When a patient presents with a wound, it is not surprising that the first field of focus is the wound itself. Assessing the wound indicates to the wound care professional what the wound condition is, whether it is chronic or the result of a recent injury, related to surgery, if infected and at what level, possible co-morbidities, and much more. The second field of focus is the computer screen to chart the course of treatment so the wound healing can begin.

All this can be achieved without ever looking beyond the wound or the chart. But limiting the focus and not including the patient’s complete condition is a mistake that can significantly delay wound healing. The injury from a wound goes far beyond the wound’s perimeter.

A study of outpatients in wound care clinics found 81 percent [1] of its patients tested positive for depression. Further, it found depression common in patients with wounds, especially those with wounds lasting more than 90 days[2].

“The visibility of the wound creates a negative self-image because much of our self-image is based on external appearance and is a reminder to the patient that they may no longer look like most other people, “said Tim Paine, physical therapist with Litchfield Hills Orthopedic Associates, Torrington, CT.

Chronic wounds are stressful for a patient. As a long term condition requiring ongoing care and medical attention, these individuals are often removed from their life’s routine, limited in mobility, and isolated from family and friends. It can result in depression and stress, especially in older individuals. [3]

“Healing a chronic wound takes a long time, and requires constant attention to help the healing process, and it is very common for the patient to become emotionally and physically fatigued, which often results in depression and loss of motivation. This in turn prolongs the healing process. This cycle of emotional fatigue, physical fatigue and change in self-image results in a cycle of slowed healing and loss of motivation,” Paine added.

Surgical wounds are likely representative of a co-morbidity meaning the patient is concerned not only with the healing of wounds at a surgical site but also the primary cause and disorder for which the surgery was indicated.[4]

The most common site for slower healing wounds are on the feet and lower legs.[5] Studies indicate patients with lower extremity wounds when combined with stress are 25 percent slower to heal than those patients in a healthy mental state.[6]

Pain associated with wounds can be severe, if left unmanaged. As healing begins, pain and itching can cause sleeplessness impacting emotions, energy and motivation – including motivation to heal.[7]

Mental health is among the leading causes of disability around the world [8],with depression and stress highly prevalent in those with wounds. And once a patient’s wound is considered healed, it is estimated that 12 percent [9] of those patients will have some sort of psychological impact from the experience.

It is long recognized that collaborative care improves wound healing when it includes nutrition, physical therapy, and other specialties.[10] Integrating mental and emotional health assessments in the initial stages of wound care and treatment has been shown to decrease healing time.[11] While mental and emotional health conditions are harder to detect, early intervention can help a wound care patient begin to adjust to potential long term life changes, work through acceptance and avoid withdrawal which may lead to deepening depression.[12]

Mental and emotional health may be overlooked as part of the collaborative care model. As wound care professionals, there is an opportunity to be aware and alert to potential injury beyond the site of the wound. Watch for hard to detect symptoms of emotional and mental suffering, and add to the care team appropriate care givers to treat the patient’s mind while the wound heals.

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The AAWC’s regional WIS meetings are well known by members and others in the wound care world as the Wound Infection Summits. However, the WIS acronym could just as easily stand for Where Information Starts. It is at the WIS meetings where key learnings, new findings, and bold treatment plans are shared and become the renewed start in advancing wound care.

The next WIS is August 16-17^th in Detroit. The two day meeting is overflowing with programs designed to engage those in attendance to individually and collectively advance wound care. Through a series of lectures, panels, and interactive discussions, those attending will learn about:

• bacteria and biofilms,
• special needs of those with wounds resulting from IV drug use,
• use of oxygen in hyperbaric chambers for wound care and therapy,
• impact of nutrition in wound care and treatment, and
• the application of advances in research on biofilms, topical antiseptics, swab cultures and planktonic bacteria to clinical practice.

Meeting attendees are encouraged to submit case studies for use in the “Making the Diagnosis” session where participants will engage with a multi-disciplinary panel to examine case-based differential diagnoses, identify gaps in assessment and discuss diagnosis and the complexity of wound infections.

“The AAWC is able to attract some of the most well-known names in wound care’” said Victoria Elliott, R.Ph., MBA, CAE, and AAWC Chief Executive Officer. “As the foremost recognized multidisciplinary organization in wound care, we find there is great interest in becoming part of the WIS faculty."

The speakers and panel leaders include nurses, doctors, physical therapists and other professionals in various categories of wound care. Among them are Thomas E. Serena MD, Garth James PhD, Claudiu Georgescu MD, Barbara Pieper MD, Jennifer Gaddy MD, Jennifer Hurlow, Greg Bohn MD, Lindsay Kalan PhD, Randy Wolcott MD, Frank Aviles PT, Karen Bauer DNP, Kara Couch CRNP, Jeff Shook DPM, and Munier Nazzal MD.

“The varied professions of the faculty represent the AAWC’s professional membership roster,” said Ms. Elliott. “Further, it is reflective of the collaborative disciplines brought together in teams to treat patients with wounds.”

Among the most anticipated event of the August WIS is a segment entitled “The Patient Experience.” Those in attendance will hear from a patient who has experienced a chronic wound that became even more complicated by infection. Facing the specter of amputation, the individual will share a story of personal bravery, bold treatment plans, a willingness to consider new therapies, comprehensive and collaborative care, and ultimately, the happy new beginning.

