Mobile Healthcare Applications Part 3: Nursing Education at Your Fingertips

healthcare-apps-part-3.pngRounding out this blog series on mobile health applications (apps) or mHealth apps, I wanted to touch on apps specifically designed to provide educational tools and quick references for the nursing profession. According to a survey conducted by Wolters Kluwer Health, 65 percent of nurses said they currently use a mobile device for professional purposes at the bedside.1  The study also found that 95 percent of health care organizations allow nurses to consult websites and other online resources for clinical information at work.1  A major advantage of mobile apps is that they provide a variety of references in one central location, that is easily attainable, from almost anywhere there is a reliable internet connection. Nurses employed in every clinical setting stand to benefit from resources at their fingertips, particularly those in home and public health settings, where access to evidence-based information may be limited.

As discussed in Part 1 of this blog series, there are thousands of mHealth apps available to clinicians. The most common are drug manuals, tools to help evaluate lab and diagnostic studies, and differential diagnosis guides2. Utilization of mobile devices in professional nursing practice may improve efficiency and assist clinicians to:
  • Complete professional development;
  • Stay up-to-date with the latest research and literature;
  • Provide patient and peer education;
  • Translate medical terms for patients and family members;
  • Compute drug dosages;
  • Calculate physiologic assessments, such as Body Mass Index (BMI), Mean Arterial Pressure (MAP), Glascow Coma Scale score, Apgar score, Stroke Scale and many more;
  • Organize shift work; and
  • Communicate with other health care professionals.
With an ever increasing number of mHealth apps on the market, how can nurses decipher which are useful and contain the most relevant and accurate information? In order to utilize these resources effectively, nurses should be competent in several key areas, including basic computer knowledge and use, information literacy, (IL) and information management3. Information Literacy (IL) is defined as the ability to recognize when information is needed and to locate, evaluate, and effectively use that information. Therefore, nurses must be able to assess mHealth apps for accuracy, credibility, bias, timeliness, and breadth of information.3  A study, conducted by Arith-Kindree and Vandenbark (2014), asked nursing students to assess a variety of mobile apps for usefulness. The study found that some apps, while from reputable sources, provided recommendations that were incomplete.3  Based on the findings from this study, nurses should critically evaluate each app to ensure it is:
  • Credible – verify the author’s credentials, publisher’s reputation, and peer-review status;
  • Relevant – assess the intended audience, purpose, and publication date;
  • Current – check that the content is consistently updated on a regular basis;
  • Utilitarian – confirm the app is useful and functions as it was designed; and
  • Comprehensive – establish that the information is complete and derived from a trusted source.
Health care apps can serve as useful tools for clinicians at the bedside, however, there are logistical and cultural obstacles that stand in the way of implementation and utilization. This opens up many opportunities for nurses in the field of informatics to develop policies, organizational infrastructure, and competencies for integrating mHealth solutions within health care organizations and communities.4  Several challenges, however, must be overcome which include:
  • Establishing hospital administrator support;
  • Overcoming staff resistance to change;
  • Training to different learning styles and comfort levels with technology;
  • Securing patient confidentiality;
  • Cost of infrastructure and maintaining consistent internet access;
  • Preventing vital machine failure or malfunction due to interference from handheld devices; and
  • Ensuring that mobile devices are not a distraction in the workplace.
Digital tools can potentially make us more efficient, effective, and informed practitioners. We are fortunate to live in an age of innovation where tools are available at our fingertips, any time, and anywhere. Unfortunately, not all mHealth apps are accurate and some cannot be trusted. We, as health care providers, need to develop a critical eye when evaluating the use of new technologies and verify that they are consistent with evidence based practice prior to full integration into the health care delivery system. In addition, more research is needed in the area of mHealth to assess the true impact it could have on workflow, quality, and patient outcomes.

References:
  1. Wolters Kluwer Health Survey Finds Nurses and Healthcare Institutions Accepting Professional Use of Online Reference and Mobile Technology. (2014). Retrieved on July 11, 2016 from http://wolterskluwer.com/company/newsroom/news/health/2014/09/wolters-kluwer-health-survey-finds-nurses-and-healthcare-institutions-accepting-professional-use-of-online-reference--mobile-technology.html
  2. Baca K, Rico M, & Stoner M. (2015) Embracing Technology to Strengthen Care and Enhance Human Connection. Dimensions of Critical Care Nursing, 34(3), 179-80.
  3. Airth-Kindree  N & Vandenbark T. (2014) Mobile Applications in Nursing Education and Practice. Nurse Educator, 39(4). 166-169.
  4. Austin, R. & Hull, S. (2014) The Power of Mobile Health Technologies and Prescribing Apps. CIN: Computers, Informatics, Nursing, 32(11). 513-515. 
Myrna B. Schnur, RN, MSN 

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Posted: 7/19/2016 5:29:04 AM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Technology


Mobile Healthcare Applications Part 2: To Regulate or Not?

