Wound Care Home Care
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Wound care, home care, domiciliary
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Wound Care Home Care
- 1. Wound Care Vs Domiciliary Care : An Integrated Service Dr Wan Zuraini
- 2. About me • Clinic Manager Klinik Luka & Perubatan Rehabilitasi Hospital Serdang (2008 – 2013) Klinik Rehabilitasi Kardiak Hospital Serdang (2008 – 2013) Klinik Perubatan Luka PKD Kuala Langat (2013 – current) • Program Manager Domiciliary Care Services PKD Kuala Langat (2013 – current) Domiciliary Palliative Care Services PKD Kuala Langat (2016 – current)
- 3. GENERAL GUIDE SLIDE WITH CROSSMARK LOGO CARRIES SIGNIFICANT ACADEMIC & CLINICAL IMPORTANCE YOU COULD ALSO PRE-ACCESS THIS PRESENTATION ON SLIDESHARE.NET KEYWORDS: Wan Zuraini, Domi wound care, home wound care
- 4. Outline Definition and protocol of DCS Wound care within DCS Best practice Documentation Limitation Common wound Conclusion
- 5. DEFINASI DCS PERKHIDMATAN PERAWATAN DOMISILIARI (MENGGUNAPAKAI DEFINISI PERKHIDMATAN PERAWATAN DI RUMAH) Perkhidmatan Perawatan Domisiliari (PPD) adalah satu perkhidmatan perawatan holistik yang diberikan kepada kes stabil yang terlantar dan memerlukan kesinambungan penjagaan serta perawatan selepas discaj dari hospital atau rujukan dari klinik kesihatan. Perkhidmatan Perawatan Di Rumah telah diluluskan semasa Mesyuarat JDPKK Bil. 4/ 2007 bertarikh 19 Disember 2007. Melibatkan penjaga & pesakit terlantar
- 6. OBJEKTIF DCS 1. OBJEKTIF UMUM : Untuk membantu dalam perawatan dan penjagaan pesakit yang terlantar di rumah ke arah meningkatkan kualiti hidup pesakit. (QOL) 2. OBJEKTIF KHUSUS : Membantu pesakit meneruskan rawatan dan penjagaan di rumah sebagai kesinambungan rawatan selepas discaj dari hospital (continuation of treatment) Memberi panduan dan tunjuk ajar kepada pesakit dan keluarga bagi meningkatkan penjagaan kendiri. (guidance) Menggalakan penyertaan keluarga dan masyarakat dalam pengendalian pesakit terlantar bagi mengurangkan kemasukan semula ke hospital. (carer involvement)
- 7. History & Development of DCS NBOS 7 1Malaysia Family Care – perawatan rehabilitasi di komuniti (CBR) melalui penaiktarafan perawatan di rumah (PDR) PDR – rawatan di rumah atas rujukan yang tidak berstruktur & tiada system discaj Cth: 2wkly RT Change
- 8. SKOP PERKHIDMATAN DCS • Perkhidmatan perawatan termasuk latihan teknik mencegah berlakunya kudis tekanan, pendidikan mengenai rawatan luka dan penjagaan kebersihan, menukar tiub nasogastrik, kateter urethral, pemeriksaan darah ujian gula darah dan mengambil tekanan darah dan penyediaan sokongan emosi. 1. Perawatan • Aktiviti rehabilitasi bagi kes yang memerlukan termasuk rehabilitasi pergerakan aktif dan pasif serta latihan activity of daily living. 2. Rehabilitasi • Perkhidmatan ini merangkumi perawatan yang melibatkan penjagaan paliatif. 3. Paliatif
- 9. DOMI CARE + WOUND CARE = HOME CARE WOUND CARE (HCWC)
- 10. Best practice of HCWC Minimum recommendations for Health Care Professionals’ knowledge and skill 01 Recommendations for products, devices and materials for wound prevention and wound management 02 EWMA Document HCWC 2014
- 11. 1. Minimum recommendations for Health Care Professionals’ knowledge and skill A. Level of knowledge • Assess complex wounds and wound healing • Implement wound management based on best practice and evidence • Select best available wound care products in the context of holistic care • Support patient’s independence and participation in decision making • Educate patient and informal carers in self-care and wound prevention • Document wound healing, symptoms and treatment of wounds as well as patients’ and informal carers’ concordance with care • Ensure the continuity of care in all circumstances/conditions • Integrate multi-professional knowledge for the patient care by using consultation and ehealth
