The Nurse Knot
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Tips & Tricks

I am a member of our wound team at the Clearfield Hospital Home Health Department. Our Ostomy Nurse, Heather, became so busy traveling to all the locations we cover, so she organized a group of 10-15 nurses that cover local and outlying areas to help with wound care and assessments. Other Staff Nurses in Home Health can also care for and assess wounds, but it is required that someone on the Wound Team is to see these patients at least every 2 weeks. Heather shares wound care and prevention tips and tricks with us every week or so and I would like to share them with all of you. If you have a subject you would like to find more information about, please let me know. The contact form is here. If you have tips and tricks of your own, please feel free to share those, too. I'm always open to new ideas, suggestions and easier ways to do things. Subscribe to our newsletter for tips and tricks. Delivered to your mailbox every week!
Avoiding Sores Before They Occur Less is more, especially when it comes to sheets or pads on your patients beds. Research shows that the more layers of linens on a bed, the worse the pressure. This is true regardless of what type of mattress you have on the bed. It doesn't matter if it's a regular mattress, an alternating air mattress, foam, specialty bed or replacement mattress. The more layers of linens, the higher the temperature of the bed. Studies are also linking increased skin temperature to pressure ulcers. Higher temps can also increase the risk of yeast infections and higher bacterial levels. Reference: Hospital Association of Pa
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Skin Prep for Peri-Wound Areas It's always a good idea to use skin prep on the peri-wound of most wounds to help protect skin from drainage and to protect from any adhesives on dressings or tape that may be used. But remember, skin prep doesn't need to be used on per-stomal skin. Many manufacturer's include warnings in their printed product infor that skin prep can affect the adhesion of the appliance. Clean, dry skin is best. Use skin prep only with stoma powder for areas of erythema/denudment.
How to Accurately Document Wounds Documentation is important in any aspect of nursing. Wound documentation is no exception. Consistency is key in protecting yourself and properly assessing the progression of an existing wound. Wounds must be measured in centimeters frequently. Pick a day of the week and measure your wounds every week on that same day. Assess for tunneling and undermining and include these descriptions. Describe wound edges of full thickness wounds--are they opened or closed? Assess tissue to the wound base. You can simply use colors to describe this but percentages should also be included. Assess drainage and be sure to include amount and description, including whether there is an odor present. Assess the surrounding area within a 4 cm radius of open area and describe color of this area, the presence of edema or induration. Chart each wound separately, don't include them all together as they may progress at different rates. At Start of Care, each wound needs to be numbered in the documentation and be sure to place the most problematic wound as wound #1. The care plan then needs to be set up with wound care being labeled specific for each wound. Wound photos need to be consistently taken every 2 weeks and don't forget to take pictures of healed wounds.

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