Evidence-based topic on cellular and/or tissue products (also known as human skin equivalents, or skin substitutes) - clinical, coverage and reimbursement updates.

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.

CPT® codeThere is one relevant CPT code for the debridement with enzymatic debridement agents such asSANTYL Ointment:97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia(e.g., wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topicalapplication(s), wound assessment, and instruction(s) for ongoing care, per sessionNOTE: Under Medicare, this code is only separately payable to hospital-bas

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-

Save time and money with a well planned wound care formulary. Learn how to setup an institutional formulary to better manage your inventory of dressings and bandages.

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

Practice essentials on dressings. Summarized information on the main types of dressing used in wound management, organized in a practical tool

  Product Inhibition (%) Description Manufacturer Antibacterial active Mafenide Acetate 0.0 Sulfonamide-based antimicrobial Sigma Aldrich Antibacterial active Mupirocin 0.0 Carbohydrate-based antimicrobial Sigma Aldrich Antibacterial active Chlorhexidine Gluconate 0.0 Biguanide-b

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.

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

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)

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)

Pressure Ulcers/Injuries - evidence-based, always current review on management with a concise algorithm/pathway for use at the point-of-care

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.

Coordination of care for prevention and management of pressure ulcers/injuries - problems and practical solutions

A practical framework for clinicians on how to differentiate Stage 2 pressure ulcers/injuries on the gluteal region from selected common conditions, namely incontinence-associated dermatitis (IAD) and friction-induced skin injury (FISI). Includes pictures and ICD-10 codes for these conditions

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

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.

Collection period for MIPS Year 3 started in January 1st, 2019. In 2019, CMS expanded the types of clinicians who are subject to participation in MIPS, and implemented other updates. This blog post summarizes some of these changes and provides an overview on how WoundReference can help eligible clinicians and groups perform well in MIPS.

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.

Pyoderma gangrenosum is a rare but serious primary ulcerating condition of the skin that falls into the category of neutrophilic dermatoses. This topic provides a framework for assessment of patients with pyoderma gangrenosum. 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)

Pyoderma gangrenosum is a rare but serious primary ulcerating condition of the skin that falls into the category of neutrophilic dermatoses. Currently, there is no definitive guideline or gold standard in management of pyoderma gangrenosum, as data from controlled clinical trials are scarce. This topic provides an evidence-based, always current review on management of pyoderma gangrenosum, with a concise algorithm/pathway for use at the point-of-care

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

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.

The MIPS Improvement Activities Category is one of the four categories comprising the Centers for Medicare and Medicaid Services (CMS)'s Merit-based Incentive Payment System (MIPS). MIPS is part of the CMS Quality Payment Program (QPP), in which eligible clinicians are required to participate during 2019 to avoid a negative impact on the physician fee payment for the year of 2021. This blog post provides a summary on the

This topic provides an update on Quality in wound care and how clinical decision support systems like WoundReference can help clinicians achieve better outcomes more efficiently. The topic lists resources such as a quality framework intended to be used for creation or assessment of wound care services, algorithms demonstrating application of evidence in product selection, quality measures specific to wound care, and guidance for wound and hyperbaric programs to successfully navigate the CMS Quality Payment Program (MIPS).

As a prerequisite to setting realistic treatment objectives, chronic wounds should be classified according to their ability to heal, that is, as healable, nonhealable, or maintenance. This designation defines for the clinician, patient, and family an expected course of action, plan of care, and healing rate. It also facilitates responsible use of available resources along with realistic treatment goals. This topic serves a tool to help clinicians assess wound healability.

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.

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.

Unna Boot, also known as Unna's Boot or paste boot, is an inelastic bandage that is frequently used in compression therapy to treat venous leg ulcers. Application of UB is one of the most common clinic procedures billed to Medicare. This topic provides practical guidance on how to apply an Unna Boot, assess effectiveness, troubleshoot, code and document each application. See step-by-step protocol, and documentation checklist.

Framework for assessment of patients with skin tears. 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)

Topic on skin tear management and prevention, with a concise algorithm which can be used at the point-of-care

This topic provides guidance on selection of Offloading Devices with an interactive framework

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.

Find out how wound care and HBOT clinicians can leverage telemedicine to continue to care for their patients in a safe manner.

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)

Sign up for a Free Basic Account and watch this webinar produced by WoundReference and presented on Wounds Research.  Click HERE to watch the webinar  Arterial Ulcer - Surgical 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

INTRODUCTIONIt is crucial that nurse practitioners have a clear understanding of how their state laws and regulations impact their scope of practice. Nurse practitioners fall under the following scopes of practice environments: Depending on the state in which they practice, they may be able to work independently, with a reduced practice, or with a restricted practice. The difference between "reduced" and "restricted practice is the amount of oversight that is nee

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

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.

This topic provides a review on the available knowledge on cutaneous manifestations associated with COVID-19, based on literature review and on data published by the international registry from the American Academy of Dermatology and International League of Dermatological Societies.

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.

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.

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).

Nutrition plays a major role in wound healing. The main goal of nutrition in wound healing is to provide optimum calories and nutrition to support healing. [1][2] Deficiencies in protein, vitamin D, vitamin C and zinc have been demonstrated to impair wound healing, and are often present among patients with chronic wounds. This topic aims to provide practical guidance to support clinical decisions when screening, assessing and managing nutrition in patients with chronic wounds.

Guidance on strategic planning and performance improvement tailored to wound care and hyperbaric oxygen therapy (HBOT) programs is still scarce. This topic provides an Editable Balanced Scorecard Tool with sample metrics for wound care and HBOT programs. Institutions can make a copy of the tool, and use it to select and monitor their own objectives and metrics, according to their own vision and mission.

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.

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.

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

¿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

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.

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

ABSTRACTINTRODUCTIONOverviewasdBackground DefinitionsMedical ethics: medical ethics applies moral principles to the solving of dilemmas A

INTRODUCTIONOverviewBackgroundDefinitionsRelevanceGRADE APPROACH

INTRODUCTION"An evidence-based hospital discharge checklist that starts at admission might improve safe transition from hospital to home." REF The sample checklist below was created by a multidisciplinary consensus panel of experts (in acute, chronic, home, and long-term care and in rehabilitation medicine). It may be adapted to each organization Policies and Procedures, and completed during a typical hospitalization. DISCHARGE CHECKLIST

INTRODUCTIONMusculoskeletal SystemFig. 1. Positions prone to pressure and bony structures involvedRelated topicsPressure Ulcers/Injuries - Overview

Standard of Care: The Foundation of Wound Care The standard of care is a diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance. In other words, this is the level of care widely accepted in the medical community. (1) In the wound community, we are quite familiar with the term standard of care as it was

Handling Medical WasteOverviewHealthcare settings, including hospitals, doctor's offices, dental clinics, blood banks, veterinary clinics, and research labs, produce various kinds of medical waste. As someone working in healthcare, you might encounter these wastes directly in your role, whether you're involved in patient care, housekeeping, maintenance, or other tasks. It's important to note that some medical waste can pose health risks. This training aims to outline the potenti

PPE Overview

Bloodborne Pathogen and Biological Hazard

Hazard CommunicationIntroduction Hazard communication is an essential aspect of occupational safety and health to protect workers from potential hazards in the workplace. This encompasses safety practices such as labeling of hazardous chemicals, Safety Data Sheet (SDS) provision and employee training programs. These practices are important parts of keeping a safe working environment. Topic Objectives