increased likelihood of unavoidable pressure ulcers/injuries (PUs/PIs) and delayed transition of care.
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Lymphedema - Treatment and Emerging Strategies for Prevention
Evidence-based, always current review on lymphedema management with a concise algorithm/pathway for use at the point-of-care
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Lymphedema - Surgical Management
For well-selected patients with chronic lymphedema, surgical management offers a chance for reduction of limb volume, decreased episodes of infection and improved quality of life. This topic provides updates on recent surgical advancements, along with specific indications and guidance on preoperative evaluation.
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How to Interpret Audible Handheld Doppler Ultrasound and Waveforms to Rule out PAD
Audible handheld Doppler ultrasound and waveforms have been gaining acceptance as a tool for bedside non-invasive arterial assessment of lower limbs. This topic provides a primer (includes videos) on how to perform and interpret audible handheld doppler and waveforms to detect peripheral artery disease.
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Patient education - Lymphedema
Topic on lymphedema and its complications for patients and caregivers. The topic can be shared with patients and caregivers by email or print.
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Cutaneous Vasculitis
INTRODUCTIONBackgroundDefinition:Vasculitis of the skin (cutaneous vasculitis) includes several inflammatory disorders that compromise blood vessels and specifically the cutaneous vascular system (i.e. arterioles, capillaries, postcapillary venules), and lead to cutaneous changes. (Papi and Papi 2016) According to the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides (CHCC2012), cutaneous vasculitis can present in 3
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Case: New-onset cutaneous vasculitis
Wound care clinicians often face challenging ulcers that have been previously treated with little or no success by other healthcare providers. Some of these ulcers are related to cutaneous vasculitis. This topic describes how an atypical lower extremity ulcer was diagnosed as new-onset cutaneous vasculitis at a wound care clinic.
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Patient Education - Venous Leg Ulcers (Spanish)
Venous leg ulcer for patients and caregivers in SPANISH. This illustration-rich topic can be shared by email, or the attached trifold brochure can be printed and handed directly to patients.
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How to Perform Conservative Sharp Wound Debridement
This topic provides practical guidance on how to perform conservative sharp wound debridement, assess effectiveness, troubleshoot, code and document each procedure. See step-by-step protocols with pictures, video, checklists and documentation template.
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Patient Education - Shower Instructions for People with Wounds
Shower instructions for patients and caregivers. The topic can be shared by email, or the attached trifold brochure can be printed and handed directly to patients.
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Telemedicine/ Televisit Implementation Playbook - Part 1
Telemedicine can be a plausible option to do more with less in wound care. The purpose of the first part of this playbook is to guide healthcare professionals in assessing the benefits telemedicine can bring to their practices.
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How to Select Offloading Devices
This topic provides guidance on selection of Offloading Devices with an interactive framework
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Telemedicine/ Televisit Implementation Playbook - Part 2
Telemedicine can be a plausible option to do more with less in wound care. This is the second installment of the Telemedicine/ Televisit Implementation Playbook. The first installment guides healthcare professionals in assessing the benefits telemedicine can bring to their practices. This topic provides a practical pathway for implementation of telemedicine solutions.
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Arterial Ulcer - Introduction and Assessment
Evidence-based review on arterial ulcer. Framework for assessment of patients with arterial ulcers. Includes concise abstract and comprehensive resources on the condition (e.g. epidemiology, risk factors, etiology, pathophysiology, history, physical examination, diagnosis, differential diagnoses, documentation and ICD-10 coding)
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Arterial Ulcer - Surgical Treatment
This topic covers surgical management of arterial ulcers (AUs) with focus on surgical indications and selection criteria.
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Arterial Ulcer - Treatment
Concise Algorithm for Assessment of Arterial Ulcer for use at point-of-care. Comprehensive topic including epidemiology, risk factors, etiology, pathophysiology, history, physical examination, diagnosis, differential diagnoses, documentation and ICD-10 coding. Free Abstract Summary
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How to Assess a Patient with Chronic Wounds
Treat the cause IV a. Determine if there is adequate blood supply to heal b. Identify the cause(s) as specifically as possible or make appropriate referrals c. Review cofactors/comorbidities (systemic disease, nutrition, medications) that may delay or inhibit healing d. Evaluate the person’s ability to heal: healable, maintenance, non-healable 2a. Develop an individualized plan of care IV b. Treat the ca
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Patient Education - Arterial Ulcer
Arterial Ulcers for patients and caregivers. The topic can be shared by email, or the attached trifold brochure can be printed and handed directly to patients.
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How to Collect a Wound Swab (Levine Technique) for Culture
This topic provides the steps for collecting a superficial wound swab for wound culture and susceptibilities (C&S) when there is a suspected wound infection.
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Telehealth in Wound Care - Evidence and Best Practices
Telehealth has become an important tool in the management of chronic wounds. This topic explains the differences among telehealth modalities and their indications, provides evidence-based recommendations, and summarizes best practices and tips for telehealth in wound care.