Mobile-Apps-twitter-292994_1920.jpgIn Part 1 of this series, I provided a general overview of mobile medical applications (apps) that are available on the market in the areas of general health, wellness, disease management, and hospital clinical workflow. There are many potential benefits of mobile medical apps, such as facilitating communication between patient and provider, enhancing efficiency, and advancing the overall quality of patient care. There have been recent reports in the news, however, pointing to the dangers of patients being misdiagnosed via telemedicine websites and mobile apps. Serious patient safety questions arise when mobile medical apps are designed to act as a medical device or provide patients with a medical diagnosis. Should these apps be regulated by the government? Part 2 of this blog series focuses on the current regulation recommendations* surrounding the use of mobile apps as it applies to direct patient care.

The Food and Drug Administration (FDA) is the government organization responsible for protecting the public health by assuring the safety of drugs, biological products, medical devices, food supply, cosmetics, and products that emit radiation.1 In 2015, the FDA released a document that outlines the use of health care applications and states that apps that act as either a medical device or an accessory to a medical device will need to obtain FDA approval. The intended use of a mobile app determines whether it meets the definition of a “device.”  When the intended use of a mobile app is for the “diagnosis of disease or other conditions, or the cure, mitigation, treatment or prevention of disease, or is intended to affect the structure or any function of the body, the mobile app is considered a device.” 2 Intended use is communicated to the consumer through product labeling, advertising, or verbal and/or written statements made by manufacturers. All products that fall under the definition of device are subject to regulations set forth by the FDA before they can be marketed and sold to the general public.

FDA regulation will focus on mobile apps that turn a mobile platform into a regulated medical device, which could pose a risk to a patient’s safety if it did not function properly. Examples include medical apps that:
  • Connect to and control medical device(s) in order to actively monitor or analyze medical device data. (i.e., an app that controls the delivery of insulin on an insulin pump);
  • Turn the mobile platform into a medical device by using attachments, display screens, or sensors, or by including functions similar to those of currently regulated medical devices. (i.e., an attachment of electrocardiograph (ECG) electrodes to a mobile platform to measure, store and display ECG signals);
  • Perform patient-specific analysis and provide patient-specific diagnosis, or treatment recommendations. (i.e., apps that use patient-specific parameters to calculate dosage or create a dosage plan for radiation therapy).
The following medical apps pose low risk to patient safety, and therefore, the FDA will exercise discretionary judgment with regard to regulation. Examples include apps that:
  • Help patients self-manage their disease or condition without suggesting specific treatments (i.e., apps that coach patients with cardiovascular disease to maintain a healthy weight, eat nutritiously, and exercise);
  • Provide patients with simple tools to organize and track their health information, without recommending a change to previously prescribed treatment or therapy (i.e., apps that log blood pressure, drug intake times, diet, daily routine, or emotional state);
  • Provide easy access to information related to patients’ health conditions or treatments (i.e., apps that use a patient’s diagnosis to provide a clinician with best practice treatment guidelines for common illnesses or conditions);
  • Help patients document, show, or communicate potential medical conditions to their providers (i.e., apps that serve as videoconferencing portals to facilitate communications between patients, health care providers, and caregivers);
  • Automate simple calculations routinely used in clinical practice (i.e. medical calculators for Body Mass Index (BMI), Glascow Coma Scale Score, or APGAR score);
  • Enable patients or providers to interact with Electronic Health Records (EHR) systems to view or download data to facilitate general patient health management and medical record-keeping;
  • Transfer, store, convert format, and display medical device data, without controlling or changing the functions of any connected medical device.
Mobile apps that are not considered devices under the FDA definition and are not required to undergo regulatory requirements include apps that:
  • Provide electronic copies of medical textbooks or references not intended to diagnose, treat, or prevent disease by helping a clinician assess a specific patient;
  • Act as educational tools for medical training and may have more functionality than an electronic copy of text (i.e., videos, interactive diagrams), but are not intended to diagnose, treat, cure, or prevent disease by helping a clinician assess a specific patient;
  • Provide general patient education and patient access to commonly used reference information;
  • Automate general office operations and administrative functions (i.e., coding, billing, accounting, scheduling, payment processing);
  • Act as generic aids (i.e., using the mobile platform to record audio, or send HIPAA compliant messages between health care providers in a hospital).
As more and more apps are developed in the field of health care, clinicians will play a pivotal role in how these apps are implemented in the routine care of patients. We need to have a basic understanding of app functionality, which ones are purely informational and which ones act as medical devices. More importantly, it is essential that we fully comprehend the impact these apps will have on the safety of our patients, as we are ultimately responsible for protecting them from harm.

