“Footing the Bill” Printed in McKnight’s – Long-Term Care News & Assisted Living
See on-line at: The November 2008 Issue of McKnight’s Long Term Care News
|By Julie Williamson – November 01, 2008
Roughly 8.6 million Americans over age 60 are diabetic and up to 15% of them developing a diabetic foot ulcer. Knowing these stats, it’s little wonder that managing these wounds has become a major topic for long-term care providers…
Bridging the gaps
… “It’s important to recognize that a diabetic wound is a symptom of a greater problem. While it’s obviously important to manage and heal the wound, it’s imperative that the underlying cause of that wound is properly and consistently addressed,” says geriatrician Jamehl Demons, MD, assistant professor, department of internal medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC. The medical center notably is home to the J. Paul Sticht Center on Aging…
An inside-out approach
…“The goal is to prevent future damage, minimize current damage, ensure maximum function, improve quality of life and prevent or delay amputation. And to do this, you need a team approach,” says Allys Ansah-Arkorful, RN, a wound care nurse at Shervier Nursing Care Center, a long-term care facility associated with Bon Secours New York Health System, Riverdale, NY.
Teamwork is key
The ideal scenario? Consistent collaboration among physician, certified wound specialist, educator, frontline caregivers, nutritionist, physical and occupational therapists, dietitian, consultant pharmacist, PODIATRIST, and vascular specialist, experts agree…Ongoing education is also key to ensuring that staff are well-versed on proper protocol for diabetic residents, and are following proven diabetic care and wound prevention and management practices. Such practices include thorough daily skin assessment, proper off-loading, repositioning and debridement, proactive blood sugar and edema management, limb revascularization, and proper use of accepted skin and wound care products, among other approaches.
“One of the biggest challenges that must be addressed relates to debridement…He explained that proper debridement requires total removal of necrotic tissue. Calluses, which some caregivers mistakenly believe protect the skin, must also be removed.
“Many times, there’s an abscess underneath. The sooner we debride that thickened skin the sooner we can address the wound and reduce the risk for additional complications.”
Failure to identify onset of infection, which can be subtle in a diabetic, is another relatively common mistake…
A step in the right direction
Having diabetics’ feet examined by a PODIATRIST at least annually and, ideally, every six months, and encouraging the use of proper-fitting footwear also play key roles in wound prevention. Shoes should be wide enough and feature a generously sized toe box to prevent tugging and friction…“I can’t stress enough the importance of proper footwear. It’s one of the factors that can have the biggest impact, yet it’s also one that is most frequently overlooked,” says Steven Tillett, DPM, a podiatric expert for the American Podiatric Medical Association. “The right footwear may not heal a wound, but it sure can go a long way toward preventing it.”
* Dr. Steve Tillett, 6327-B S.W. Capitol Highway; 503-246-2212
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