By the end of this program, attendees will be able to:
Explain the way HCPs have altered their approach in the delivery of quality health care to patients across the spectrum of the health system (from the acute to post-acute setting) utilizing education, technology and community-centered care.
Share existing challenges and proposed solutions to managing wounds in this wound care environment.
Demonstrate how their team / institution is setting patients up for success and discuss the patient continuum of care.
Exchange of dialogue, ideas, best practices, case presentation from each speaker.
So we're going to be speaking today on putting the patient first, maintaining team solidarity across the spectrum of health care during these uncertain times, for information that you should always consult the eye of you and that the photographs used are ours are were give information. We're both speakers for Casey. I now part of the three m complete. So our goals today or to explain the way health care providers have had to alter their approach to the delivery of quality health care across the continuum, which would include acute to post too cute how we utilize education, technology and community centered care. We're going to share some of our existing challenges and proposed solutions to help manage England's. During this challenging environment, we're going to demonstrate how our team and institution and setting up patients for success and discuss the patient continuum along the care on. Then we'll have some time for Q and A at the end of the session. So called crisis, you can see our beautiful faces over here on the left are actually just are beautiful eyes. Uh, this is what we look like David Day. It's already go with crisis. So as it became a pandemic in the U. S. Has certainly shifted how all of our medical care was delivered. Onda how we triage and things like that. So services that were deemed non essential were being shut down. Stop was being furloughed. Um, here in Pennsylvania are crisis struck in mid March and then repeat at the mid to end of April s. Oh, now we're starting to finally see things. What I'll say normalize. But is the new normal? But office visits were shifted to touchless healthcare systems on There has been some leniency on the CMS guidelines. So I'm not going to spend too much time on this because I feel like a lot of other webinars have and thistles all information that you can find us well through the resource is but we carry Move it. Where does your Paulus faras essential versus a non essential service? And how do we balance providing care for a fragile green care patients with increase without increasing their exposure thio medical teams that could potentially increase their exposure thio prove it on what additional measures should be implemented to prevent infection on DSO, the Alliance of care stakeholders really spearheaded this for us by dealing that we care was essential and by having care clinics and care services available that way would help prevent the unintended negative effects of doctoring wounds on DSO Way would agree. Who cares? A sexual where he just still be working? Because we have certainly been busy so you can just see the pre pandemic model Cara versus a pandemic that the majority of our care has shifted from. Hospital supports the home setting on that's through physician, whole business telling Health Home Health. I know our home house has been great remote patient monitoring himself. Care. Andi. This is the wound Care Without Walls, which was published in March. And so this is saying, what is critical services? And obviously that's gas gangrene, severe Subsys limb threatening down to stand well, which is like uncomplicated venous leg ulcers. So perhaps how frequently, frequently we're monitoring that for seeing that patient in the clinic would be infected. I know a lot of our skilled nursing facility patients get even, are Healthy Shipping Care clinic because of exposure risks both for the staff and for the rest. It's are. So here's our pre pandemic care models so the evaluation, typically with face to face way, would take a look at their infection assessments or labs or vascular assessments or indifferent, uh, treatment, obviously of a single, especially in our health issues. Nuclear centers within basic diagnostics revascularization, cervical receptions for closures for reconstructive procedures and then cellular tissue products application treatments. Such a total contact casts making a pressure human therapy, offloading devices, compression dressings, advanced surgical drug things or description dressings. Things that perhaps staff that isn't trained to move here may not know how to apply on follow up was typically weekly toe every tube during our pandemic model. We really had to triage. And I know I spoke extensively with our stuff at our outpatient care center. About 50. They had a 50% layoff, not lay off, but just they had teams for loads. Um, where half of their stuff was working. So they had two teams. So if one team with some, yeah, go with that, they would have another team that could step in. And then there are also, um um not getting the exposure. They would have their to quarantine, in other words, so eh, so we would also triage patients was always that are still nursing facility patients were did not come in is regularly. A lot of them chose not to fund it at all because of three outbreaks that we have in our local nursing homes. Um, evaluation face to face was done if necessary. However, we also implemented telling health services, um, for our patients and