In Part 3 of this blog series, I will provide an overview of the medical mobile educational tools available to nurses and how clinicians should evaluate which are the most reliable and relevant sources of information.

*Note: This article is a summary of the FDA guidelines and is not meant to be all-inclusive of the recommendations made by the FDA.
References
  1. The U.S. Food and Drug Administration. About FDA. Retrieved on June 27, 2016 from http://www.fda.gov/AboutFDA/WhatWeDo/default.htm
  2. Mobile Medical Applications: Guidance for Industry and Food and Drug Administration Staff (2015). Retrieved on June 23, 2016 from 
    http://www.fda.gov/downloads/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm263366.pdf

Myrna B. Schnur, RN, MSN
 

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Posted: 7/10/2016 5:45:50 AM by Lisa Bonsall, MSN, RN, CRNP | with 3 comments

Categories: Technology


Mobile Healthcare Applications Part 1: Your Health at Your Fingertips

mobile-phone-630413_640.jpgIf you own a Smart mobile phone, chances are you have downloaded a mobile application (app) or have used one at some point. According to a 2015 Pew Research Study, two-thirds of Americans own a Smart phone and more than half have used their phone to get health information.Mobile apps are software applications designed to run on platforms, such as smartphones, tablet computers and other handheld devices. Apps are downloaded onto your mobile device and are designed to provide consumers with quick access to information and tools with or without internet connectivity. As of June 2015, more than 100 billion mobile apps have been downloaded from app stores and the number of mobile app buyers in the United States is projected to reach 85 million in 2019.Apps developed specifically for health care are on the rise. There are over 150,000 mobile health, or mHealth, apps on the market focusing on various areas of wellness, including fitness, general health and drug information, disease management, telemedicine, and clinical workflow, to name a few. These are available for free or for a small fee and are typically intuitive and easy to use, even for those that are not technology savvy.

Fitness apps are perhaps the most widely used mHealth apps available today. Many of these apps have companion external devices known as wearables that help consumers track steps, weight, pulse, and calories. As a runner, I have used several training apps in preparation for long distance races. These assist in mapping routes, tracking training sessions, and calculating distance and speed. Some provide feedback on performance, while others send motivational reminders to users to get out and exercise. These digital coaches can facilitate healthy lifestyle changes and can be very cost effective to the average consumer, but only when integrated into a regular routine.

General health care apps provide a range of capabilities, such as allowing patients to organize documents, appointments, and medications into a personal file that can be easily accessed at provider appointments and by family members. Others allow consumers to have direct access to all of their electronic health records (EHR) integrated into one place that automatically update with new information, such as medical history, medications, allergies, prior surgeries and procedures, vital signs, changes in weight, and glucose readings via a patient portal. These apps facilitate the sharing of medical records with providers in real-time, which may promote patient safety, disease prevention, continuity of care, and patient self-management.

Drug information apps provide clinicians with medication references, such as drug indications, dosages, contraindications, safety information, and prescription interactions. Apps aimed at improving medication compliance provide patients with reminders to take their pills, how many to take, and when to refill a prescription. Disease management apps help clinicians monitor patients’ health status and streamline communication. For example, there are several apps on the market targeting diabetes therapy. Some simply help patients monitor blood glucose levels, while others provide sophisticated data analytics to the patient’s health care provider and team, along with a patient self-management plan. Telemedicine apps support communication between patients and providers and is one of the fastest growing areas of app development. These apps enable patients to connect with clinicians via video or text consultation in real time. Some healthcare providers are able to refer to specialists, order lab tests and prescribe medications through the app. Others allow providers to make a diagnosis and determine if an emergency room visit is necessary.

