Nursing Footcare Newsletter
August 2012 - Issue 7 |
|
|
|
This is an ongoing program. Dr. Julia takes only 4 students at a time for a full day of hands-on foot and nail care training. This very popular program is offered at a facility near Seattle,Washington. Students come in from around the Country for this special opportunity.Several spots still open in August!!
|
Honor Roll!!
The following Nurses have passed their WOCN Foot and Nail Certification Test:
Patty Kuhn
Cheri Burrel
Yvonne Martineau
Nancy Reid
Pat Conway
Ted Green Beverly Thrasher Shirley Taylor Judy Fine Samantha Musser Joan McMunn Sergei Ucharalets Lisa Hansen Dianne Eccles Tyree Fender Donna Zeznock Judy Fine Shawnie Tallman Martina DeVillez Sharon Thomas Jule B. Monnens Lauriann Galer Congratulations!! If you've passed, too, please let us know so we can list you here on the Honor Roll!!
|
|
|
| Greetings! | 
Guidelines for Hemostasis & Infection Control
Whether you are working in a long-term care facility, a retirement home, or seeing patients in senior centers or in their own homes... one of the most important issues we face is patient safety and infectious disease control. I want to devote this issue of the newsletter to helping standardize our protocols and procedures for infection control.
Even though wound care is an extremely high risk setting, and problems can certainly occur, the high risk nature of wound care is understood by everyone. But foot care is different. No one expects anything to go wrong. Even when we're working on high risk patients and providing excellent care. People sometimes assume that any problems are due to improper care by the nurse providing nail and callus care. Believe me, whether it's wound care or foot care, there are MANY issues which go wrong between the initial care and an amputation. To protect ourselves ethically and legally, those of us performing wound care or routine foot care must follow guidelines and document carefully.
"Routine" foot care is frequently performed for the benefit of high risk patients. But for some reason it is not perceived that way. If a small scratch or infection occurs as part of foot care it can be perceived as gross negligence of the provider without taking into account the high risk nature of the patient. All of us who perform "routine" foot care are at high risk for accusations of malpractice. That is why I am always emphasizing the need for malpractice insurance.
As part of teaching good standards and practices and documenting appropriately in practice I have developed various forms and practice guidelines that I would like to share with you. We will discuss them in the article below but you can download free copies of the forms from the RainerMedEd.com website. Feel free to change them in any way you like for your specific situation. But I want all of us providing routine foot care to use the same professionalism that we do in wound care and other high risk medical practices.
I hope this makes it easier for you to achieve your goals of adding foot care to your nursing practices.
Your friend,Dr. Julia Dr. Julia Overstreet, DPM, FAPWCAPodiatric Physician & Surgeon
Wound Care Specialist
High Risk Foot Care Specialist
DrJulia@RainierMedEd.com
|
|
|
|
|
Feature Article
| 
Hemostasis & Infection Control
As I mentioned in the introduction, the very nature of our work in toenail and callous care puts us with a patient population that typically has multiple comorbidities. The high risk nature of providing care to these patients is why so many facilities refuse to allow their nursing staff to perform procedures. I think that is amazing!! With appropriate training you are permitted to do any number of challenging procedures on high risk patients. Many of which are invasive by nature and can have immediate adverse events that endanger the patient. But somehow providing toenail and callous care with appropriate training is just too dangerous... And I think this will become more the standard as health care policies evolve in the coming decades.
The trend now is for patients to remain in any given setting as short a time as possible. Addressing only immediate issues and pushing them on to the next facility or level of care. In that agenda there is no way that the administration would take the staff time, resources, etc. to treat even grossly overgrown nails and callouses. I assume the hope is that by the time further damage is done because of the lack of foot care, the patient will be in another setting and someone else's problem. I'm sorry if that sounds cynical but I don't know how else to evaluate this situation.
Even in years past when more podiatrists provided this routine service in their offices most of the care was done in the non-medical community. And usually not by nurses. Usually by retired ladies who would go into the retirement homes or into individual homes to provide a needed service. Often they had no health care training and certainly no organized foot care training. Because of their lack of health care training, there was usually little or no infection control, instrument disinfection or minor laceration treatment guidelines. And yet, the work needed to be done and the non-medical providers generally did a great job and helped generations of seniors live better and more active lives by providing the care. I am wholly in support of their efforts.
Now that we are fortunate enough that most states allow nurses to perform this care after appropriate training we need to upgrade the process
to the same level of organization that we have in place for other specialized procedures such as wound care.
Below you will find examples of guidelines which I have developed for hemostasis and infection control in routine foot care. Whether you are providing care in a facility or on your own, you need to have Guidelines in your administrative files. This again is common practice in other clinical specialties. It has the advantage of standardizing care throughout the continuum as well as providing documentation of these standards in the event questions arise about any adverse event. You need to be able to produce these Guidelines in any setting in which you work. They are the basis for training of all personnel as well as assuring that the most current practices and procedures are being followed. So whether it's new employees or a subpoena for court documents in a lawsuit, we need to have these documents prepared and routinely reviewed and upgraded. That is the best way to assure doubters that this care can be performed professionally and safely even for high risk patients.
As mentioned above, these and other forms I have developed are available on the RainierMedEd.com website or click the link below the forms here. They are free for you to download and use or change in any way you need to. I have not copyrighted them. In fact, I want you to review, evaluate and adjust these in any way that fits your practice and your understanding of appropriate care. My goal is to help in any way I can to ensure that our patients receive excellent care and that administrative bodies understand our professional approach to this.
|
|
Patient Information Handout
| |
This first form below is a handout that I give to patients who may have come in with an ingrown toenail or who received a scratch or minor laceration during treatment. I strongly believe in written information for patients. We all understand how difficult it is for the patient to absorb everything we tell them during a visit. And when it is necessary for them to provide their own follow-up care this becomes essential.