“This is an exciting addition for the AAWC Summits,” said Ms. Elliott. “To hear about the personal and successful journey of an individual who has benefited from the help of wound care professionals is a defining moment for those on the front lines of patient care. This story is the personification of how we advance wound care.”

Registration is open for this Wound Infection Summit, and the one to follow in Kansas City. Additional details about the program, the schedule of events, and the travel and lodging information can be found at www.aawcsummits.com

Continuing education credit is available for nurses and physicians through Amedco, LLC. AAWC.  This activity has been submitted to the Board of Texas Physical Therapy for approval of credits.

As the largest member based multi-disciplinary organization dedicated to the prevention and management of patients with and at risk for wounds, it is THE AAWC’S responsibility to draw attention to issues that IMPACT clinical practice and PATIENT CARE.  One such recent topic concerns terms used to describe skin breakdown that appears to coincide with impending death: the Kennedy Terminal Ulcer (KTU), acute skin failure, Skin Changes At Life’s End (SCALE) and Trombley-Brennan terminal tissue (TB-TTI).  First proposed and described in 1983, the KTU was introduced as a subset of pressure ulcers that a patient may develop as they were nearing death.  These were characterized by shape (pear, butterfly or horseshoe), edges (irregular), and color (red, yellow or black).  The KTU may initially be an abrasion, black or darkened area that then rapidly deteriorates into a Stage II, III or IV or unstageable pressure ulcer.  This concept has sparked much interest and debate, including validity of the concept, further descriptions of the event, and case reports.  In a recent scoping review of the concept, Latimer et al (2019) identified a need for further research to deepen understanding of the phenomenon which could then inform practice.  Similarly, Ayello et al (2019) reported a review of literature on the concepts pertaining to pressure ulcers in patients at end of life.  In this report the authors acknowledge that there exists a gap in Understanding of the pathophysiology of changes that occur in the skin as a patient is dying. 

Opinions abound on the merit and validity of KTU, SCALE and TB-TTI and skin failure.  These opinions and debates are beneficial to the discussion because they add perspective and challenge us in the way we think about these conditions in terms of biologic plausibility, defining characteristics, AMONG OTHERS. 

Thus far, the level of evidence that exists to substantiate or refine these phenomenon and terms is largely composed of expert opinion, case reports, and descriptive studies.  This is to be expected with new concepts (and yes 30 years for a relatively rare event, is still legitimately considered a “new” concept).  As the body of descriptive evidence grows, more sophisticated methods of research can be designed and conducted to validate and refine the terminology and thus move the science to a more objectively identified condition. 

However, there is also an expressed desire to agree on definitions and terms concerning skin failure and skin changes at end of life (Ayello et al, 2019).   Recently, an editorial by Schank (2019) hypothesized there may be a plan or steps being put into place to eliminate the terms such as KTU or SCALE.   The state of the existing science concerning the KTU or end of life skin changes phenomenon need a more objective and rigorous scientific process through which to advance what is known before terms can be dismissed or consolidated.

Traditionally the strategy that has been employed to advance policy concerning pressure ulcers has been the use of consensus conferences sometimes in a fully transparent process, sometimes not so much. This is a valid and appropriate methodology for rare conditions when the decision-making participants in the audience are experts with that rare event. Another scholarly approach is to use a process known as a concept analysis to compile what is known about a new condition or phenomenon and, through the rigor of the analysis, explore the utility, practicality, precision and appropriateness of that term.

It behooves all of us to be aware of the issues surrounding ulcers that may masquerade as pressure: the KTU, SCALE, TB-TTI and skin failure. The articles cited in this blog provide a succinct history of the evolution of these terms.  As the multidisciplinary membership of healthcare professionals interested in wound care, attention to these terms and these phenomena is critical so that we are prepared to engage and influence patient care, public policy and professional practice in a responsible, scholarly process that is informed by science, not opinion.

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References:

1. Understanding the Kennedy Terminal Ulcer. http://kennedyterminalulcer.com/  Last accessed 6/15/19.
2. Latimer S, Shaw J, Hunt T, Mackrell K, & Gillespie BM (2019). Kennedy Terminal Ulcers: A scoping review. J Hospital and Palliative Nursing. doi: 10.1097/NJH.000 000 000 000 0563.
3. Ayello EA, Levine JM, Langemo D., Kennedy-Evans KL, Brennan MR., & Sibbald RG (2019).  Reexamining the literature on terminal ulcers, SCALE, skin failure, and unavoidable pressure injuries. Advances in Skin & Wound Care 32(3): 109-121.  www.woundcarjournal.com
4. Schank JE (2019). Special Report: Terminating the Kennedy Terminal Ulcer? Wound Management & Prevention (formerly Ostomy-Wound Management); 65(4). ISSN 2640-5245  http://www.o-wm.com/article/terminating-kennedy-terminal-ulcer

There is a difference between having a certificate and being certified. Having a certificate means that an individual has completed required courses of learning in a particular area. Being certified means that an individual has the specific knowledge and skills required to perform successfully in a particular role. Certification in health care originated from the specialty organizations in the field, with the purpose of conferring upon their members public recognition of having met these criteria of knowledge and required skills. Certifications of value have historically been those that are supported or endorsed by the specialty organization in the field.

In the healthcare field, being certified and maintaining certification is more often than not an essential requirement to remaining in a job. Standards of care evolve based on research findings and practical experience, and keeping current on best in class practices makes a difference in patient outcomes. Maintaining certification provides independent verification of certain levels of expertise and on the job capabilities.