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2021 Office/Outpatient E/M Services Updates for Wound Care and HBOT
As of January 1, 2021, evaluation and management (E/M) CPT® codes 99202-99215 can be selected on the basis of the complexity of the medical decision making (MDM) or on the basis of the total time on the date of the encounter. This topic provides a summary of the main updates, along with a printable point-of-care tool that includes sample verbiage for support documentation of MDM in wound care and hyperbaric and oxygen therapy (HBOT).
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How to Perform a Wound Biopsy
A number of wounds are misdiagnosed every year, leading to delayed treatment. Performing a skin biopsy is a simple skill that once learned, can greatly help with the diagnosis of chronic wounds. This topic provides an overview of the different available techniques for wound biopsy, along with a step-by-step protocol for conducting a punch biopsy.
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Skin Failure - Introduction and Assessment
This topic provides decision support on identification of manifestations of skin failure such as Kennedy terminal ulcers (KTU), Skin Changes At Life’s End (SCALE), Trombley-Brennan terminal tissue injuries (TB-TTI), pressure ulcer/injury (PU/PI) and other conditions.
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Antimicrobial Stewardship In Wound Care
INTRODUCTIONOverviewThe inappropriate use of antimicrobial medications contributes to antibiotic resistance and adverse drug events, and improving antimicrobial prescribing practices is a patient safety priority.[1] The Centers for Disease Control and Prevention (CDC) estimates that annually at least 2 million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the United Stat
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Patient Education - Arterial Ulcer (Spanish)
¿QUÉ es una úlcera arterial?Las Úlceras arteriales o isquémicas, son una herida o abertura en la piel debido a la mala circulación sanguínea debido a arterias estrechadas o dañadas (insuficiencia arterial). Las úlceras comúnmente ocurren a lo largo de las piernas, los pies o los dedos de los pies.¿QUÉ causa una úlcera arterial?La Enfermedad arterial periférica (PAD) causa la mayoría de las úlceras arteriales. La PAD comúnmente ocurre en pacientes con diabetes mellitus
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Patient education - Lymphedema (Spanish)
¿QUÉ es la linfedema?La linfedema es la acumulación de líquido en partes de su cuerpo, debido a un problema con su sistema linfático. Si el sistema linfático está dañado o bloqueado, se acumulará líquido y causará hinchazón (Figura 1). El sistema linfático es una red de diminutos vasos que actúa como una esponja que extrae líquido de los tejidos y lo dirige de vuelta a la circulación. Si la "esponja" no funciona correctamente, se acumula líquido "impuro", su
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Patient Education - Shower Instructions for People with Wounds (Spanish)
¿CÓMO una buena higiene ayuda a mi herida?La higiene se refiere a mantenernos limpios a nosotros mismos y a nuestro entorno para prevenir enfermedades y dolencias.La higiene personal es el cuidado de nuestro cuerpo para mantenerlo libre de infecciones. Incluye lavarse las manos y el cabello, bañarse o ducharse, limpiarse la ropa y cuidar una herida.Nuestros cuerpos entran en contacto co
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How to Administer Local Anesthesia for Wound Care Procedures
This topic provides the steps for collecting a superficial wound swab for wound culture and susceptibilities (C&S) when there is a suspected wound infection.
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Atypical Ulcers
Algorithm NeoplasticPrimary skin cancer: basal cell carcinoma Primary skin cancer: squamous cell carcinomas Primary skin cancer: malignant melanomas Malignant Fungating Wounds Soft tissue sarcomas in skinKaposisInflammatory: Small/medium/large vesselInflamma
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Medical Ethics In Wound Care
ABSTRACTINTRODUCTIONOverviewasdBackground DefinitionsMedical ethics: medical ethics applies moral principles to the solving of dilemmas A
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Surgical Wound Complications
Abstract We will write the summary section once topic is completeINTRODUCTIONOverviewwerBackgroundDefinitions: what is a surgical woundRelevanceExplain the importance of this condition. What is the social, financial burden? Surgical wound healing process: primary (closed), secondary (open), tertiary intentionCDC surgical wound classification- clean, clean contaminated, contaminated,
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Applied Anatomy and Physiology in Wound Care
INTRODUCTIONMusculoskeletal SystemFig. 1. Positions prone to pressure and bony structures involvedRelated topicsPressure Ulcers/Injuries - Overview
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How to Apply a Multilayer Compression Bandage
Practical guidance with step-by-step pictures, protocol and tips on how to apply different types of cellular and/or tissue products (CTPs), also known as skin substitutes
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How to Perform Incision and Drainage for Skin and Soft Tissue Abscesses
This topic provides the steps for collecting a superficial wound swab for wound culture and susceptibilities (C&S) when there is a suspected wound infection.