Wound Care Certificate Day 1/4 - Lesson 1A: Skin Health

Please watch the following recorded lecture and respond to the discussion question below.

Introduction
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Lesson 1A: Skin Health
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What risk assessment tools are used in your organization?

Instructions: You must post your responses in the comments section below before the  live lesson on Day 1. The instructor will review your comments and have a debrief discussion at the start of the next live session. The comments section will not be moderated otherwise.

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10 comments on “Wound Care Certificate Day 1/4 - Lesson 1A: Skin Health

  1. In past practice I have regularly used the Braden scale. I started as a manager here at Kwanlin Dun Health Centre 9months ago and am continuing to learn what tools and assessments are happening here. I am looking forward developing and strengthening areas, as a team, through best practice to better meet the needs of the clients.

  2. Aligning with what my coworkers have already stated in their comments, my practice at the health centre rarely uses formalized risk assessment tools. I believe this is a gap our team could address with the possibility of an Evidence Based Practice group where we can come together and share and adopt tools that will help guide our practice. We are a stand-alone health care team that works directly for the First Nation, so we don't have the same resources/guidelines/policies that an organization under a bigger government or corporation would have. I am hoping with this course we are exposed to some tools we can use going forward.

  3. In practice at the Kwanlin Dun Health Centre I use as previous coworkers mentioned, the diabatic foot screening assessment form. The practice of footcare is a very hands on assessment as well. Mostly I feel the approach is very collaborative between the nurses at KDHC, gathering to assess wounds and discuss best treatment between nurses and with the clients and physicians involved. We do address underlying causes, monitoring diabetes and friction/pressure concerns that are contributing factors to clients with chronic wounds we are seeing lately at KDHC.

  4. I honestly rarely use risk assessment tool in my organization. I am still fairly new in my workplace but I believe braden scale is the most common risk assessment tool as well as diabetes foot assessment, ABI, and some lower leg assessment.

  5. I am a new LPN at the KDFN health centre practising since Sept 2020. I have been dealing with chronic and acute wounds since day one, however I have not used a wound assessment tool other than the diabetes foot screen. As a student LPN I utilized the Braden scale regularly in long term care and at WGH but have not been using it in practice at the health centre as of yet.

    I have done informal assessments on my clients evaluating/considering my clients underlining conditions such as how well their diabetes is being managed, their nutritional status, mobility, mental health and addressing gaps in knowledge. I have had a client’s ABI assessed outside of our health centre. I am really looking forward to learning of comprehensive wound assessment tools to help navigate my daily world of wounds!

  6. Risk assessment tools I regularly use in my daily practice include the lower leg & upper leg assessment tool (originally adapted from VIHA), Diabetic Screen tools (many out there), WATFS (Wound Assessment Treatment Flow Sheet) and even the PPS (Palliative Performance Scale) if appropriate to help me make an evidenced based decision about level of risk, plan of care, and what wound product selection I use. Moreover, our annual holistic assessment tool called the RAI automatically generates lots of outcome scales (such as the level of function (physical and mental) in addition to the fragility scale) which is very purposeful in identifying level of risk insofar as skin risk and other risks. In addition to these risk assessment scales, I ask myself the following questions when I see any skin issues 1) cause of wound; 2)factors contributing to wounds; 3) modifiable factors/non modifying factors affecting wound healing 4) chronic or maintenance wound. I find assessment tools very useful in order to standardize levels of assessments from one clinician to another and helps to unifying common understanding.

  7. I think the main risk assessment tool that I have used at the health center is the 60 second foot screening tool for persons with diabetes. As an outreach LPN, I only have a few clients that receive regular dressing changes and their wounds are chronic in nature. The RN that I work with has implemented the use of a wound care flow sheet for one of our clients which has been useful in goal setting, wound assessment, and dressing choice.

  8. I will be honest and say that I rarely use an official assessment tool in my work at KDFN for skin/wounds. Most of my wound care is very reactive. My clients in the outreach program are quite high risk to skin infections/wounds due to life style, substance use and malnutrition and the healing process can be quite prolonged because of these factors.

    Like people have said the 60 second diabetic foot screen is used quite often and is the one I can really think we use here at the clinic.

  9. The primary risk assessment tool we use in our clinic is probably the 60 second diabetic foot screen. This is well adopted by our physicians and nurses, and is a regularly part of screening with our diabetic clients.

    Certainly in acute care I've used the Braden scale frequently. Very interesting about screening for pressure ulcer development decreasing the incidence by 60%! I haven't used the Braden scale in clinic at Kwanlin Dun--do any of the other nurses who are doing more home visits use it regularly?

  10. Although I am fairly new to the organization. I have identified several risk assessment tools available within the organization for use.

    The most basic/universal overall skin assessment risk we have is the Braden Scale. This allows us to identify clients at low/moderate or high risk and offers various interventions for us to implement depending on the scoring. This assessment looks fairly holistically at a client considering factors such as nutrition, mobility, and cognition. Various interventions such as frequent toileting, pressure relief, and increasing nutritional intake can all be implement.

    Not specific to our organization but the Canadian Best Practice Guidelines
    for the Prevention and Management of Pressure Ulcers in People with
    Spinal Cord Injury is also available for use and consideration. It recommends the use of the Waterlow scale, Braden, and the Spinal Cord Injury Pressure Ulcer Scale. It also highlights the importance of ongoing re-assessment.

    Within our organization we also have a basic and advanced lower limb assessment. Additionally the use of the 60 second diabetic foot screen allows us to identify various risks in this population such as self care deficits and infection risks.

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