How to do it...wound care

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1 Providers who establish clear objectives when initiating NPWT will stand a greater chance of success, says Greg Bila, group manager for Post Acute Marketing at KCI.

“It is important to determine the goal of therapy for each patient so the facility can obtain the desired results,” he says. “Facilities often waste money using a variety of products with no real goal in mind.”

2 Frequent monitoring and thorough wound progression documentation ensure patient safety and optimal reimbursement. It also helps reduce liability exposure, experts say.

For example, indispensable features of the best NPWT programs provide pressure sensing at the wound bed and alarms that notify the user when therapy may be compromised, says Bila. In tandem, clinicians' therapy documentation should include ongoing assessments of viable and non-viable tissue characteristics, the type of drainage/exudates, coverage size, pressure type and setting, drain and sponge type utilized, hours of therapy with date initiated, dressing change, and canister drainage amount/type, says Sheila Cougras, director of quality for Net Health Systems.

3 Follow manufacturers' and prescribers' instructions precisely, experts say.

“By following manufacturer and FDA guidelines, following the prescriber orders, and having a prescriber follow the wound's progress closely, facilities can minimize complications from NPWT,” says Melanie Chandler, MPT, CWS, senior clinical specialist for Invacare.

“When NPWT is applied inappropriately, little to no results can be seen, and negative outcomes can occur if the manufacturer's guidelines and device labeling are not followed,” adds KCI's Bila, who advises clinicians to participate in vendor training and certification programs when available.

4 Working with vendors that provide clinical education and support is essential, experts say. While NPWT can assist in achieving successful outcomes, “it takes more than a device to achieve results that are measured by Centers for Medicare & Medicaid Services, so be sure to consider the vendor's expertise and the services that go beyond the product,” cautions Bila.

Chandler agrees: “A company's clinical specialists can help facilities establish wound programs by offering on-site in-servicing, on-line support tools, educational programs, audits on product utilization, protocol/algorithm development, and interfacing with prescribers and clinical decision makers, providing literature and brochures for marketing.”

5 NPWT is not designed to treat every type of wound, so providers are cautioned to identify appropriate wounds as candidates for treatment. For example, wounds that have more than 20% nonviable tissue will not benefit from NPWT until that nonviable tissue has been removed, says Chandler.

6 Beginning a NPWT program too late will reduce its effectiveness. Knowing when to discontinue NPWT also is critically important.

“One way to utilize NPWT cost-effectively is to discontinue it once the wound has almost healed and use a more conventional treatment such as a non-adhesive foam, hydrocolloid or medicated meshed gauze to bring the wound to closure,” Chandler recommends.

7 Finally, providers are advised to take a holistic approach to negative wound pressure therapy.

Consider “existing comorbidities that can impede wound healing, such as nutritional status, infection, glucose levels if the patient is a diabetic, lab values, etc.,” Chandler says. “The whole person must be treated.”

Mistakes to avoid

*Using NPWT on inappropriate wounds. In general, the best candidates for NPWT are chronic wounds, such as pressure sores and surgical wounds.

*Expecting NPWT alone to heal a wound, without considering existing co-morbidities.

*Failing to protect surrounding tissues of the treated wound or applying NPWT too late.