Finally, clinical workflow improvement apps streamline communications and data management for nurses and other providers within the clinical setting. These are the most advanced apps on the market, often linking multiple health information systems and improving efficiencies in the workplace. Incorporating mHealth apps into the in-patient care setting, however, involves a high level of commitment, coordination, and resources. Questions hospital administrators should consider when developing a strategy involving mHealth include4:
  1. Do mHealth technologies enhance workflow, reimbursement, and quality of patient care?
  2. Which mHealth apps are approved for recommendation to patients?
  3. When can an mHealth app be recommended to the patient and how would this information be communicated to the health care team?
  4. Who will provide guidance to the patient on the use of the mHealth app, and who is responsible for monitoring compliance and outcomes?
  5. What is the evaluation process for new mHealth apps? How will effectiveness be tracked?
  6. What new skills are needed by clinicians, information technology professionals, and hospital executives to ensure successful implementation of new digital tools?
Integrating mHealth has the potential to improve disease management, communication, and overall patient care. Complete adoption of mHealth, however, will depend largely on:
  1. Payers’ recognition of the value apps provide in health care management
  2. Establishment of standards for security and privacy guidelines that protect patient’s personal health information
  3. Evaluation and regulation of health care apps
  4. Full integration into health information systems4
Technology has and will continue to rapidly transform every aspect of our daily lives. Managing our health is no exception. As mHealth apps become more sophisticated and increasingly ubiquitous in our modern society, patients and consumers will demand higher quality and functionality. We, as health care providers, need to be armed with the skills to adopt and manage digital tools as they will inevitably become an integral part of how we deliver patient care.
 
References
  1. U.S. Smartphone Use in 2015. The Pew Research Center. Retrieved on June 15, 2016 from http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/
  2. Mobile App Usage – Statistics & Facts. Retrieved on June 20, 2016 from  www.statista.com. http://www.statista.com/topics/1002/mobile-app-usage/
  3. AJN Reports (2015). The World of Apps in Healthcare: Opportunities and Challenges for Nurses. American Journal of Nursing. 2016; 115 (11): 18-19.
  4. Austin R, Hull S. (2014). The Power of Mobile Health Technologies and Prescribing Apps. Computers, Informatics, Nursing.

Myrna B. Schnur, RN, MSN
 

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Posted: 7/3/2016 7:53:25 AM by Lisa Bonsall, MSN, RN, CRNP | with 3 comments

Categories: Technology


Medication Safety: Go beyond the basics

For any nurse working in a direct care setting, preparing medications and administering them to patients is part of the daily routine. Mistakes can happen at any point in the process. Administration errors are one of the most serious and most common mistakes made by nurses. The result may lengthen a hospital stay, increase costs, or have life and death implications for the patient. So, what can you do to safely administer medications?

Start with the basics
  • Verify any medication order and make sure it’s complete. The order should include the drug name, dosage, frequency and route of administration. If any element is missing, check with the practitioner.
  • Check the patient's medical record for an allergy or contraindication to the prescribed medication. If an allergy or contraindications exist, don't administer the medication and notify the practitioner.
  • Prepare medications for one patient at a time.
  • Educate patients about their medications. Encourage them to speak up if something seems amiss.
  • Follow the eight rights of medication administration.

do-not-disturb.PNGMinimize distractions and interruptions:
  • Know that interruptions and distractions have a marked effect on your performance, causing a lack of attention, forgetfulness, and errors.
  • Make sure you have all the required supplies and documents available before beginning preparation or administration activities.
  • Follow your facility’s policy related to the use of a “No Interruption zone” (NIZ), a practice recommended by the Institute for Safe Medication Practices (ISMP) to enhance patient safety. Your NIZ should be a discreet area where medication tasks are performed.  It may be a dedicated medication room or a quiet area sectioned off by visual markers.
  • If required by your facility, wear a special vest, apron, sash, lighted lanyard, or other item that indicates that you are administering medications and shouldn’t be interrupted.
  • If your facility utilizes mobile devices, temporarily transfer calls and other notifications to another staff member or place the device on pause during the most complex parts of the medication preparation and administration tasks.