In wound care, there are numerous certifications which can be earned, and members of the AAWC represent virtually all of them. Once earned, certifications are valid for varying periods of time and may last up to a decade before re-certification is required.

While some employers pay for an employee to maintain certification, it is increasingly a cost line axed by tightening budgets leaving an individual to cover the costs independently. Until now, there has been no alternative to the high cost of maintaining certifications.

The American Board of Wound Healing has recently offered a special opportunity to AAWC membership to grandfather existing certifications at no cost. Modeled after other American Board of Medical Specialties organizations, the ABWH is an example of a professional society that supports and endorses a certification in wound care. Further, ABWH does not charge annual maintenance fees to its certificate holders.
 
“This opportunity offers a significant savings to the AAWC membership,” said Victoria Elliott, R.Ph., MBA, CAE and Chief Executive Officer, AAWC. “We are grateful to ABWH for recognizing the depth of capabilities of our membership and its willingness to support the certification process in this way.”

Savings to the AAWC membership will vary according to the certifications held. For those with multiple certifications, the accumulating costs are significant. For example, an individual with a certificate valid for 10 years paying an annual maintenance fee of $150 will pay $1,500 for the duration of the certification. At expiration, additional fees are required to complete reexaminations to maintain certification and once renewal is earned, the maintenance fees continue unabated.

With the offer from ABWH, through November 2019 all AAWC members may apply for a conferment of their existing certification(s) to the equivalent ABWH certification. On completion of a satisfactory review by the ABWH Board, the comparable certification(s) will be issued. The ABWH does not charge an annual maintenance fee. Successful applicants must maintain AAWC membership for the duration of the certification period. Re-certification requirements as outlined with each exam category will apply.

“ABWH recognizes the high degree of expertise represented by the AAWC membership,” said Greg Bohn, MD and President, American Board of Wound Healing. “We are pleased to make this offer to them.”

The process for AAWC members to take advantage of this opportunity is as follows. An applicant would identify the appropriate category for certification and submit the required documentation as indicated in the application. In addition, the Applicant would provide ABWH with:

• Current certification, including dates of expiration
• Documentation of current AAWC membership
• A complete application with required information supporting the certification requested

After review and confirmation by ABWH leadership, comparable certification will be issued. A copy of the certificate can be provided on request and for a small fee. ABWH will advise the AAWC about which members have become certified and the expiration date of the certification. To qualify for certification conferment, applicants must maintain continuous membership in AAWC and comply with re-certification requirements as outlined with each exam category. 

More information can be obtained by visiting https://abwh.net/recertification/.

A simple search of professional medical and healthcare organizations reveals thousands of options for medical professionals. Without looking at the remainder of the alphabet, there are hundreds beginning with the letter A: American this, Academy that, Association of – it is an almost endless list and presents myriad choices for those in the medical and healthcare communities.

Professional organizations are the members’ sources for industry trends, legislative updates, connections of clinical practices with advancing research, and peer-to-peer relationships, among other benefits. But membership alone is not sufficient. Studies on member value show membership becomes meaningful only when individuals feel engaged and attached with the organization.

Being active and informed, developing relationships with other professionals while advancing the organization’s mission, is the difference between being a member of something versus being a part of something. The Association for the Advancement of Wound Care offers many opportunities to enhance membership and make it matter.

“We are what our members make us,” said Victoria Elliott, R.Ph., MBA, CAE, & AAWC Chief Executive Officer. “It is through member engagement and participation that the AAWC drives its vision to advance wound care worldwide. We rely on the volunteers to support the three strategic pillars of Education, Policy and Research.”

The AAWC has a class of 150 volunteers engaged throughout the year on many important issues and programs that membership at large has defined as key to their profession. Volunteers are the ones who serve as conference planners and speakers, facilitators, moderators and program reviewers. Content creators develop newsletter articles, blogs, social media posts and other content for various communications platforms. Those involved in policy matters develop letters and position papers, write platform materials, and visit with elected state and federal officials. In the area of awards and scholarships, volunteers work to define appropriate honors, review submissions and requests, and select recipients.

Recent achievements of AAWC volunteers include successful focused-topic regional summits, and advancing policy considerations in Washington, D.C. by giving voice to the need for increased prevention of pressure ulcers for our nation’s veterans. Educational programs have improved with expanded and participatory Journal Clubs featuring AAWC volunteer faculty, linking new research findings from the lab with the practice in clinical settings.

Volunteers report having a greater sense of community in the wound care profession and a deeper connection with their peers across all disciplines of care. “I was unsure whether I really had anything to contribute,” said one volunteer. “I was new to the AAWC and fairly new in my job, and was intimidated by the experience of others. But by becoming involved in a committee for one of the Summits, I was able to build my skills and develop a greater sense of confidence.”

There are currently a variety of education, content creation and committee volunteer positions available to members. For more information, go to https://aawconline.memberclicks.net/volunteer-opportunities.

“This is how to make membership matter,” said Victoria Elliott. “Get involved, make a difference for yourself, for others and for the AAWC.”

There are thousands of medical professional conferences each year around the world. The cost to host and attend professional conferences continues to increase while organizations are decreasing budgets allocated for attending. Then there is a notion that the internet and social media platforms make conference information and contacts available without ever leaving the office.

Historically, success is evidenced when meetings draw crowds, sponsors and exhibitors quantify a positive return on their investment, and the content is graded as informative by attendees. But success can also breed complacency with the temptation to re-bake the same successful recipe year after year. That is a mistake.