infection assessment waas a little bit more subjective. Because of that, the change of the service sites are home Health agency nurses really helped with picking up, uh, doing the dressing changes and probably manage these patients in the Senate. On then. Treatments might have been a change of service, or we might have emphasized a little bit more on a more advanced dressing that could stay and face for longer, Um, or that would help prevent infection on day. Then the follow up was all based upon their level of triage. How critical it was that they got seen, uh, care settings. Like we talked about the cute care. We really focused on infection prevention, limiting exposure. I know we had thio really take a look at which patients required a surgical, um, disagreement versus those that could be done at the bedside. Anybody that was undergoing anesthesia, it was kind of taking a look at to see whether or not they truly needed, um to get innovated or if they needed to go to the operating room because of the risk of exposure on. Then we're also trying to get those patients out of the hospital much sooner eso that they didn't have the risk of exposure as well. Um, outpatient clinics were limited patient visits screened in frequency. So if they were seeing link leaving, they were seen every other week. Um, there are rolling layoffs. Is we discussed? I don't tell e health visits and then engaging home health, um, home health and increased referrals. And I know our home health agency. It did see this, but they were able to manage it well on then. The still nursing facilities assisted living, and we like to say in frustrated, because we do have an incarcerated population here. They really did not want Thio accept any new admissions. They had no visitors, and there was like two week quarantine. If you didn't go out of the facility for any services including medical visits. So our new focus is really prevention of a commission, so prevention of any type of union complication for infection. This helps conserve PPT management and prevention of infection. So the use of anti microbial Asians aggressive agreement at the time of business, Ford missions, monitoring via phone health for Kelly House and then good interdisciplinary communication, which I think is really important on day three decrease the risk of legendary shared by implementing at whole methods for biofilm activate management and patients actively involved in their treatment fanned with extensive education. Um, discharge, please. Discharge planning. So once they were hospitalized, there were delays in discharging divisions, especially to a sniff rehab hospital, etcetera, you know, isolation restrictions. So, um, like, for example, Kirsten and I knew if we got a skilled nursing facility he checked into the hospital, they would automatically you need to get tested at least twice to rule out that they had that they were testing positive for Coleman. So this means that they're in the hospital for at least 3 to 5 days so we can provide some aggressive doing their key early on. Just see the most benefit. Sometimes when these patients have shorter admissions were not even difficult meant a strategy that we can't see the benefit from during their stuff. So it all starts with Wen killing basics so traditional with negative pressure. Win therapy science. We will get macro strain and micro strange, so macro strain is just bringing those wounded. Just together you remove the infectious material reducing diva and improved profusion. The in vitro studies show that cellular stretch under negative pressure, stimulate cellular activity, which can result Congratulations, tissue formation on Ben in vitro and in vivo. Studies show that the phone contact with tissue under negative pressure creates this tissue micro deformation that that causes that cellular stretch. So basically encouraging. Congratulations issue. So this is the basics of negative pressure promoting unfeeling environment. There's more mechanisms faction, now that we've added installation therapy s oh well that can protect from the external environment. Remove infectious materials and excavate, remove oedema, promote profusion and regulation tissue. The installation also helps cleanse the living with that sick, with both delivering it'll. 12. The topical solutions way use a few different times here, depending on the nature of balloons on, then we provide thorough coverage with solution. During that 12 time and it can help tiny and for your life, infectious, considerable degree. So this is just a nice little diagram that shows the the right side is what negative pressure or back there you could do on. Then the left side is installation and, well, phase on. I really love this image because if you can see that small little tunnel or like, micro tunnel way, no blocks of booms that have these small purposes and when you're cleansing a little bit may just, like run right over that little micro Channel but went, well, a solution. You can really get into every nothing granny like, yeah, noodle out that that's a bring that's in that micro title through dwelling. And that's something that's a benefit that you're not gonna get from traditional therapy on. Does something that we've seen really help improve our nation outcomes. Um, so some of the county yachts is that careful therapy can provide the installation of that solution were missed the degree, um, it's not a treatment for women infection on day. It's not meant to deliver idea antibiotics. So some new information that just came out, which we're happy to share, is that while the benefits