- 12. 1. Minimum recommendations for Health Care Professionals’ knowledge and skill B. Competencies • Be able to attend the patient and/or the environment of the patient during the different phases of their illness • Provide education for patients and their informal carers within their social environment • Coordinate the management of the wounds regarding the prophylactic and therapeutic principles • Engage in continuous professional development to maintain knowledge and skills
- 13. Key features for selection of products, devices and materials for wound prevention and wound management • Use safe products (with minimal collateral effects) • Use simple to use products (to reduce risk and anxiety from the informal career or the patient) • Use disposable products when possible (to reduce risk of transmission of infections from home to Home) • Use products that reduce pain (to reduce risk and anxiety from the patient and the informal career) • Use products that have a wide range of application
- 14. Cont’ - Key features for products, devices and materials for wound prevention and wound management Wound dressings can be effectively used through extended parts of the healing continuum Wound dressings should not stick to the wound bed, and should eliminate or minimize need for wound bed cleaning Wound products are easy to use and access, especially if patient or informal carer takes part in wound management Wound products enable the lowest overall cost, including the cost of home care services and patient costs Wound product are eco-friendly
- 15. HCWC RECOMMENDED 1. Products 2. Device 3. Materials
- 16. What should be in your bags? 1. Recommended products for HCWC PRODUCTCATEGORIES 1. Wound prevention – lotions for thin and flat epidermis, loss of skin elasticity Lotion for thin and flat epidermis, loos of ski elasticity 2. Wound bed preparation Antimicrobial strategy 1. Cleansing agent Moisture control Debridement 3. Dressings Absorbent dressings, antimicrobial dressings, foams, gels, hydrocolloids, polymeric membrane dressing, periwound management 4. Fixation Bandages and tapes
- 17. 2.Recommended device for HCWC For wound prevention • Pressure redistribution mattresses • Cushions • Total offload device • Garments • Therapy shoes
- 18. Pressure ulcer risk assessment scale (PURAS) NORTON SCALE (England 1962, 5 parameters) – physical condition, mental state, activity, mobility, incontinence WATERLOW SCALE (England 1984, 8 parameters) – BMI, skin visual, sex, age, continence, mobility, appetite, medication BRADEN SCALE (USA 1987, 6 subscales) – sensory, perception, mobility, activity, nutrition, friction & shear GOSNELL SCALE (USA 1973, 5 parameters) – mental status, continence, mobility, activity, nutrition RAMSTADIUS TOOL (AUSTRALIA 2000, 2 questions) – skin integrity, mobility
- 20. 2.Recommended materials for HCWC Patient education materials – leaflets information on nutrition, wound care at home 1 Best practice evidence – National and international guideline 2
- 22. Wound Assessment Tools 1. Pressure ulcer Scale for Healing (PUSH) 2. Pressure Sore Status Tools (PSST) 3. Bates-Jensen Wound Assessment Tool (BWAT) 4. Sessing Scale (SS) 5. Sussman Wound Healing Tool (SWHT) 6. Wound Healing Scale (WHS) 7. DESIGN 8. Leg Ulcer Management Tool (LUMT) 9. ASEPSIS 10. Barber Measuring Tool (BMT) 11. Photographic Wound Assessment Tool (PWAT) 12. Triangle of Wound Assessment (TOWA) 13. Wound Chart (Manual Wound Care Malaysia 1st Edition 2014) Assessment of wound healing: validity, reliability and sensitivity of available instruments, Pillen & Miller 2009
- 23. Limitation • Lack of adherence to clinical guidelines • Lack of wound care expertise demand below competencies • Finance resources for dressing materials, devices and education training
- 25. CASE 1 Diagnosis: Paraplegia secondary to spinal cord tumor Stage IV NPUAP PI
- 26. What is wrong with this equipment? • Improper seating and support surface • Wrong type of WC • Wrong size of WC
- 27. CASE 2: Deconditioning secondary to bilateral post TKR What is wrong with skin?