In 2019, the AAWC began offering regional education summits. The model offers science-based deep dives into specific topics crucial to advancing wound care. At the same time, the model is responsive to reduced budgets and enables members to travel shorter distances. On the other hand, the content of each summit draws global expertise to bring best in class research and care direct to those involved in the day-to-day ministrations of wound care. The increased intimacy of the regional meetings improves face-to-face interaction and connection so it is possible to actually meet with all those on a target list.

For example, the AAWC continues to host one annual Pressure Ulcer Summit (PrU) drawing attendees from across the globe. This topic is one of daily challenge to wound care providers and staying in front of current research is crucial. The Summit is designed to be collaborative, evidence-based, interactive, scientific, open and cutting edge. One attendee reported it to be, “a learning bonanza.” Ninety-eight (98%) percent of attendees said they were satisfied or highly satisfied with the multi-disciplinary approach to wound care and 94% said the PrU Summit exceeded their expectations.

In 2019 the AAWC will be host to multiple Wound Infection Summits (WIS, pronounced WISE) and the feedback about those held to date underscore the content and operational model are highly successful. With 94% reporting WIS to be scientifically sound and 92% reporting it helpful in practice and treatment strategies. One attendee said it was, “concise, relatable, and comprehensible.” Another described it as “exciting, collaborative, cutting-edge information.”

Conversely, AAWC members report different experiences with a recent national conference. One found the agenda to be virtually identical to offerings of prior years with the same topics for the educational tracks and even some repeat speakers. One said she will have a hard time selling through to her employer a compelling reason to attend again.

As the AAWC’s national and global presence expands, its influence for advancing wound care makes the AAWC’s leadership coveted partners at meetings hosted by others. This year, the AAWC has been invited to develop multidisciplinary wound care educational tracks for several prominent national meetings including DFCon, focusing on diabetic foot wounds, Desert Foot focusing on limb salvage, and the C3 Summit focused on collaboration among cardiovascular disciplines necessary to successfully manage complex coronary, carotid, and peripheral arterial disease. As an international partner to the European Wound Management Association (EWMA), the AAWC will participate in their global Summit in June.

While AAWC is likely to host national meetings in the future, it will do so with an eye toward assuring attendees find it fresh, scientific, medically practical, collaborative and interactive. However, for 2019 the bold move to shake up its conference model has proven smart. The following is the schedule for the remaining 2019 AAWC conferences. We hope to see you there.

AAWC Regional Wound Infection Summit

Detroit	Kansas City
August 16-17, 2019 Detroit, Michigan	October 5-6, 2019 Kansas City, MO

AAWC Regional Lower Extremity Summit
November 1-2, 2019
Sacramento, CA

Also look for AAWC Featured Tracks at these meetings:
Special AAWC Member Rates will apply!

***Log in to the Members Only section of the AAWC website to obtain Member Discount Codes***

Complex Cardiovascular Catheter Therapeutics: Advanced Endovascular and Coronary Intervention Global Summit (C3)
June 23-26, Orlando, FL
AAWC Members save 15% on registration!
http://www.c3conference.net/Main/Conference-Registration

DFCon – Diabetic Foot Global Conference
October 17-19, Los Angeles, CA
AAWC Members save 15% on registration!
http://dfcon.com/

Desert Foot
December 4-7, Phoenix, AZ
AAWC Members pay only $99!
https://www.desertfoot.org/

There is knowledge in numbers – even small ones and the AAWC is making sure that wound care clinicians from facilities large and small can take part in AAWC’s valuable programming.

Most AAWC members work in institutional or clinic settings of varying sizes. Regardless of size and budget, it is important that all the wound care clinicians have access to education and resources needed to provide the best in class patient care. That is why the AAWC has established a Group Membership option. The two-tiered program enables either up to four or up to eight employees from one facility to engage with member activities and receive member benefits such as the newsletter, Journal Club and member rates on AAWC Regional Summits. As a group membership, it is interchangeable among employees. If an employee were to leave that facility, another can be added at no additional charge for the duration of that membership year.

“The knowledge transfer accruing from AAWC membership is unique, valuable in routine wound care practice, and essential to advancing wound care worldwide,” said Victoria Elliott, AAWC Chief Executive Officer. “A group membership option allowing for individual interchange means that anyone from that institution or clinic can participate in a program and bring the knowledge back to be shared among colleagues. Otherwise, if the one member was unavailable for a program, the facility might miss out on the knowledge shared.”

The costs for the group membership are $480 for up to four employees and $959 for up to eight employees. Those facilities with more than eight can receive a discounted membership of $95 for each additional member, a $20 savings over individual AAWC membership. The membership for all individuals in the group option would begin and then renew at the same time.

To learn more about a group facility membership option, please contact Lyn Donze, [email protected] or visit https://aawconline.memberclicks.net/about-membership.

When Florence Nightingale began nursing patients in the mid 1800’s, she was joined by a team of fewer than 40 women all of whom she had trained herself. Credited with establishing the nursing profession, the seed she planted has grown exponentially across many specialty care areas. Today it is estimated that there are about 29 million nurses across the globe, with nearly four million in the US alone.

International Nurses Week from May 6-12^th is dedicated to honoring those men and women who put their patients first with International Nurses Day May 12^th, Florence Nightingale’s birthday.