safety-measures.PNGImplement these additional safety measures:
  • Be especially alert during high-risk situations, such as when you are stressed, tired, or angry or when supervising inexperienced personnel. Monitor and modify work schedules to minimize work- or fatigue-related medication errors.
  • Be familiar with all appropriate antidotes, reversal agents, and rescue agents. Know where they are stored on your unit and how to administer them in an emergency situation.
  • Be familiar with high-alert medication (such as anticoagulants, antidiabetic agents, sedatives, and chemotherapeutic drugs). Ask another nurse to perform an independent double check and rectify any discrepancies BEFORE administering the drug.
  • Be aware of the ISMP’s and your facility’s list of confused drug names, which includes sound-alike (such as Zocor and Cozaar) and look-alike (such as vinblastine and vincristine) name pairs.  Take extra precautions when administering drugs from these lists. Your facility may also have extra safeguards in place, such as requiring both the brand and generic name be recorded, including the purpose of the medication with all orders, or setting up computer selection screens to prevent look-alike names from appearing near each other.
  • Pay attention to Tall Man lettering, a visual safety feature that highlights a section of a drug’s  name using capital letters to help  distinguish look alike name pairs from each other, such as BuPROPion (an antidepressant) from  BusPIRone (an anxiolytic) or glipiZIDE from glyBURIDE (two different antidiabetics). 
  • Measure and document a patient’s weight in metric units (grams and kilograms) ONLY to allow for accurate dosage calculations. Also, weigh the patient as soon as possible on admission and don’t rely on stated, estimated, or historical weights.
  • For patients receiving IV opioid medication, frequently monitor respiratory rate, sedation level, and oxygen saturation level or exhaled carbon dioxide to decrease the risk of adverse reactions associated with IV opioid use. If adverse reactions occur, respond promptly to prevent treatment delays.
  • Administer high-alert intravenous medication infusions via a programmable infusion device utilizing dose error-reduction software.
  • Reconcile the patient’s medications at each care transition and when a new medication is ordered to reduce the risk for medication errors, including omissions, duplications, dosing errors, and drug interactions.
  • Educate and provide written instructions to the patient and family (or caregiver) regarding prescribed medications for use when at home and verify their understanding prior to discharge.
By being familiar with medications you administer and following safeguards, you can help protect your patients from medication errors.

For more information on medication safety, go to:
CDC: Medication Safety Program
Institute for Safe Medication Practices
AHRQ Patient Safety Network: Medication Errors
US FDA: Medication Errors Related to Drugs
 
References: 
Institute for Safe Medication Practices. (2016). "2016-17 targeted medication safety best practices for hospitals" [Online]. Accessed April 2016 via the Web at http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf

Safe medication administration practices, general. (2015). In Lippincott procedures. Retrieved from http://procedures.lww.com.

Nursing 2016 Drug Handbook. (2016). Wolters Kluwer: Philadelphia, Pennsylvania.
 
Joan M. Robinson, MSN, RN
Clinical Director
Lippincott Solutions

 
 
Posted: 5/9/2016 9:49:40 PM by Lisa Bonsall, MSN, RN, CRNP | with 6 comments

Categories: Patient Safety Technology


Nursing Informatics Day: Celebrate with NursingCenter and CIN: Computers, Informatics, Nursing

mollie-cummins.jpg“The most important thing for nurses to understand about informatics is that it’s not technology. Informatics is not about hard drives, and it’s not even necessarily about programming, and we certainly cannot fix someone’s problems with Outlook. Informatics is about how we’re managing data, information from both a process perspective and a technical perspective to advance health care.” Mollie R. Cummins, PhD, RN, FAAN has been a practicing nurse since 1994 and has made waves in the nursing informatics specialty throughout her career. She holds a doctorate in nursing science and information science from Indiana University, serves as an associate professor of nursing and adjunct professor of biomedical informatics at the University of Utah, and currently serves as the president of the Utah Nursing Informatics Network. Cummins also recently served as editor the ANI Connection and CIN Plus columns of the journal, CIN: Computers, Informatics, and Nursing.

CIN.pngNursing Informatics Day is May 12th and takes place during National Nurses Week. She says, “It’s important that nursing informatics celebrate its profession in conjunction with nurses week, especially this year because this year the focus is on safety. IT has been identified as one of the most promising approaches for improving safety in the clinical setting. IT-based strategies, such as barcode medication administration, can really reduce safety inefficiencies and vulnerability in the clinical setting, so it’s very important that nursing informatics be a part of this.” 




I had the chance to speak with Cummins over the phone about ways to celebrate Nursing Informatics Day and why nurses in all specialties should pay attention to technology in the workplace. 

