Litigation

• Inadequate or improper communication
  • Set realistic goals and expectations
  • Communicate these to the patient and the family
  • Most conflicts arise at all levels because of a difference in expectations

• Family members
  • Include in care plan
  • Invite family members to rounds

• Documentation
  • Documentation of conversations with patient and family is key
  • Early recognition of change in patient status
  • Problems with current management
  • Wound complications
  • Intervention with appropriate care is essential

Modern Wound Management

• Moist wound bed healing
• Based on scientific data, not tradition
  • For example, wounds should not be left open to air

 

• Debridement
  • Sharp
    • Most effective
    • Contraindications

 

• Coagulopathy (for example, from anticoagulant therapy)

 

• Ischemia

 

• Pain

 

• Patient refusal

• Enzymatic

 

• Frequency of dressing changes
  • Minimize to decrease nursing care and patient inconvenience
  • Dressings may require changes daily, every few days, even weekly

 

• Control exudate
  • Promotes wound healing by achieving proper moisture balance
• Reduces risk of infection
  • Decreases periwound maceration

 

• Control odor

 

• Nutrition

 

• Adequate protein stores is essential for wound healing
• Assess serum albumin or prealbumin
• Refer to dietician when indicated