Complex Wound Care with Negative Pressure Wound Therapy (NPWT):
Adverse Events and Litigation

* Shipping and handling will be added to CD orders.
** Replay allows you to download a video recording of the webinar. Please note that the MP3 and CD include the audio of the presentation. PowerPoint slides will be included with the purchase of any of the above formats.

FREE
with webinar:
Chapter 1, "Interprofessional Wound Care"
and
"Six Sticky Wickets of Wound Care"

Presenter

Dr. Diane L. Krasner is a board certified wound specialist with experience in wound, ostomy & incontinence care across the continuum of care. She is a Fellow of the American Academy of Nursing and a Master of the American Professional Wound Care Association. Dr. Krasner is a Wound & Skin Care Consultant in York, Pennsylvania and works part-time at Rest Haven - York as the WOCN / Special Projects Nurse. Krasner graduated from The Johns Hopkins University with degrees in Ancient Near Eastern History and Egyptology. She went on to receive her Bachelors, Masters and PhD from the University of Maryland School of Nursing and a Masters in Adult and Continuing Education from Johns Hopkins School of Continuing Studies. Dr. Krasner was a Johnson & Johnson Medical Post Doctoral Fellow at the Center for Nursing Research at Johns Hopkins University School of Nursing.

Dr. Krasner is the lead co-editor of Chronic Wound Care: A Clinical Source Book for Healthcare Professionals (4th edition, 2007, HMP Communications). She currently serves as the clinical editor of the Kestrel Wound Product Source Book. Krasner is also on the editorial boards of WOUNDS, The International Journal of Wound Care and World Wide Wounds. Since 1992 Dr. Krasner has served on the Board of Directors and as an Officer of several national wound care organizations, including The American Academy of Wound Management, The Association for the Advancement of Wound Care and The National Pressure Ulcer Advisory Panel. Dr. Krasner’s research interests include wound pain, palliative wound care and legal issues related to wound care. She has numerous publications in the wound care literature and lectures nationally and internationally on wound & skin care.

Connect with Diane on LinkedIn:

Moderator: Patricia Iyer MSN RN LNCC

Related Article: "Why is Litigation related to Negative Pressure Wound Therapy (NPWT) on the Rise?"

Related article: "Why is Litigation related to Negative Pressure Wound Therapy (NPWT) on the Rise?"
by Diane Krasner

(read full article)

Since the 1990s, wound care took a substantial leap forward. The new device was first marketed in the US by KCI (San Antonio, TX) in 1995 as the V.A.C. Therapy System. It efficiently provided a means to apply negative pressure (sub-atmospheric pressure) via the V.A.C. pump ranging from 50 to 200 mmHg to the wound beds of both acute and chronic wounds (wounds, burns ulcers, flaps and grafts) – thereby promoting wound healing. NPWT is contraindicated in the presence of exposed anastomotic sites, exposed vasculature, exposed nerves, exposed organs, necrotic tissue with eschar present, untreated osteomyelitis, non-enteric and unexplored fistulas, and malignancy in the wound.

Over the past 15 years, NPWT has gained widespread acceptance and use internationally. A number of other NPWT products (6 to date in North America) have been brought to market. NPWT devices improve wound healing through a number of different mechanisms: by improving local blood flow (perfusion, reducing swelling, removing drainage from the wound, and by stimulating scar tissue formation. Patients feel less pain when dressings are changed because NPWT devices make it less necessary to change dressings frequently. By reducing the frequency of dressing changes, the device has been demonstrated to be cost-effective, in spite of the cost of supplies and pump rental costs. In the United States, NPWT is reimbursed by Medicare and Medicaid when ordered by a physician for qualifying wounds. There are over 300 peer-reviewed articles in the literature providing a growing evidence-base for the use of NPWT.

Litigation on the Rise

Why is litigation related to NPWT on the rise? With an increased frequency of use of NPWT for complex and difficult wound management, the chance of adverse events is increased. Additionally, because NPWT devices have very specific and somewhat complicated guidelines for use, there is a steep learning curve (as opposed to simpler wound dressings). With the complexity of use of the device, there is greater potential for user error.

In November 2009, the FDA issued a warning to healthcare professionals about NPWT...(read more)

Related Article: "Hospital Acquired Pressure Ulcers: The Risks"

Related article: "Hospital Acquired Pressure Ulcers: The Risks"
by Patricia Iyer

(read full article)

Litigation over hospital-acquired pressure ulcers represents a significant fraction of a medical malpractice attorney’s case load. We frequently receive requests for nursing experts to review liability issues associated with pressure sores. The issues have shifted since October 1, 2008 when the Centers for Medicare and Medicaid Services and several private payors began denying reimbursement for care related to hospital-acquired stage III and IV pressure sores (defined below). Prior to October 2008, the experts battled over whether a pressure sore was avoidable. Now, they still do, but plaintiff attorneys and their experts can point to the government’s stance that pressure ulcers are avoidable, “never events”. Defense experts must assert that everything possible was done to avoid the ulcer, or it was not really caused by pressure.

What a pressure ulcer is and is not
The National Pressure Ulcer Advisory Panel defines a pressure ulcer as an area of localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. Note this definition allows for tissue damage without skin damage, known as “deep tissue injury”.

Standardized set of definitions to stage an ulcer
These definitions do not apply to tissue or skin damage caused by circulatory changes (arterial or venous), skin tears unless caused by friction or shear, or diabetic wounds. Lesions from herpes, fungal infection, or moisture are also not pressure sores. The battle over ulcers that start in the feet is usually simplified by looking at the location of the wound. Gangrenous toes are usually not caused by pressure. Ulcers on the side of the foot may be caused by prolonged pressure. Ulcers on the heel, which lacks a deep layer of fat, are often due to pressure and failure to elevate the heels off the mattress or apply protective cushioning boots.

(read more)