Listen for the whole interview…
Podcast-(1).jpg
   
Be sure to stop by our National Nurses Week page for more ways to celebrate, including discounts and giveaways for nurses week! BONUS: Read the current issue of CIN on NursingCenter for free as our featured journal until May 15th. 
 
Posted: 5/2/2016 2:49:50 PM by Cara Deming | with 1 comments

Categories: Technology


The Essentials of Negative Pressure Wound Therapy (NPWT): Part 2

I have learned quite a bit on my journey to gaining a better understanding of Negative Pressure Wound Therapy (NPWT). In Part 1 of this series, I provided an overview of NPWT, including what it is, how it works and the risks and benefits. In Part 2 of the series I will review the practical application of NPWT including prescribing orders, procedural steps, general patient care, and tips to troubleshoot the device. Let’s jump in!
 
negative-pressure-wound-therapy-2.PNG
 
What are the steps in applying NPWT? Each device has a specific design and manufacturer’s instructions for use that should be reviewed. The following procedural steps provide a general guide.
  1. Pre-medicate the patient for pain as needed and as prescribed.
  2. Prepare the wound by:
    • removing the prior dressing very carefully to avoid tissue damage and bleeding
    • debriding the wound, performed by a qualified practitioner
    • cleansing the wound as needed/prescribed
    • assessing wound size and depth
  3. Cut foam dressing to size and place into the wound. Document the number of foam pieces used; foam acts as a filter to catch blood clots and large tissue particles that might clog the vacuum system.
  4. Trim clear occlusive dressing to size, peel back one side of Layer 1 and place adhesive side down over wound. (see photo 1)
  5. Remove the remaining side of Layer 1 ensuring it creates a tight seal.
  6. Cut a hole into the clear dressing about the size of a quarter (2.5 cm). (see photo 2)
  7. Remove Layer 1 from adhesive pad connected to the pump tubing.
  8. Place pad and tubing directly over hole affixing it to the clear dressing. (see photo 3)
  9. Remove Layer 2 from the adhesive pad.
  10. Connect pad tubing to canister tubing and be sure the clamps are open.
  11. Turn on power to the vacuum device, set the prescribed pressure settings, and confirm that the dressing and foam shrink down. (see photo 4)
NPWT-part-2-photo-1.jpg


NPWT-part-2-photo-2.jpg


NPWT-part-2-photo-3.jpg


NPWT-part-2-photo-4.jpg

 
Wound Care Tips:
  • Use protective barriers, such as non-adherent or petroleum gauze, to protect sutured blood vessels or organs near areas being treated with NPWT. 2
  • Avoid overpacking the wound too tightly with foam; this prevents negative pressure from reaching the wound bed, causing exudate to accumulate. 2
  • Avoid placing the tubing over bony prominences, skinfolds, creases, and weight-bearing surfaces to prevent tubing-related pressure ulcers. 2
  • Count and document all pieces of foam or gauze on the outer dressing and in the medical record, to help prevent retention of materials in the wound; 2 when possible, only use one piece of foam dressing.
  • With a heavy colonized or infected wound, consider changing the dressing every 12 to 24 hours as directed by the prescribing clinician.2

