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Gentell, Inc. (www.gentell.com), a leading manufacturer of wound and skin care products has released its first products in a new generation of packaging.  “After testing many designs with nurses and retailers,” says Gentell founder and Executive Vice President, David Navazio, “we learned that our customers want clear identification and product benefits so that they can easily select the correct product under stressful conditions.”

Since its founding in 1994, Gentell has been a leader in Hydrogel, which speeds wound healing by maintaining a moist environment.  “It made sense that our first upgraded package would be Hydrogel,” says Navazio.  “The name, ‘Hydrogel,’ can be clearly read from across the room, and the Hydrogel package and matching cap pick up the identifying blue color of  the Gentell logo.”

Gentell President Fred Brotz notes, “The new packaging is the logical extension of our plan to provide the best possible wound and skin care products at the best prices while manufacturing here in the United States.  Gentell’s new high-speed bottling and labeling lines ensure that our U.S.-based manufacturing plant has a price advantage over our foreign competitors.”

The new Gentell Hydrogel package also includes product benefits that will help retailers sell Gentell Hydrogel.  In addition to the green Aloe Vera symbol, the package notes that Gentell Hydrogel has these attributes:

• Hydrates and protects for 24 hours
• Richer formulation for easier application
• Crystal clear for easier observation

Gentell’s new packaging for its Shield & Protect Anti-Fungal Moisture Barrier Cream is also easy to read from across the room.  In addition to a seal that notes “Non-Sensitizing, Non-Allergenic,” Gentell Shield & Protect Anti-Fungal also promotes three key benefits:

• Shields skin from wetness with Zinc Oxide
• Protects skin with a Dimethicone barrier
• Nourishes skin with Vitamins A&D

“We are very pleased with Shield & Protect,” says David Navazio, “because, while it is thick enough to protect the skin, it will not clog the pores in adult diapers, which is a critical problem for nurses and patients.”

Gentell Hydrogel and Shield & Protect are now available in the new Gentell packaging.  Gentell will release new packaging for many of its other products through 2012.

Gentell is making a statement in Wound Source this year with a full-page letter to the industry near the beginning of the book.

 

It’s hard to miss this stand-out letter in a sea of bottle shots and charts.  Founder David Navazio notes, “We’re not the biggest wound care company, but we’re delivering better results with better technology while helping our customers save money.”  It’s a worthy mission.

Gentell’s ad on page 9 of McKnight’s Long-Term Care showcases our “Total Wound Care Solution” including Advanced Wound Care Products, the Gentell Fastcare Wound Documentation System, sale the Gentell Wound Advisor and our on-site Wound Education Specialists.

I am in and out of long term care facilities every day.  I not only educate providers and nursing staff about product selection and usage, but focus on state survey readiness.  Now days, state surveyors are looking at dressing orders more frequently.  Many state surveyors are now mandated to get wound care certified.

While working out in the field, I observe physician orders written for name brand products all day long. It is good practice to use dressing category names, not brand names.  Otherwise, when writing an order with a specific name brand, you are setting your facility up for a possible medication error.   If a physician is set on a specific brand name product, you can write DAW (dispense as written).  This will avoid any discrepancies.

I have listed the categories below, along with some key points to remember.  The frequency follows Medicare reimbursement guidelines.

DRESSINGS BY CATEGORY

ALGINATES 

Pads and ropes available

Variety of sizes

Derived from seaweed

Designed to absorb and wick away drainage

Autolytic debridement

*MODERATE TO HEAVY EXUDATE, DAILY

COLLAGENS

Pads and particles available

Collagen is a protein that gives strength for the skin

Ideal for stalled wounds

*MINIMAL TO HEAVY EXUDATE, DAILY OR QOD

COMPOSITES

Variety of sizes available

Multifunctional dressing

Bacterial barrier

Primary or a secondary dressing

*MINIMAL TO HEAVY EXUDATE, DAILY OR QOD

CONTACT LAYERS

Variety of sizes available

Thin, non-adherent sheets placed on an open wound bed to protect tissue

Conforms to the shape of the wound

Porous to allow exudate to pass through for absorption by an overlying, secondary dressing

Indicated for infected wounds, donor sites and split-thickness skin grafts

May be used with topical medications

*ONCE A WEEK DRESSING

HYDROCOLLOIDS

Variety of thicknesses, shapes and sizes available

Promotes an optimal moist healing environment

Cost effective, adhesive dressing

Autolytic debridement

*LIGHT TO MODERATE EXUDATE, CHANGE EVERY 3 DAYS

HYDROGELS

Gel, impregnated gauze, strands, and sheet covers available.

Promotes moist healing

*MINIMUM TO MODERATE EXUDATE, DAILY TREATMENT

ANTIMICROBIALS 

Honey, Silver, Cadexomer Iodine, PHMB, Methylene Blue, and Gentian Violet

One or more ingredients may be impregnated into dressings such as: foams, gels, hydrocolloid, sheets, and or alginates.

Can help maintain a moist healing environment, reducing surface bacteria

Autolytic debridement

*DAILY TREATMENT

FILLERS

Wound fillers can consist of non-adherent beads, foams, gels, ointments, pads, pastes, pillows, powders, strands.