Nurses are caregivers, scientists, technical specialists, ministers and healers who work with their heads, hands and hearts – and they do it 24/7/365. They are special people with skills extending far beyond bedpans and blood pressure cuffs. In the course of a shift, a nurse is responsible for administering medications and managing IVs as well as observing and monitoring patients’ conditions, maintaining electronic and traditional records, and communicating with doctors, patients and patients’ families. They are the first line in the fight for healing and total health.

Wound care nurses bring specific skills to the bedside. They are responsible to assess and evaluate a patient’s complete condition and then assess and evaluate acute and chronic wounds, obtain cultures, evaluate how other presenting illnesses impact the wound. They initiate the care to manage the wound, coordinate with other caregivers, and educate and counsel the patients and their families on wound care and self-management of the wound.

Florence Nightingale’s initial nursing assignment along with her team was to provide wound care to British soldiers injured in combat during the Crimean War. She described it as the most challenging of her life. Working in horrific conditions, she treated wounds while working to improving sanitary conditions, food and nutritional needs, and establishing a library to stimulate intellect.  

It is the model of modern day nursing to treat the whole patient with nurses ministering to the mind, body and spirit of patients and their loved ones. The nursing profession continues to evolve as all nurses, including those in wound care, work to advance and improve patient care. AAWC salutes all nurses for their selfless service to their patients.

In the May 2019 Journal Club webinar, Kara Couch, MS, CRNP, CWCN-AP, Director of Inpatient Wound Care at the George Washington Hospital, will examine the Hypertensive Ischemic Leg Ulcer, also known as Martorell’s ulcer.  This is an atypical lower extremity ulcer that is likely underdiagnosed as some of its clinical features closely mimic other atypicals such as calciphylaxis and pyoderma gangrenosum.  Couch will review the pathophysiology of the Martorell's ulcer, discuss its prevalence and explain the appropriate workup and treatment options.

One of the distinguishing characteristics of Martorell’s is excruciating pain. Using a recent patient case, Ms. Couch will be joined by her patient to give both the provider and patient perspective in managing this rapidly progressive and extremely painful ulcer. In this particular case, the patient also has an unusual co-morbid condition called Liddle’s syndrome which will also be discussed.

AAWC’s monthly Journal Club is free to members. The next journal club is May 8 from 1:00 to 2:00 p.m. Eastern. CLICK HERE to sign up today!

As Jennifer Hurlow, GNP, CWOCN, highlighted in the February Journal Club Presentation “Diabetic Foot Infection: A Critical Complication,” the science is there, but clinical practice – often – is not. Evidence suggests that approaches to treatment for chronic wounds that incorporate biofilm research, like Biofilm Based Wound Care (BWCC) can lead to significant increases in the efficacy of treatment of chronic wounds, but most traditional diagnosis and treatment methodologies overlook the importance of biofilm in wound healing. So how can YOU help make the transition and bring more of these evidence-based practices into the wound care community?

Read Up. For a start, AAWC members can review the recorded webinar and hear about some of this research from Jennifer, first hand, by logging into AAWConline.org. Or, the article was originally published by the International Wound Journal and you can access the full text there with a subscription.  Equip yourself with a thorough understanding of the research so you and your teams can better use it to inform your practice.

Join the Conversation at the upcoming Wound Infection Summit Atlanta. Jennifer and several other researchers and clinicians with BWCC expertise will be sharing their insights, practices and tactical approaches as a part of the program. Not only that, the summit includes additional conversation on gaps between scientific research and clinical practice, helping share practices and new ideas across disciplines. Learn more and register today for the WIS Atlanta!

Reach out. Who are the fellow healthcare professionals you interact with regularly in your community that you “only wish more fully understood and appreciated the great information that is available”? Invite them to membership and engagement with the AAWC. The more diverse healthcare providers are included in this multi-disciplinary wound care community, the better the results… if you’re not already a member, join today and invite those you work with to join!

On Wednesday, March 13, the Association for the Advancement of Wound Care (AAWC) President-elect Ruth Bryant, PhD, RN, CWOCN, met with a number of House and Senate offices on Capitol Hill to educate lawmakers on the need for increased prevention of pressure ulcers for our nation’s veterans. Dr. Bryant was joined by Martin Burns, CEO of Bruin Biometrics, and representatives from Arnold & Porter specializing in health care policy.

Congress is now developing the appropriations bills that will fund the federal government’s departments and programs in the 2020 fiscal year. BBI and AAWC met with House and Senate offices to discuss the need for increased funding for research on pressure ulcer prevention at the Veterans Hospital Administration (VHA), particularly with high risk populations such as veterans with spinal cord injuries, and BBI’s interest in developing a pilot program for the VHA using SEM Scanner technology*. Veterans treated in Veterans Health Administration (VHA) hospitals are 52% more likely to develop a pressure ulcer than patients in civilian hospitals. It costs the VHA between $20,900 and $151,700 to treat each individual pressure ulcer, totaling an estimated $1.3 to $3.6 billion in costs annually. Dr. Bryant discussed the importance of finding new approaches that could allow the VHA to save resources and ensure the highest quality of care for veterans.