of back their flow therapy, um, have been well known for many years. I mean, this this information was published in 2014 with Gabriel, but, you know, decrease operating room trips, decreased length of stay and potential cross sieving to the institution from those above. Factors with factor of your therapy. Now with my therapy, it just came out that way. Have proved, uh, there's a reduced length of stay, which is reducing inpatient stays in acute for I c U unit by at least 50%. Reduced impatient days in long term by about 30%. Reduced home care length of stay by 34% for surgical lose. Um produced home care linked to stay by 49% for pressure injuries on. Then when they took Olympic, the retrospective analysis went back. Therapy was initiated early at the daycare center setting treatment time period compared to elite initiation. Um, significant closure was a 75% moon surface area production. That's half the time for acute food. One third of the time for promised forms on DSO. This is our, you know, read information toe have in your back pocket again when We're starting with care choices early and being aggressive, um, back therapy and back here for therapy or definitely hiding their arguments when we took a look at the consensus guidelines for back there flow. It's inappropriate for patients with substantial morbidity s. So basically any complex patient, any complex school where they would benefit from improved, particularly the recommended settings or the 12 times should be from 10 to 20 minutes, depending on your solution. Negative pressure cycle times should be in 2 to 4 hours, and then the pressure should be a negative 1 25 and then normal. Singling solution is the preferred solution. Class. They're significant bio virgin. So there's quite a few different dressings for back there for therapy now. So there's traditional back their flow dressings, which come in small and medium. On Ben. There's a large dressing that as well that's the black folks. So the smaller medium are split and spiraled, and they come with a fair attracts past the large dressing that is split of not spiral, and it comes with a duo track that we do. A track pad is one of my ear things way. Love it because the installation for is the soft report and it from separate than the negative pressure report on. So we use this almost exclusively on all of our post your trump room because we can instill directly over the wound and then the negative pressure port, which is a little bit harder than the bridge to the hips. So so that there's not the risk of a medical device related pressure injuries. We also use it in some of our larger, complex students tackle facilitating the movement of the installation solution through it. So we just recently had a case of a young woman with necrotizing fasciitis in her harm and chest. E put the installation for by her shoulder and the negative pressure port down by her lateral chest to help facilitate the cleansing of the entire room. So that works really well. There's also the very slow cleanse dressing, which is a tubular gray phone dressing with a little bit sensor pours that's meant for really just helping cleansing on. Then the very pro cleanse choice dressing has three layers. The contact layer has through old that can help um uh, facilitate the removal of non viable tissue and ex TV and cellular debris. E think we're going to talk a little bit more about that, uh, things that you want to consider for cleanse choices that it's in. It's from goods with 20 to 40% surface area of coverage of clean tissue, but it does have extra date. That's really the ideal for a lens choice contaminated with heavy bio burden. Acutely infected in conjunction with systemic therapy like idea antibiotics. Chronically infected wounds in conjunction with appropriate anti my four wheels on Ben cleansing in patients that are not candidates for sharp disagreement. So we've seen a lot of success in patients were not able to go to the operating room, Um, and especially now during this group in crisis, where we're really triage when we sent to the operating room. We've seen some benefits to the plans choice dressing. So this is my case study. It's a 58 year old male who had a past medical history of a right middle finger off their my latest status. Post amputation. Hey, had a lot of social issues. He was seen by plastic surgery, and, um, and he had an imputation on his finger. I think two days later, he decided to leave. AM a Thio go do a welfare check at his home. While he was admitted to the hospital for the finger amputation, he was noted toe have a thick Asher on his great DK a stump eso When he came back in, the stump was dripping house. And that was right on. So he was seized by vascular surgery. Who recommended, um that he had an a k A. Which he actively refused. So when it does come from one care s So this is what he looked like when we saw him? Um, he was refusing a K or operating room. Grieving. Um, he's okay with local care or minimal local backsides agreement. So we did do a slow that side agreement and you can see he had just a lot of fatty process and slept in that one days after we did that. So the day of the treatment, he was covered with abated. I'm dressing and the next day we applied bigger forefront choice stressing to him. So this is on the left what he looked like before the application. You can see there is really no healthy tissue in the base there. Um and then that's what the dressing looks like. So we use a lot of barrier rings in our clan's choice and are fearful applications on. Then we just bridged it to the front