General Patient Care:
  • Assess the patient for wound healing issues, such as poor nutrition (low protein levels), diminished oxygenation, decreased circulation, diabetes, smoking, obesity, foreign bodies, infection and low blood levels.2
  • Assess and manage the patient’s pain; be sure to premedicate as needed before each dressing change.
  • Provide patient education on:
    • Alarms and device ‘noise’
    • Dressing changes
    • Signs of complications (bleeding, infection)
  • Patients should seek medical care if they notice:
    • Significant change in the color of the drainage (cloudy or bright red)
    • Excessive bleeding under the clear dressing, in the tubing or in the canister
    • Increased redness or odor from the wound
    • Increased pain
    • The device has been left off for more than 2 hours
    • Signs of infection, such as fever, redness or swelling of the wound, itching/rash, warmth, pus or foul smelling drainage
    • Allergic reaction to the drape/dressing: redness, swelling, rash, hives, severe itching. Patient should seek immediate medical assistance if they experience difficulty in breathing
Troubleshooting the Device
  • Confirm that the unit is on and set to the appropriate negative pressure, that the foam is collapsed and the NPWT device is maintaining the prescribed therapy and pressure. 2
  • Be sure the negative pressure seal has not been broken and leaks are minimal.4
  • Ensure there are no kinks in the tubing and that all clamps are open.4
  • Address and resolve alarm issues; reasons for the unit to alarm include: canister is full, there is a leak in the system, battery is low/dead, therapy is not activated.
  • Do not leave the device off for more than two hours; while device is off, apply a moist dressing 2 and notify the prescribing clinician immediately.
  • Avoid getting the electrical device wet; educate the patient to disconnect the unit from the tubing and clamp the tubing before bathing.
  • Check the drainage chamber to make sure it is filling correctly and does not need changing.4
While I am not an expert in the field of wound care, I am now more confident and better prepared to manage patients receiving Negative Pressure Wound Therapy. I would love to hear your experiences. Let me know if you have any tips or other suggestions that can help nurses and patients safely operate and maintain these devices.
References:
1. Centers for Medicare and Medicaid Services. (2014). Negative Pressure Wound Therapy Technologies for Chronic Wound Care in the Home Setting. Retrieved from the Centers for Medicare and Medicaid Services: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/id96ta.pdf
2. Rock, R. (2014). Guidelines for Safe Negative-Pressure Wound Therapy: Rule of Thumb: Assess Twice, Dress Once. Wound Care Advisor, 3(2), 29 – 33
3. Federal Drug Administration. (2009). FDA Preliminary Public Health Notification: Serious Complications Associated with Negative Pressure Wound Therapy Systems. Retrieved from the Federal Drug Administration: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm190658.htm#table1
4. Wound Care Centers. (2016). Negative Pressure Wound Therapy. Retrieved from Wound Care Centers: http://www.woundcarecenters.org/article/wound-therapies/negative-pressure-wound-therapy
 Myrna B. Schnur, RN, MSN

 
Posted: 4/22/2016 6:43:57 AM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Diseases & Conditions Technology


The Essentials of Negative Pressure Wound Therapy (NPWT): Part 1

negative-pressure-wound-therapy.PNGSince I began working in a reconstructive surgery clinic several years ago, I have been exposed to a myriad of complex acute and chronic wounds that require advanced treatment modalities, such as Negative Pressure Wound Therapy (NPWT), in order to heal. These devices were new to me, and I quickly realized that they can be a source of great anxiety for both patient and clinician. I decided I needed more information and education on the topic. In Part 1 of this blog series, I will discuss the basics of NPWT, what it is, how it works, as well as risks and benefits. 

What is Negative Pressure Wound Therapy (NPWT)?
Also known as vacuum-assisted wound closure (VAC), NPWT is the distribution of negative pressure across a wound1. The therapy, which emerged in the early 1980’s, includes the placement of a dressing (foam or gauze) onto the wound and is connected to a vacuum pump via tubing1. A clear occlusive dressing is placed on top, forming an air tight closed system. Gentle, controlled suction is applied pulling wound debris into a collection chamber. The Food and Drug Administration (FDA) approved the first device for NPWT in 1997. Currently, there are over a dozen FDA approved devices available on the market1, many of which are small and lightweight, allowing patients full mobility3. Due to varying designs, it is important that you become familiar with the manufacturer instructions for the specific device in use.
 
how-does-npwt-improve-wound-healing.PNG

Which types of wounds benefit most from NPWT?
  • Surgical wounds, especially those which need to heal by secondary intention1
  • Open abdominal incisions1
  • Dehisced surgical wounds1
  • Burns
  • Skin flaps and preparation for skin graft sites1
  • Traumatic wounds1
  • Chronic wounds, such as venous insufficiency ulcers, diabetic foot ulcers, and pressure ulcers1,4
  • Wounds at high risk for infection4
  • Wounds with copious drainage4
  • Meshed grafts, to either secure the graft in place or improve epithelialization4
  • Adjunct to skin graft/flap procedure4

How effective is NPWT? Compared to traditional forms of wound therapy, advantages of NPWT include:
  • Improved healing of transplanted skin and decreased length of hospital stay for patients receiving split thickness skin grafts.4
  • Decreased wound infections in patients following orthopedic trauma and open fractures.4
  • Improved wound healing, shorter length of stay, lower hospital mortality in patients with mediastinitis and unsuccessful wound healing following sternotomy.4
  • Improved wound healing in patients with diabetes mellitus and gangrene that might require amputation.4
what-are-the-risks-of-npwt.PNG
 