- 28. EXCORIATION
- 30. Conclusion With adequate knowledge and resources, it is mandatory to perform a synergistic comprehensive wound assessment and management within Domiciliary Care Service to ensure holistic care are properly delivered.
- 31. Thank You Dr Wan Zuraini Mahrawi Wound Care Clinician MSc Wound Healing & Tissue Repair (UK), GCFM mrs.wanzu@gmail.com +6011-33515410
Editor's Notes
- Animated spinning picture (Intermediate) Tip: Some shape effects on this slide are created with the Combine Shapes commands. To access this command, you must add it to the Quick Access Toolbar, located above the File tab. To customize the Quick Access Toolbar, do the following: Click the arrow next to the Quick Access Toolbar, and then under Customize Quick Access Toolbar click More Commands. In the PowerPoint Options dialog box, in the Choose commands from list, select All Commands. In the list of commands, click Combine Shapes, and then click Add. To reproduce the shape effect on this slide, do the following: On the Home tab, in the Slides group, click Layout, and then click Blank. Also on the Home tab, in the Drawing group, click Shapes, and then under Basic Shapes click Oval (first row). On the slide, drag to draw an oval. Select the oval. Under Drawing Tools, on the Format tab, in the Size group, enter 6” in the Height box and 6” in the Width box. Also on the Format shape, in the Shape Styles group, click Shape Outline, and then click No Outline. On the Home tab, in the Drawing group, click Shapes, and then under Basic Shapes click Pie (second row). On the slide, drag to draw a pie. Select the pie. Drag the yellow diamond adjustment handle to create a wedge shape. Under Drawing Tools, on the Format tab, in the Size group, enter 5.7” in the Height box and 5.7” in the Width box. Press and hold CTRL, select the oval, and then select the pie. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following: Click Align to Slide. Click Align Center. Click Align Middle. Press and hold CTRL, and then select the oval and then the pie shape. On the Quick Access Toolbar, click Combine Shapes, and then click Shape Subtract. Select the new shape. Under Drawing Tools, on the Format tab, in the Shape Style group, click the Format Shape dialog box launcher. In the Format Shape dialog box, click Fill in the left pane, in the Fill pane, click Picture or texture fill, and then click the button next to Texture and click Recycled Paper (third row). Also in the Format Shape dialog box, click Picture Color in the left pane, in the Picture Color pane, under Recolor, click the button next to Presets, and then click Grayscale (first row). Also in the Format Shape dialog box, click Picture Corrections in the left pane, in the Picture Corrections pane, under Brightness and Contrast, in the Contrast box, enter 20%. Also in the Format Shape dialog box, click Shadow in the left pane, in the Shadow pane, click the Presets button, and then under Outer, click Offset Diagonal Bottom Left. Also in the Shadow pane, in the Blur box, enter 10 pt. To reproduce the picture effects on this slide, do the following: On the Insert tab, in the Images group, click Picture. In the Insert Picture dialog box, select a picture and then click Insert. Select the picture. Under Picture Tools, on the Format tab, in the Size group, click the Size and Position dialog box launcher. In the Format Picture dialog box, resize or crop the image so that the height is set to 5.8” and the width is set to 5.8”. To crop the picture, click Crop in the left pane, and in the right pane, under Crop position, enter values into the Height, Width, Left, and Top boxes. To resize the picture, click Size in the left pane, and in the right pane, under Size and rotate, enter values into the Height and Width boxes. Under Picture Tools, on the Format tab, in the Size group, click the down arrow under Crop, and then click Crop to Shape. Under Basic Shapes, click Oval (first row, first option from the left). Also under Picture Tools, on the Format tab, in the Arrange group, click Send