The group met with the staff of the following members of Congress:

•    Rep. Sanford Bishop (D-GA)
•    Rep. Doug Collins (R-GA)
•    Rep. Tom Emmer (R-MN)
•    Rep. Chellie Pingree (D-ME)
•    Rep. Martha Roby (R-AL)
•    Rep. Rob Woodall (R-GA)
•    Sen. Susan Collins (R-ME)
•    Sen. Dianne Feinstein (D-CA)
•    Sen. Marco Rubio (R-FL)

The group also discussed the unique challenges facing the VHA in addressing pressure ulcers with staff members of the House and Senate Appropriations Committees, which are tasked with crafting the legislation that is ultimately approved by Congress. The day was highlighted by a meeting with Representative Debbie Wasserman Schultz (D-FL), who serves as Chairwoman of the House Appropriations Committee’s Subcommittee on Military Construction, Veterans’ Affairs, and Related Agencies, which oversees the Department of Veterans Affairs. Rep. Wasserman Schultz has been supportive of efforts to combat the threat of pressure ulcers in the past, and expressed interest in BBI’s pilot program proposal.

Throughout the day, Dr. Bryant provided valuable insight into the challenges of identifying and treating pressure ulcers, and the harm they cause to patients. Her perspective as an expert on the subject provided valuable information for Congressional staff, who have been concerned about higher pressure ulcer rates at the VA. Dr. Bryant’s efforts ensured that Congressional leaders are aware of new developments in the science and technology to alleviate the burden of pressure ulcers, setting a strong base for progress on this issue down the road. The AAWC is committed to continuing to work with Congress to improve the identification and care of patients with pressure ulcers and to improve prevention strategies for those at risk.


* Bruin Biometrics (BBI) is a medical device company that has developed innovative technology called the “SEM Scanner,” for early detection and prevention of pressure ulcers. The hand-held, portable wound assessment device can alert caregivers and providers to increased risk 5 days (median) before ulceration or visual signs of skin damage. The SEM Scanner, currently deployed across the UK and Canada, has seen success in reducing facility-acquired pressure ulcers (FAPUs). The SEM Scanner has been used in Europe since 2014 to prevent pressure ulcers, with up to 100% reductions in PU incidents across all care settings. In December of this past year, the U.S. Food and Drug Administration granted marketing authorization for the SEM Scanner, as an adjunct to the standard of care when assessing patients in the U.S. who are at increased risk for pressure ulcers. BBI is interested in partnering with the VA to pilot the technology.

AAWC walks a careful line toward assuring balance for members. Policies have long been in place to prevent organizational endorsements of any businesses or corporations or products associated with wound care. Additional policies assure the AAWC leadership does not benefit financially from relationships with wound care businesses. The AAWC expects and offers transparency, and holds both leadership and membership accountable.

And yet at all Summits, there is an exhibition hall of sponsors members and summit attendees are asked to visit. The sponsors are there because they have been invited by the AAWC or they have asked and paid the AAWC to participate. It may seem a violation of the organization’s very tenets. But it isn’t and here is why.

On the front lines of wound care in clinical settings across the country and around the world, members need the very best tools available to successfully treat patients under care. It is not possible for individuals or even individual institutions to remain on the cutting edge of all things new in wound care. Having developers and manufacturers of tools, treatments, practices, and devices willing to participate in a Summit helps advance wound care. It enables care providers to do what they do best, confident in the knowledge they have what is new and best.

Removing vendors as sponsors and exhibitors would limit the potential of providing best in class care for patients in need of healing. These opportunities for engagement one-on-one with those most familiar with innovative healing tools are crucial to advance wound care. AAWC Summit attendees and all members can trust that policies prevent inappropriate relationships and can use the time to learn how the newest options can help in the clinic.

At a White House dinner for Nobel Prize recipients, President Kennedy said, “I think this is the most extraordinary collection of talent, of human knowledge, that has ever been gathered at the White House - with the possible exception of when Thomas Jefferson dined alone.”
A more than appropriate reference to President Jefferson, a man who was a statesman, a visionary, an inventor, an educator, a lawyer, a farmer – and many other things.

And on April 26-27th at the AAWC Wound Infection Summit, the same concept is likely to apply. On those days in Atlanta, some of the brightest minds and advanced care givers in wound care will gather to share expertise on a range of topics as vast as Mr. Jefferson’s accomplishments.
It is there when attendees will learn about the cost of wound care, the gaps in research and practice, how to bring research to the bedside, various approaches to wound care, how radiology is used in wound care, the impact of topical treatments on wounds, and the necessity of a systemic approach to wound treatment, among many other topics.

Like the Nobel recipients listening to Mr. Kennedy, the Summit attendees will hear from those most connected with advancing these matters in a practical environment. Registration is open at WoundInfectionSummit.com. Don’t miss your chance to join the best thinkers and practitioners in wound care.

In coming weeks, the AAWC will share speaker highlights and new research findings of the Wound Infection Summit – Atlanta. Stay tuned!

The principle of stewardship centers on an individual’s responsibility to use resources in a responsible manner. In medicine the emergence of resistant organisms has given rise to the concept of antibiotic stewardship.

Initial efforts, focused primarily on inpatient antibiotic use, led to the development of hospital stewardship committees monitoring patterns of resistance and antibiotic utilization.  But what about outpatient wound care centers? Antibiotic and antiseptic use follows no prescribed guidelines and varies drastically between centers.

Recent evidence suggests patients on antibiotics heal faster. However, in the absence of reliable diagnostic tools and the inaccuracy of clinical examination in making the diagnosis of infection in chronic wounds, clinicians prescribe antiseptics and antibiotics in a random fashion.

The AAWC Wound Infection Summit will face head on antibiotic stewardship in the wound center, presenting evidence and suggesting practical approaches. Join us in Atlanta April 26th and 27th to become a better steward. Click here to learn more or to register for the Wound Infection Summit – Atlanta.