In addition, be sure to document that you provided this information both verbally and in written form to the patient. Putting it in the chart that you did this assures anyone reviewing your work, including attorneys, that the patient had all the information necessary to follow through. In particular, a common accusation in a law suit is often one of the following,
1. "They didn't tell me that there was a cut"
2. "They didn't tell me what to do to take care of it at home"
3. "They didn't tell me what to look for to see if it was getting infected"
4. "They didn't tell me what to do if it looks red"
These are common issues you will see on any lawsuits dealing with this type of care. Be certain that your charting shows that you gave them that information verbally and in writing. This helps remove any question about the care you provided and patient education.
============================================================
Patient Handout
Infection & Bleeding Control
How the area was treated:
- The bleeding was stopped with gentle pressure and/or a chemical agent that helps stop bleeding
- The area was cleansed with alcohol, betadine and/or an antiseptic wash
- An antibiotic ointment (Bacitracin) was applied
- The area was dressed with an appropriate bandage to keep the area clean and protected.
What you, the patient, need to do:
- Keep the bandage clean and dry for two days.
- When the bandage comes off or is removed - look for signs of infection including localized redness, localized swelling, creamy discharge.
- Contact your primary doctor right away if you see any of those changes.
What to do if there is blood on the bandage later today:
- Understand that this is normal. This commonly happens once you have your shoes back on and walk away after today's visit. The sore area rubs on the shoes and can restart bleeding which was stopped during your treatment.
- Remove the bandage
- Clean the area with soap and water
- Apply an antibacterial ointment that you commonly use (such as Neosporin)
- Reapply a clean bandage.
- When the bandage comes off or is removed - look for signs of infection including localized redness, localized swelling, creamy discharge. Contact your primary doctor right away if you see any of those changes.
We hope this information is helpful!
================================================================
|
|
Treatment Guidelines
|
The form below is "Treatment Guideline for Hemostasis and Infection Control". As you will see, it covers everything from a minor scratch that is easily treated with pressure to significant bleeding that might require referral. It represents my personal protocols and should be adjusted for your treatment standards.
======================================
Treatment Guidelines
Hemostasis & Infection Control
4-12-2012
1.0 Hemostasis for Iatrogenic Lesions During Foot Care
- Very minor bleeding: Apply gentle pressure with sterile gauze pad.
- Minor bleeding: Check for allergies to astringent preparations. If none, apply Aluminum Chloride (eg Lumicaine) to sterile gauze and use to apply gentle pressure over wound.
- Minor bleeding which does not respond to measures above: Apply Silver Nitrate Sticks to area per product use directions.
- Bleeding which is not controlled by any of above should be dressed with sterile gauze secured by 1 inch Coban (to provide pressure) and the patient should be transported to ED or Physician for care. The foot should be elevated above heart level.
2.0 Infection Control for Iatrogenic Lesions During Foot Care
- After hemostasis has been achieved (bleeding is stopped by one of the methods above) ask the patient about allergies to antibacterials such as alcohol and Betadine. Use either alcohol, Chlorhexidine Gluconate (Chlorascrub), or Betadine to cleanse the area unless there is an allergy reported. Alternatively, can use antibacterial cleansers such as chlorhexidine topical (eg Hibiclens, CalgonVesta) or benzalkonium chloride at 0.12% (eg RemedyŽ Olivamine Antimicrobial Cleanser). Use each according to product directions.
- Dress the lesion with a dressing appropriate to its size and location. (must fit in shoes without pressure). Cloth Band-aids (Coverlets) of appropriate size are preferred due to ease of use and shoe fit considerations. In the event of larger size of wound or bleeding that was difficult to control, consider gauze and Coban if shoe fit issues are addressed.
3.0 Patient Education for Iatrogenic Lesions During Foot Care
- Advise the patient that a laceration or abrasion has occurred during treatment.
- Advise the patient of the methods used to stop the bleeding, clean the wound, and the dressing applied.
- Advise the patient that even though bleeding has stopped at this time, it may restart when the shoes are replaced and the patient is ambulating away from today's visit. They should remove their shoes and socks upon return home and check their feet for signs of rebleeding. In that event they should apply pressure to stop the bleeding. Then they should cleanse the area by washing with soap and water and replace the Band-aid.
- Instruct the patient to remove the band-aid in one to two days and observe for signs of infection or other complications including: redness, swelling, creamy discharge, pain, increased warmth or tenderness in the area. Instruct them to contact you, their physician or the urgent care department with any findings or concerns.
Click here to download entire form.
|
|
|
Final Thoughts...
I hope this Newsletter has given you a head start on providing the most professional level of foot care. Even if you're in business for yourself, we need to maintain the standards of quality care and documentation that we do in clinics and facilities. Watch for more help with this in the next Newsletter.
Until then,
Take care and keep clipping!
Dr. Julia Enjoy your summer!!
Dr. Julia Overstreet, DPM, FAPWCA
Podiatric Physician & Surgeon
Wound Care Specialist High Risk Foot Care Specialist DrJulia@RainierMedEd.com
|
|
This is an ongoing program. Dr. Julia takes only 4 students at a time for a full day of hands-on foot and nail care training.This very popular program is offered at a facility near Seattle, Washington. Students come in from around the Country for this special opportunity.Several August spots still open!!
|
New Hands-on Workshops!!
 
| |
|
|
|
|