Backward. To reproduce the other shapes on this slide, do the following: Also on the Home tab, in the Drawing group, click Shapes, and then under Basic Shapes click Oval (first row). On the slide, drag to draw an oval. Select the oval. Under Drawings Tools, on the Format tab, in the Size group, enter 0.17” in the Height box and 0.17” in the Width box. Also on the Format tab, in the Shape Styles group, click Shape Fill, and then under Theme Colors, click Black, Text 1, Lighter 25% (fourth row). Also on the Format tab, in the Shape Styles group, click Shape Outline, and then click No Line. On the Home tab, in the Drawing group, click Shapes, and then under Basic Shapes click Donut. On the slide, drag to draw a donut. Select the donut. Under Drawing Tools, on the Format tab in the Size group, enter 0.25” in the Height box and 0.25” in the Width box. Also on the Format tab, in the Shape Styles group, click the Format Shape dialog box launcher. In the Format Shape dialog box, click Fill in the left pane, in the Fill pane, click Gradient fill, and then click the button next to Preset colors and click Silver (fifth row). Also in the Format Shape dialog box, click Line Color in the left pane, in the Line Color pane, click No line. Also in the Format Shape dialog box, click 3-D Format in the left pane, in the 3-D Format pane, under Bevel, click the button next to Top, and then click Circle (first row). Press and hold CTRL, and then select the freeform shape, the picture, the small circle, and the donut. On the Home tab, in the Drawing group, click Arrange, point to Align, and the do the following: Click Align to Slide. Click Align Center. Click Align Middle. Also on the Home tab, in the Drawing group, click Shapes, and then under Basic Shapes click Oval. On the slide, drag to draw an oval. Select the oval. Under Drawing Tools, on the Format tab, in the Size group, enter 0.65” in the Height box and 0.65” in the Width box. Also on the Format tab, in the Shape Styles group, click the Format Shape dialog box launcher. In the Format Shape dialog box, click Fill in the left pane, in the Fill pane, click Picture or texture fill, and then click the button next to Texture and then click Recycled Paper (fourth row). Select the freeform shape. On the Home tab, in the Clipboard group, click Format Painter, and then click the new oval. Position this circle over the top edge of the freeform shape. On the Home tab, in the Drawing group, click Arrange, and then do the following: Under Order Objects, click Send to Back. Point to Align, and then click Align Center. To reproduce the animation effects on this slide, do the following: Select the picture. On the Animations tab, in the Advanced Animation group, click Add Animation, and then under Emphasis Effects, click Spin. Also on the Animations tab, in the Animation group, click the Show Additional Effects Options dialog box launcher. In the Spin dialog box, on the Effect tab, do the following: In the Smooth start box, enter 5 sec. In the Smooth end box, enter 5 sec. Also in the Spin dialog box, click the Timing tab, and then do the following: In the Start list, select With Previous. In the Duration box, enter 20 sec. Select the small oval at the top edge of the freeform shape. On the Animations tab, in the Advanced Animation group, click Add Animation, under Motion Paths, click Shapes. On the slide, drag the bottom, left, and right sides of the motion path so that it matches the inside edge of the freeform shape. Also on the Animations tab, in the Animation group, click the Show Additional Effects Options dialog box launcher. In the Circle dialog box, on the Effect tab, do the following: In the Smooth start box, enter 5 sec. In the Smooth end box, enter 5 sec. Also in the Spin dialog box, click the Timing tab, and then do the following: In the Start list, select With Previous. In the Duration box, enter 20 sec. To reproduce the background effects on this slide, do the following: On the Design tab, in the Background group, click Background Styles, and then click Style 9.