When it comes to treating wounds and providing best in class care for patients with wounds, none can go it alone. And with the numerous and different medical professionals typically involved in the care of any one individual, unique perspectives come to the bedside to develop a comprehensive treatment plan. Best outcomes result from cross-professional collaboration.

This is one of the many reasons why the AAWC Summits are crucial to advancing wound care. Those attending find an emphasis on audience interaction during the educational sessions, in the exhibit halls, and at the breaks. Speaker presentations are interesting and professional, engaging with the audience, sharing their experiences, and inviting the audience to do the same.

Professionals in all segments and levels of wound care gather to think, to listen, to share, to learn. A recent AAWC Summit focused on care and treatment of pressure ulcers. There was increased attendance from the previous year, with feedback indicating nearly all respondents found the sessions met or exceeded their expectations. Participant evaluations referred to the meeting as “thought provoking”, “interactive”, “evidence-based”, “cutting edge”, “relevant” and “practical”.

Among the most well-received program elements was the newly included patient success stories. Several patients benefiting from wound care specialists shared the challenges and triumphs of their wound healing journeys. In this video, wound care patient Tom Barnard shares his experience with the complications of paraplegia and how the support of a caring wound care clinician and family helped him overcome the associated pressure ulcer challenges.

The AAWC plans four additional regional Summits for 2019: three comprehensive wound infection summits and one lower extremity summit. In addition, the AAWC has been invited to develop a specialty advanced wound care track at the global summit for Complex Cardiovascular Catheter Therapeutics (C3), and others at DFCon 2019 and Desert Foot conferences focusing on wounds to the feet. You may view the full line up of AAWC Summits and Invited Tracks online.

There is no profession which benefits more than medicine from collaboration and sharing best practices and lessons learned. The AAWC Summits create professional forums for these exchanges. Participating is crucial to advancing wound care and advancing our collective roles in improved patient outcomes. February’s Pressure Ulcer Summit reached maximum enrollment and the upcoming summits are sure to fill quickly. Registration for the April Wound Infection Summit is now open. Make plans now to join us! Click here to register.

The classic signs of infection first recorded by Celsus in the first century A.D. (warmth, pain, redness and swelling) fail the wound clinician. Infected chronic wounds do not exhibit the classic signs and symptoms known since antiquity. As a result, clinical examination detects only a percentage of infections. Unseen biofilms mature in the non-healing ulcers open for weeks to months. Scientific research on infection in chronic wounds is expanding rapidly; however, a gap in knowledge exists between the bench and the bedside. 

The AAWC plans to convene three Wound Infection Summits this year focusing on infection in chronic wounds. These inter-professional conferences will examine the scope of the problem, present the latest evidence from the lab to recently completed clinical trials, and provide attendees with practical information that will have an immediate impact on their practices. The meeting format encourages discussion and debate.

Registration is open for the AAWC’s First Wound Infection Summit of 2019 in Atlanta from April 26-27th. Join us to advance the practice of wound care and learn from one another how we can improve our practices on behalf of our patients.

The AAWC welcomed Former Secretary of Health and Human Services director, Tom Price, MD, to the Pressure Ulcer Summit to address whether the problem of pressure ulcers and chronic wounds has finally grabbed Washington’s attention? After speaking with the Secretary and listening to his lecture, it is clear that it has.

In his address, Secretary Price emphasized that politics are all about relationships. If the AAWC wants to influence policy, the AAWC must get to know key elected officials, especially members of their staff. In return, when a matter develops or counsel is needed on a wound related issue, Congress will turn for guidance to the society with whom they are most familiar: The AAWC.

Secretary Price outlined a plan. First, meet your regional representative, preferably in his or her home district. Share success stories about healing patients and the challenges in the wound care profession. Consider what is known in Washington as a “fly-in,” where select AAWC members come together in Washington to educate their congressional representatives on the issues facing the profession and patients. Make the fly-in a regular event. He recommended forging relationships with staffers as well as the legislators themselves. The representatives rely heavily on their staffs and when informed on matters, they can serve as advocates for the AAWC. Finally, keep in mind that if the AAWC is not present in Washington, DC and does not engage and inform Congressional representatives, another organization will fill the void.

To the applause of the members of the eight societies that joined together in support of the Pressure Ulcer Summit, Secretary Price stressed the importance of speaking with one voice. Disagreement between societies, he said, will not be mediated by Congress. On the contrary, they will find a united group and engage with them.

The AAWC must speak with one voice! Our plans for 2019 include engaging as much as Secretary Price recommended. On the ground in DC is are partner organizations willing to help the AAWC approach those on the Hill most influential on matters important in wound care. The AAWC is listening to its membership to bring together with one voice the issues which need to be before Congress. The AAWC is grateful to Secretary Price for recognizing the leadership role the organization plays in the wound care community. We look forward to seeing him and others in DC.

Last week I told you how fortunate I was to attend the AAWC’s 2nd Pressure Ulcer Summit (PrU Summit) in Atlanta. Along with three colleagues and nearly 200 others, we learned about the latest research, thinking, and best in class approaches to the challenges of managing pressure ulcers. Today I wish to share a few of the key learnings I took away from the Summit.
 