because we want that you want the installation to be in the pink of the mountain is so that gravity takes the solution. Now, um, he was 20 MLS and normal singly for five minutes. Well, everywhere this is him. Give treatment 35 and eight with the same dressing settings on. Then he was discharged on day of treatment e which we switched him because he had no insurance. And he's not a US citizen way switched him. Teoh a medical. Great, honey, Just saying hey came back in and we switched him over Thio from ground and silver salt dancing while he was re admitted for some respiratory issues. Eso This is day 58 a 65 that you can see how using the advanced doing hairdressing helped him for just into okay. And that's over the years now. Thank you. So I was kind of alluded to earlier in one of your slides and things changed a year. Something changed. You know, the outpatient clinics and opposite for women to patients is patients and patients that they saw with layoffs and furloughs. Our health is implemented some places on, but there was also increased. Refers to health. And those kinds of things that I never focused on is not smooth. Um, someone we're thinking about just instruction. Once again, that was earlier. That you really had to look at these patients where they live and get the big guns moving. Because what, they didn't know how long we're gonna have the most of them have 7 30 of time, but, you know, depending on what the situation, they were coming from the implement something. I don't know what their followers gonna be like outpatient. How often is officially the president is going to be able to see these patients? Um, you know, and, you know, home health really overwhelmed. So you know how often this home health you want to get a communications to really needs to consider that when we look at our dressing selection So that that included was, you know, an anti microbial, um Or addressing that's gonna address file. Sell your silver cells here. Purcell a junior artist self. You know, things like that, actually, management from dressing, Uh, that's gonna absorb a lot of black. You know, patients were being stations that you can use The stresses that the profession s O that we doesn't for Steptoe back into a larger definitely a You suggesting that some kind of e once again like a face for several days? So here's my case study whispers. A 53 year old gentleman on anti fragmentation for history. A fin uh, he sustained a fall before the storm eso he fell off the store for gentleman, and he got this human drama. It was managed by with feelings. He, uh, over lines in the curses attempted and mobilization by interventional radiology. Plastic surgery got involved. Uh, this is what it looks like. So you can see on the patch. Looks like preoperative. Not really. You know, healthy working at all. Definitely some interventions on their plastic surgery, different heart breaking down. We decided to do back there for lunch choices. You know, hit the big guns. Initiated this fast book at the healing process, going as soon as you know, as soon as we can. Eso When you put friends choice on him 40 million years ago, Sailing 12 it for 10 minutes every two hours, Um, at 1 25 and changed every 48 to 72 hours. So you can see here these pictures on the left That's treatment day seven on, then treatment, they 10 way transition time from the cleanse choice dressing to standard negative pressure would do that for seven days on. Then this was a patient that we will move on to an out facial wound Care scenting center was setting forward to home health. Hey, actually went on Thio to the outpatient move care center. He transitioned him to program Prisma and Silver. So addressing s so that way, you know, it was sort of educating is gonna promote feeling. And it's also going to allow that patients do not shop tohave addressing change. Uh, you know, every other day to do it twice, twice with some kind of principle. But, um, you know, like you said earlier, looking at all those aspect, uh, when you come into the facility of what we need to get them to, so that way they have proper treatment. So outpatient continuity with terrorist there he was able to maintain the same kind of dressing Andi he went on to keep very well. You could feel the killing professional there at treatment number 46. So when we look at ion progress with therapy monitoring, this is something that's available in the United States. So this is really great for those patients who, you know from the get through the first time you do that assessment that they're gonna be non confined or not in here to work there. So this is a really great, um program in which the patient goes home. The information that we're making a pressure machine goes thio people that task. And they're like, uh, which are sheet off. There's a week or whatever the implication across listen, therapies and active or or doesn't have a seal or shut off. Just sell it on eBay. Um, whatever it is, it's a three thio. Make sure that these patients who are, you know, important for frequent fliers or were concerned about you know them, you know, coming in. And you know they right of the imputation or something. A serious rest. These air there, these patients that we can monitor remotely to make sure that they have the there continue with proper treatment. Eso Let's just look in a side by side. I work with mechanically versus electrically powered and refresher firm therapy. You can see on the left snap and you can see on the right that doing pressure. Boone therapy. Active back. Very similar As far as their dressings, the issues are