1. ahrq.gov. accessed august 24, 2016 at … education...pathway to excellence a comprehensive...

Pathway to excellenceA comprehensive clinical education platform from Smith & Nephew

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1. AHRQ.gov. Accessed August 24, 2016 at http://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html.

2. Sen el al. Wound Rep Reg 2009;17 763-771.3. Rice et al. J Med Econ 2014; 17(5): 347-356.4. Engels D et al. Pressure injuries: Factors contributing to their

development in the OR. AORN J. 2016:103(3); 271-81.

Smith & Nephew, Inc. Customer Care Center www.smith-nephew.com 1 800-441-8227Fort Worth, TX T 817-900-4000USA F 817-900-4100

©2017 Smith & Nephew, Inc. All rights reserved. ™Trademark of Smith & Nephew.


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Pathway to Excellence

SupportEach year, we train more than 150,000 healthcare professional around the globe. In addition to the array of educational programs and online training options we provide, we maintain a team of clinicians who are specialists in skin and wound care. This Clinical Team provides face-to-face education for large groups. This Team also provides live webcasts via C2B Connect expanding the opportunity for interaction with your staff.

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add: All trademarks acknowledged.

Healthcare today demands knowledge at the clinical decision point. The challenge is to find opportunities for learning that are not always in a traditional classroom. That’s why Classroom to Bedside was designed to help connect learning to action.

The program:• Provides a clinical foundation for prevention and wound

management• Incorporates bedside tools to reinforce best practices• Includes resources for continued education• Offers product training components• Helps bring focus to outcomes and patient satisfaction

The lessons are provided in various formats so you can deliver education in a way that your staff wants it.

• Chaptered DVDs with brief lesson modules• PowerPoint™ presentations for train-the-trainer• Virtual webinar training by Smith & Nephew Clinical Team

Classroom to BedsideA Pathway to Excellence program

Topics include:• Pressure injury prevention

This lesson describes the anatomy and function of the skin. It teaches participants to identify risk factors for pressure injuries, and interventions for reducing skin breakdown.

• Wound assessment and documentationAccurate wound assessment is important to choosing an appropriate treatment plan. This lesson discusses the components of wound assessment and documentation, as well as identification of various tissue types.

• Managing non-healing woundsThe factors that contribute to impaired healing and interventions to move the non-healing wound to closure are covered in this lesson. It teaches how to identify the TIME principles of wound bed preparation – the major barriers to wound closure.

• Dressing selectionTo enable proper treatments options, it is important to understand dressing categories and negative pressure wound therapy. This lesson teaches these options and reviews the principles of wound management.

Pathway to excellence: A comprehensive clinical education platform from Smith & Nephew

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Bedside tools:• Support your core formulary to simplify decisions and help reduce product waste• Reinforce knowledge for non-wound experts• Guide bedside decisions and care

Drive clinical best practices with supportive bedside tools:

Let Smith & Nephew help you create a Pathway to Excellence.

Wound Assessment Guide*smith&nephew

Wound Assessment Guide

Lower extremity ulcers – differential diagnosis

Arterial ulcers

Venous ulcers

Diabetic ulcers

Site Size Edge Floor Edema Staining ABI Pulses Pain Management

gaiter area, medial malleolus

usually large shallow with diffuse edges

exuding/granulating

generalized always >0.8 normal some (dependent)

Compression• Optimize the local wound

environment• Review contributing factors• Establish maintenance plan

any part of leg, commonly below the ankle

usually small

deep with “cliff” edge

dry (necrotic)

localized never <0.8 reduced or absent

present, especially at night (elevated)

Reduce/eliminate cause• Improve perfusion• Manage contributing

factors• Pharmacotherapy• Vascular rehabilitation• Angioplasty/surgical

intervention

Optimize wound environment

• Assess the infection• Osteomyelitis

any part of leg, commonly below the ankle & on the foot

often very small

deep with “cliff” edge (callus)

dry (necrotic)

localized never not reliable not reliable none – neuropathy

Patient education Smoking cessation. Wash

and inspect feet daily. Do not soak feet. Moisturize feet, not between toes. Avoid bathroom surgery. Notify physician at once should a blister or sore develop. Routine podiatry visits. Protect from mechanical, chemical, thermal trauma.