Day one of the conference brought a lot of excitement about the topic of pressure ulcers.  In the room were researchers, physical therapists, physicians, surgeons, nurses, nurse practitioners, product specialists, and administrators from across the world.  The first presentation gave us a patient’s perspective on the issue of pressure ulcers. That set the stage for the remainder of the conference.  An important feature of the PrU Summit was learning how to make pressure ulcer prevention and treatment meaningful to the patient and individualizing care plans and treatment modalities. The remainder of the day was filled with research information on pressure-induced tissue damage both at the micro and macro level.  Most compelling was the research on offloading, including important patient considerations when determining how to offload and the choice of an offloading device to best fit the clinical situation.  
 
I also enjoyed being able to spend time with the pharmaceutical and wound care product vendors during the exhibit hours. It is important to nurture positive collaboration with corporate supporters and vendors. These interactions provide a mutual benefit. Companies can learn more about the challenges we face in wound care practice, taking this information to their teams to improve and advance product development in support of clinical practice and patient needs. In turn, these companies provide clinicians with important research and data to help drive evidence-based practice.  
 
Using the detailed research information from Day 1, the second day brought it all to a practical level.  One of my favorite sessions was the Topical and First Line Treatment program with Kelly Jaszarowski, MSN, RN, CNS, ANP, CWOCN & Stephanie Yates, MSN, RN, ANP-BC, CWOCN, which included ample audience participation. It is so good to hear from a room of clinicians what their practice, experience and opinions are, and then to have that conversation brought back to where the evidence is for those interventions. This interactive program also spawned a great conversation on wound cleansing, wound infection and biofilms, providing AAWC President Tom Serena the opportunity to remind attendees there is more to be learned at the Wound Infection Summit planned for April 26-27, 2019 back here in Atlanta.
 
There were many other take home points and practical applications offered including when surgical interventions for pressure ulcers are warranted; post-acute care considerations including choice of facility; the role of the outpatient wound center in navigating the treatment plan; and tips to secure insurance coverage for durable medical equipment. And that is where the information learned and experiences shared during the PrU Summit take us from here.  Participants left armed with new ideas and strategies to apply in their practices when they return to work. The PrU Summit also spawned research ideas to address new treatment and patient care questions that arose from the presentations and conversations. Wound care requires good research and guidelines that enable us to prevent and treat pressure ulcers while individualizing the plan to each patient, our staff, and our institution.  I invite all of us to come together to take a place at the table at future AAWC summits to discuss the questions, challenges, and research surrounding pressure ulcers.

This past weekend I was lucky enough to have my hospital (Reading Hospital, part of Tower Health System) support the attendance of not only myself, but of three additional nurses from my institution at the AAWC Pressure Ulcer (PrU) Summit. Amy, the nursing quality coordinator, Sylvia, a surgical Intensive Care Clinical Nurse Specialist, and Eileen, the medical intensive care unit clinical nurse specialist are NOT wound care specialists.  The vision of our institution is that engaging the entire team will help us drive change that is meaningful, hence my decision to have our team join me at the AAWC PrU Summit.  

My team and I found ourselves in the company of more than 200 clinicians representing institutions across the U.S., including individuals and teams from many practice areas and professional levels. In addition to attending the conference, we also attended the Pre-Summit Workshop titled PrU Prevention Programs: Justify, Quantify, Strategize.  There we heard from an international team that practices in a variety of settings that face challenges very similar to ours in the states. 

One of the greatest things about this conference is that we are not here to complain about the problems of our specialties.  We all know the challenges of patient care and of our practices.  Everyone in the room is here for solutions and to discover what other colleagues are doing that works well.  We learn about how external factors such as regulatory bodies, scientific studies and other published works can augment or hinder our practices.  As a wound care specialist, I was concerned whether my Tower Health colleagues would find the Summit beneficial. My passion for wound, ostomy, and continence care drive my desire to learn more. I should not have worried. Each reported learning something different but applicable from the Summit and agreed they would bring back learnings which would help in their day to day practice areas.  

There is extraordinary value in coming together. In listening to the challenges of others and learning how they have persevered through them and how our contributions and experiences can help others. Joining with researchers, physical therapists, physicians, surgeons, nurses, nurse practitioners, product specialists, and administrators, among others, we continue to drive the ever-changing and ever-improving specialty of wound care. And that is what I appreciated most about this conference.  You don’t know what you don’t know until you know what you don’t know.  

There is more to share about the take-aways from the Summit. Read more in next week’s blog!

Donald Rumsfeld famously said, “There are things we don’t know we don’t know.” From the depths of this ignorance come the most astonishing surprises and devastating disasters. In the wound care world, the unknown dangers lurk in halls of Medicare and in the sprawling, luxuriously appointed offices of private insurance companies.

The unsung heroes of the AAWC Health and Public Policy committee continuously monitor and rapidly respond to the endless policy publications of our bureaucratic overseers. Without their tireless efforts, wound care practitioners would never know the regulations that directly impact them and their patients. Recently, a physician asked me why joining the AAWC was important. I replied, “Among the many things AAWC does is protect your practice from payers and regulators because we don’t know what we don’t know.”

The AAWC has designated Public Policy as one of its three strategic pillars. We focus on the rules and restrictions that hamper our practice. In addition, we are expanding our Public Policy efforts. This month we are meeting with a member of Congress at our Pressure Ulcer Summit to discuss the challenge of pressure ulcers in the United States and the impact they have on cost and outcomes. We are expanding our initiatives to be more proactive rather than simply reactive in our advocacy on regulation and reimbursement. 
 
Strong positions on Public Policy require a committed membership speaking with one voice. Your participation and input help shape that voice and are vital to our success. Join us in protecting patients, ensuring access to care and making wound care a priority in Washington so there will be fewer things we don’t know.