a little different. One forces botanically power, the other is electrical power. But when you look at him, many types of negative pressure would therapy are available? E said. There's a little electrical which should have reported it. How many times do you hear your patients are coming back into the facility and they're active? Fact is completely dead. They forgot their charger, whatever it may be, Um, there's a battery powered and then there's the capital. They all have very smart, um, actions. But there are significant differences in the instructions and how she is. So if we look at the other like approach to the active back from the snap, you know, is the wound type indicated for negative pressure views. Who really needs a working guy because if there are contraindications cannot use it. Does the women's, uh, possess any contraindications? Like I just said, uh is the boom, you know, what are the measurements? Is afraid of the 13 centimeters by 13 7 m? Is there a lot of drainage is a little drainage. So those are all things that you need considering down my algorithm to decide classifications. I think the other thing that I like to talk about that not like we're considering snap versus staff is that what's nice is like snapfish elf on the shelf. I don't drink or whether it gets improved by insurance and we only have to change it twice a week. So we're limiting exposure during this. That is a nice thing, because, of course, that therapy is every 48 to 72 hours. Yeah, and the other thing, especially in our population. Here in our area, we have a huge you know, Amish and Mennonite population, and they don't use electrically powered stuff, So that's where the mechanically powered stuff is. We don't want to limit them. Thio resource is that we have or are available to them because you know the way that they live in belief. All of their lives, so we want to make sure that they still have that same option. So this is just kind of schematic to show you, you know, when to use back therapy. And once you snap therapy like I'm just gonna find a priest theories that were quickly because of time that what you guys have, the ability thio out lots of questions. But what I would do you want to touch on or the indications for use so stop therapy is indicated rotation to benefit from good management being the application of negative pressure, particularly as the device me promote food, feeling through the removal of excess candidate infectious material and to shoot degree. The snap therapy system is indicated for renewable or small amount of exhibit. Chronic traumatic 17 and history looms ulcers, such a diabetic rooms, Andi pressure authors and surgically, first incision flats and graphs. So basically the same text performances taking questions corrective. What is not used for? Of course, we have to do this. Is that inadequately drink? So you never want to put something on that there might be an underlying abscess, um, or, you know, something that's not explore product tissues such as far in things exposed. What vessels is a no, no, uh, foods containing the malignancies official is untreated, osteomyelitis and actively food. And we don't wanna put these kinds of dressings on comforters. So when to use the stop therapy, and you can kind of see there when you use it and put a little bit. The only difference is is a Z of January of 2019. It's not. Therapy is no longer used. Our first I think this year is that was very good. So just to make you a lot blowing sizes and exit level levels, I touched on every single every single room has a different topography. So you know you're gonna have thio design. There's do your crafting one of one to make sure that these these areas are addressed appropriately and maintaining a field. Um, there was a bunch of physicians and the nurse that being together on the 53 Ford and they recommendations for use, and we have first meant so that was published a room. So take a listen on your lives and your left a plenty of time to graduate drinking a joy. Uh, so here are the recommendations of which include optimal locations and selection, use of snap system in various work types, clinical techniques for addressing application and reimbursement. So I want to thank Dr Barrett. He actually providing this case study to us. So wonderful gentleman s O. This was the 73 year old male Longstanding. He was, like, also failing multiple layer and united repression, compliance and, uh, Andi for educating management So you can hear the sea here. The picture. This is the biggest, like ulcer, and having presented the stop therapy was applied. And then you can see here at treatment for and treatment they had. How much feeling progression you got of therapy? You know, mass celebration. And it maintains films, Extra days. So really good choice. Addressing infestation. So with all that getting, son, you know, some key points that you really want to drive home is that it will start these advanced therapies early. Don't be afraid to start controlling. Um, it's gonna alleviate a lot of fittings, and it's really gonna, you know, 400 patient out from keep a mission prevention in mind way Don't want people coming back in a Such as people have number sometimes He's like, um way don't want to keep them and happen Reinstated on, then select therapy that limitation to exposure to healthcare environments. So all those air, three key points to really keep in mind. So there was a lot of information that we want to weigh went through. Listen like oh, thank you very much. Thank you for joining today's webinar. This concludes today's presentation.