Debridement

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Wound Management – Smith & Nephew, Inc., 11775 Starkey Road, P.O. Box 1970, Largo, FL 33779, USACustomer Care Center: 1-800-876-1261, Telephone: 727-392-1261, Fax: 727-392-6914www.smith-nephew.comRA7500

Note –Leg ulcers with rheumatoid arthritis, colitis, hyperthyroidism, sickle cell anemia, neuropathies or skin cancers should be referred promptly for medical assessment. N. B. Some leg ulcers are of mixed etiology and therefore may exhibit a combination of these characteristics.

Differential diagnosis card

Pressure ulcer/injury staging badge

Pearls of Wisdom

Skin care report booklet

Skin and wound quick reference guides

Wound measuring guide

Guide to The Wound Institute™

Product application videos


©2017 Smith & Nephew, Inc. All rights reserved. ™Trademark of Smith & Nephew. All trademarks acknowledged.

PST™...Practice Success Through Prevention

The program:• Lesson modules with individual tests to assess understanding

− Introductory overview − Lesson 1: normal skin attributes − Lesson 2: skin integrity − Lesson 3: managing fragile, dry or thin skin − Lesson 4: moisture associated skin damage − Lesson 5: reportable skin conditions

• Instructor tool kit

− Certificate of Completion − Sample illustration of Report Booklet − Study notes for each lesson module

• Product application demos

Knowledge is the path for the non-licensed caregiver to be confident at the bedside. The PST program is a complete series of skin care lessons that teaches the importance of:

• Understanding skin

• Preventing skin breakdown

• Maintaining skin integrity

Skin care report booklet

Product application demos

Proper use and application of skin care products is essential to maintaining skin integrity and prevention of skin breakdown. The product application section demonstrates the correct way to use and apply cleansers, moisturizers, protectants, skin preps, and antifungals.

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©2017 Smith & Nephew, Inc. All rights reserved. ™Trademark of Smith & Nephew. All trademarks acknowledged.

DVDs

Modules are available in Acute Care or Long Term Care setting.

Study notes

Certificate of completion

Instructor tool kit

The PST report booklet brings the importance of skin assessment to the bedside with a simple method of designating the body location and condition observed.

Each module includes a PowerPoint™ version of the lesson for Trainer use, and optional study note pages for the student.

The DVD includes an interactive test section that reinforces correct answers as the student completes the test.

With successful completion of the PST lessons, a Certificate of Completion can be awarded to validate the student’s new knowledge.

PST™...Practice Success Through Prevention


Supporting bedside tools

The true test of a healthcare professional’s knowledge is at the bedside. The tools in the Pathway to Excellence educational program were created to reinforce the learning and best practices of the lesson elements.

Quick Reference GuidesAt the bedside, good skin and wound management depends on reducing clinical practice variation by compliance with a facility’s treatment and product selection guidelines. Proper product utilization may also help reduce costs by lowering product waste. The Quick Reference Guides for both skin and wound care are customizable templates that include your facility’s guidelines and product formulary to support the bedside decisions.

TIMESaver ConnectEffective wound management requires removing the barriers to healing as outlined in the TIME principle: Nonviable Tissue; Infection Management; Moisture Imbalance; Epidermal Margin. The TIMESaver helps connect wound assessment education with proper product utilization. It helps the caregiver focus on the three essential platforms of skin and wound care delivered at the bedside – Prevention, Exudate Management, and Infection Management.

Wound Assessment GuideProper assessment and documentation is critical to determining the correct intervention. The accurate evaluation of the wound type, tissue involvement, size, and other factors not only guides treatment options, but also aids communication and validates outcomes. Pocket-sized, the Wound Assessment Guide is a ready reference for all of the components of a wound assessment based on best clinical practices.