What are the factors that increase a patient’s risk for adverse events with NPWT:
  • Increased risk for bleeding and hemorrhage2,3
  • Anticoagulant or platelet aggregation inhibitor therapy2,3
  • Friable or infected blood vessels2,3
  • Vascular anastomosis3
  • Infected wounds3
  • Osteomyelitis3
  • Spinal cord injury2
  • Enteric fistulas2
  • Exposed organs, vessels, nerves, tendons, and ligaments3

Are there any contraindications for NPWT?
  • Inadequately debrided wounds2
  • Necrotic tissue with eschar
  • Untreated osteomyelitis2,3
  • Cancer in the wound2,3
  • Untreated coagulopathy2
  • Unexplored fistulas
  • Exposed vasculature, nerves3, anastomotic site3, vital organs2
  • Osteomyelitis4

While great strides have been made to improve the safety of NPWT devices, serious adverse events may still occur. Clinicians should take time to review specific device instructions for use, indications, and contraindications and adequate staff training should be provided. Healthcare providers that understand the principles of NPWT can then collaborate to ensure that each patient is selected appropriately for therapy based on wound type, risk profile and care setting. In Part 2 of this series, I will review the procedure for applying a NPWT dressing, general patient care, and tips to trouble-shoot the device.
 
References:
1. Centers for Medicare and Medicaid Services. (2014) Negative Pressure Wound Therapy Technologies for Chronic Wound Care in the Home Setting. Retrieved from the Centers for Medicare and Medicaid Services: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/id96ta.pdf
2. Rock, R. (2014). Guidelines for Safe Negative-Pressure Wound Therapy: Rule of Thumb: Assess Twice, Dress Once. Wound Care Advisor, 3(2), 29 – 33.
3. Federal Drug Administration. (2009). FDA Preliminary Public Health Notification: Serious Complications Associated with Negative Pressure Wound Therapy Systems. Retrieved from the Federal Drug Administration: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm190658.htm#table1
4. Wound Care Centers. (2016) Negative Pressure Wound Therapy. Retrieved from Wound Care Centers: http://www.woundcarecenters.org/article/wound-therapies/negative-pressure-wound-therapy
 Myrna B. Schnur, RN, MSN
 
Posted: 4/18/2016 9:32:50 AM by Lisa Bonsall, MSN, RN, CRNP | with 7 comments

Categories: Diseases & Conditions Technology


New NursingCenter YouTube Channel

We are excited to share the launch of Lippincott NursingCenter’s YouTube Channel! Our first nursing videos are compilations of inspiration from nurses at the ANCC National Magnet Conference® this past October. Learn how your nursing colleagues keep up with new research, information and evidence. Also, discover what inspired them at this year's meeting and their plans for sharing this inspiration with their colleagues.

Take a look: 


 

We are looking forward to sharing more nursing videos as we move into the New Year! Stay tuned for Clinical Resources, Training Guides, webinars, and more nursing videos as we delve into this platform. Go ahead and subscribe today to stay up-to-date and inspired. 

 
Posted: 12/7/2015 11:25:21 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Leadership TechnologyInspiration


Join our nursing community!

Since starting at Lippincott’s NursingCenter.com this past January as their Digital Editor, my favorite part about my job is talking with our nurses and members. I really enjoy the sense of community I get from speaking with nurses, whether it is in person at one of our conferences, over the phone at my desk, or on this blog. 

Another great resource for our community is our social media sites. Both our Clinical Editor, Lisa Morris Bonsall, MSN, RN, CRNP, and myself regularly update our accounts and use them as important tools to reach out to our nurses. I love seeing what people are talking about, how they are responding to current issues, and getting feedback from our followers. 

Social media is one of the best ways to reach us, so I invite you to join our nursing community by following us on Twitter @NursingCenter or @CaraGavin, Google+, Facebook, and LinkedIn. We want to hear from you! 

Posted: 9/30/2014 7:53:33 PM by Cara Deming | with 1 comments

Categories: Technology


Go ahead and share!

You may have noticed these new ‘share’ options on each of our article pages. Since we can't all read everything (although I do try!), if there is something that really interests you or that you think will benefit your friends, followers, email contacts, people in your circles, or the like, please feel free to pass it along! I hope this new feature makes it easier to share the content from our journals. 

go-ahead-and-share.png

Any problems or suggestions, you can comment here or email me at clinicaleditor@nursingcenter.com. Thanks!

Posted: 1/21/2014 1:47:07 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Technology


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