Skin and wound quick reference guides

TIMESaver Connect*smith&nephew

TIMESaver Connect

Wound Assessment Guide*smith&nephew

Wound Assessment Guide

Pressure ulcer staging system *smith&nephew

Stage I Definition Intact skin with non-blanchable redness of a localized area

usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Description • The area may be painful, firm, soft, warmer or cooler as

compared to adjacent tissue.

• Stage I may be difficult to detect in individuals with dark skin tones.

• May indicate “at risk” persons (a heralding sign of risk).

Deep tissue injury Definition Purple or maroon localized area of discolored intact skin or

blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.

Description • The area may be preceded by tissue that is painful, firm,

mushy, boggy, warmer or cooler as compared to adjacent tissue.

• Deep tissue injury may be difficult to detect in individuals with dark skin tones.

• Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar.

• Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

Stage II Definition Partial thickness loss of dermis presenting as a shallow

open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Description • Presents as a shiny or dry shallow ulcer without slough or

bruising.**

• This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.

Stage III Definition Full thickness tissue loss. Subcutaneous fat may be visible

but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Description • The depth of a stage III pressure ulcer varies by anatomical

location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers.

• Bone/tendon is not visible or directly palpable.

Stage IV Definition Full thickness tissue loss with exposed bone, tendon or

muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Description • The depth of a stage IV pressure ulcer varies by anatomical

location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow.

• Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible.

• Exposed bone/tendon is visible or directly palpable.

Unstageable Definition Full thickness tissue loss in which the base of the ulcer is covered by slough

(yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Description • Until enough slough and/or eschar is removed to expose the base of the wound,

the true depth, and therefore stage, cannot be determined.

• Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.

Wound Measuring GuideA small, paper ruler in a handy pad, this bedside tool reminds of the importance of accurate measurement. And, with space provided for the patient’s name and the date, it equally prompts documentation of the wound’s progression.

Differential Diagnosis: lower extremity ulcers and pressure ulcer/injury stagesEtiology of a wound is a key aspect of wound management. Treatment plans are based on the type of wound and the underlying conditions that contribute to the development of the wound. This reference tool helps at the bedside to differentiate the wound type or stage through photos and general descriptions and symptoms that are found with a particular wound.

Pressure Ulcer/Injury BadgeThe badge gives the wearer a quick, pictorial guide with descriptions to pressure ulcer/injury stages as outlined by the National Pressure Ulcer Advisory Panel.

Pearls of WisdomTo deepen understanding of specific conditions that have important significance for skin, four papers full of wisdom are available. Topics include dermatitis, Clostridium Difficle, friction/shear, and superficial fungal infection. The papers explain each condition, its cause and symptoms, and how to effectively treat the condition.

Skills competenciesUnderstanding the role of various therapies and product types is central to improved clinical outcomes and to reduced human and economic costs. The skill competency tools – including skills checklists and certificates of completion – help assure that each staff member knows when to use specific products and how to properly apply them.

Wound measuring guide

Lower extremity ulcers – differential diagnosis

Arterial ulcers

Venous ulcers

Diabetic ulcers

Site Size Edge Floor Edema Staining ABI Pulses Pain Management

gaiter area, medial malleolus

usually large shallow with diffuse edges

exuding/granulating

generalized always >0.8 normal some (dependent)

Compression• Optimize the local wound

environment• Review contributing factors• Establish maintenance plan

any part of leg, commonly below the ankle

usually small

deep with “cliff” edge

dry (necrotic)

localized never <0.8 reduced or absent

present, especially at night (elevated)

Reduce/eliminate cause• Improve perfusion• Manage contributing

factors• Pharmacotherapy• Vascular rehabilitation• Angioplasty/surgical

intervention

Optimize wound environment

• Assess the infection• Osteomyelitis

any part of leg, commonly below the ankle & on the foot

often very small

deep with “cliff” edge (callus)

dry (necrotic)

localized never not reliable not reliable none – neuropathy

Patient education Smoking cessation. Wash

and inspect feet daily. Do not soak feet. Moisturize feet, not between toes. Avoid bathroom surgery. Notify physician at once should a blister or sore develop. Routine podiatry visits. Protect from mechanical, chemical, thermal trauma.

Debridement

WC-0243-0311

Wound Management – Smith & Nephew, Inc., 11775 Starkey Road, P.O. Box 1970, Largo, FL 33779, USACustomer Care Center: 1-800-876-1261, Telephone: 727-392-1261, Fax: 727-392-6914www.smith-nephew.comRA7500

Note –Leg ulcers with rheumatoid arthritis, colitis, hyperthyroidism, sickle cell anemia, neuropathies or skin cancers should be referred promptly for medical assessment. N. B. Some leg ulcers are of mixed etiology and therefore may exhibit a combination of these characteristics.

Differential Diagnosis: lower extremity ulcers and pressure ulcer/injury stages

Pressure ulcer/injury staging badge

Pearls of Wisdom

Supporting bedside tools

©2014 Smith & Nephew, Inc. All rights reserved. ™Trademark of Smith & Nephew. Registered US Patent & Trademark Office. MSFE-04-0914-USE

Competency checklist Product/task Completed

ALLEVYN™ Life Advance Foam Wound Dressing

Identify mechanism of action for ALLEVYN Life Hydrocellular Foam Dressings.

Describe the appropriate wound types for which ALLEVYN Life is indicated.

State change frequency for ALLEVYN Life.

IODOSORB™ Cadexomer Iodine Gel

Identify the mechanism of action of IODOSORB Gel.

Describe wounds for which IODOSORB Gel is indicated.

State the change frequency for IODOSORB Gel.

Describe contraindications for IODOSORB Gel.

ACTICOAT™ Antimicrobial Barrier Dressing

Identify mechanism of action of ACTICOAT.

State whether ACTICOAT is bactericidal or bacteriostatic.

Describe wounds for which ACTICOAT is indicated.

Understands the importance of removal during MRI procedures.

DURAFIBER™ Absorbent Gelling Fiber Dressing

State the mechanism of action of DURAFIBER.

Describe wounds appropriate for DURAFIBER.

Describe proper application of DURAFIBER.

Competency checklist performance criteria Name______________________________________________ Date_____________

Evaluator___________________________________________ NPWT device: PICO

PICO application Completed Not completed

Discussed indications, contraindications, precautions for use of PICO NPWT

Troubleshoots loss of seal at dressing site (if applicable)

Demonstrates PICO dressing application

PICO device Discussed an understanding of the visual alarms associated with the PICO NPWT device

Identifies the battery life associated with the PICO device and the therapy time for the single use negative pressure wound therapy system.

Demonstrates ability to load batteries inside of pump and attach to the PICO dressing

24/7 Clinical Hotline 1-866-998-NPWT (6798)

This Hotline is available to support your needs for: • General system operations • Assessing problems • Dressing application – maintaining a tight seal • Troubleshooting alarms

Additional information available at: www.possiblewithpico.com

™Trademark of Smith & Nephew. Certain trademarks registered in the US Patent & Trademark Office. PCFE-04-0812-NAE

ALLEVYN LIFE application

Driving to zeroPressure ulcer prevention*

ALLEVYN LIFE competency checklist performance criteria

Name: Date:

Evaluator:

Cleanse the wound in accordance with normal facility procedures.

Completed Not completed

Intended use

Select appropriate dressing size.

Do not stretch the dressing.

Cleanse the periwound skin and remove excess moisture. Do not use emollients on periwound skin as it will affect adherence of the dressing.

Remove the protector film and anchor the adhesive side to the skin and smooth the dressing to ensure there are no creases.

Wound management by secondary intention on shallow, granulating wounds, chronic and acute exudative wounds, full and partial thickness wounds such as pressure ulcers, leg ulcers, DFU’s, infected wounds, malignant wounds, surgical wounds, 1st and 2nd degree burns, donor sites, skin tears and fungating ulcers. ALLEVYN LIFE is suitable for use on fragile skin.

ALLEVYN LIFE contributes to pressure ulcer prevention on intact skin as part of a pressure ulcer prevention protocol.

Skills competencies

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1. ahrq.gov. accessed august 24, 2016 at … education...pathway to excellence a comprehensive...

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