They maintain a moist environment, while absorbing exudate

*DAILY, 3 OZ MONTH 

GAUZES

Readily available

Sterile and non-sterile types

With and without an adhesive border

Woven and non-woven gauze dressings

Can be used as a primary or secondary dressing

*DAILY UP TO THREE TIMES A DAY

FOAMS  

Bordered and non-bordered available

Variety of sizes and shapes

Used for moderate to heavily exuding wounds

*MODERATE TO HEAVY EXUDATE, DAILY (HEAVY) OR QOD (MODERATE)

TRANPARENCIES

Variety of sizes available

Promotes a moist wound healing environment

Ideal for minimally draining wounds

*THREE TIMES A WEEK DRESSING

With approximately $20 billion being spent a year on advanced wound care supplies, cost containment is a sought after goal. Long-term care facilities battle cutting costs under one reimbursement system like everyone else, but I assure you this challenge can be simplified, while continuing to bolster quality of care. I have learned that to contain cost, you must use experience, knowledge, and strong project management. So how do we accomplish this? I have broken down a cost containment plan for your long-term care facility. These key points will help you.

What are the goals of your long-term care facility?

• Quality products for your residents
• Resident-centered approach
• Develop a user-friendly formulary for your nursing staff
• Cost-effectiveness of care, while providing continuity of care
• Evidence-based wound dressings per NPUAP guidelines/CMS regulations
• Less labor intensive woundsdressings, while avoiding three plus day dressings
• Enhance wound healing outcomes
• Documentation support to reduce discrepancies
• Wound Care Specialist clinical and educational support
• Medical Director and Provider involvement (F-tag 385 – Physician Monitoring)

Helpful Wound Management Program Tips to Contain Costs

• Keep wound dressing selection simple. I always suggest shopping for one specific vendor. Compare prices, evaluating unit cost, usage, and outcomes of the products.
• What is the vendor’s delivery method? Do they drop ship?
• Do you have the inventory space?
• Select and stock wound dressings from each category (i.e., gauze, hydrocolloid, calcium alginate, silver alginate, collagen, honey, bordered and non-bordered foam, composite, transparent, and bacteriostatic foam). Educate your staff on the wound dressing categories, NOT brand names. Use a simple algorithm, placing it in every treatment record book.
• Does the vendor offer free education for your staff? Is there clinical support? You will not only improve quality of care and enhance wound healing progress, but will also save your facility an abundance of money.
• Is there a free wound care app or EMR system that will track wound healing progress, and produce trend QAPI reports? This is perfect for being prepared when State Surveyors walk in the building.

How Vendors Can Support Long-Term Care Facility Cost Savings

I have been in approximately 1,500 long-term care facilities during my wound care career. I have seen many F-tag citations avoided when utilizing a skin and wound care management program approach. Utilizing a vendor that offers the “whole package” will not only save you thousands of dollars, but bolster quality of care at the same token. Below are some examples of features and services that you may want to look for in selecting a primary vendor for your wound dressings and supplies.

• Wound Documentation and Ordering System (with training and system hardware provided such as a tablet). Having a streamlined wound documentation and supplies ordering system reduces documentation discrepancies.
• Wound Care Education Resources (wound management and product information). Vendor provided wound care reference material and product education helps facilities gain easy access to key treatment and application information for consistency of care delivery.
• On-site Certified Wound Specialist clinical consultants, providing education as needed as well. Education is key to a successful skin and wound care management program.
• Capitation programs for skin and or wound care products, also Part B billing provided. This approach to payment structures saves money and time.
• 2-3 days shipping, and/or stocked products. Many times dressings are written out on orders as a “brand name”. Using dressing category names will reduce citations as well. You will also have dressings readily available.

There are many resources out there to utilize in helping make quality of care five stars. Identifying your facility goals, evaluating your wound care formulary, and using a vendor that covers the full spectrum of your skin care and wound dressing needs will help your long-term care facility contain wound management costs.

A good decision is based on knowledge, not on numbers. – Plato

Moisture Associated Skin Damage is preventable and manageable.  Good incontinence care is also an indicator of quality of care.  State surveyors are now looking more closely at chronic cases of MASD.  Document accordingly.  Use the term “denuded” for macerated skin impairments.  Do not use the term “excoriation” unless there is linear erosion present.  *You have a resident with a colostomy that has partial thickness, denuded skin to the peri stomal area.  You first want to remove the cause. Is the appliance fitting appropriately?  Did the resident gain or lose weight?  A treatment of a calcium alginate, and foam can be used to wick away the moisture.

Every Pressure Ulcer is investigated.  Implementing appropriate treatments, monitoring, and documentation are evaluated.  When a pressure ulcer is found, remove the cause. Friction, moisture, shearing, and pressure are included in the pressure ulcer investigation. *You have a COPD resident who needs the head of the bed up to breathe better.  We know that this is an increased risk of pressure, due to shearing.  Document, and tell the story.  Also, educate your resident and staff.

We can distinguish Moisture Associated Skin Damage from Pressure Ulcers by basic characteristics.  I always teach physicians and nurses to look at LOCATION, SHAPE, and COLOR.  This will help you identify wound types more easily.

Moisture Associated Skin Damage

LOCATION:  Diffusely distributed

COLOR:  Pink or red

DEPTH:  Partial thickness, or blistering

TISSUE:  NO slough or eschar

Pressure Ulcers

LOCATION:  Usually over a bony prominence, or under a medical device/including brief

COLOR:  Red or bluish/purple

DEPTH: Partial or full thickness 

TISSUE:  With or without slough or eschar 

The Gentell Fastcare System proves its success over and over again, to improve your wound care management program.  All data entered generates trend reports to assist you in monitoring and managing your wound care program.

It is imperative that wound documentation is without discrepancies. With long term care under a microscope, auditing documentation is paramount.

Using Gentell’s Fastcare system, eliminates the possibilities of documentation gaps.  By entering weekly assessments/evaluations per F314 compliant, State survey will be more likely to be discrepancy free.  Fastcare wound evaluation templates are HIPPA F314 specific.  It can serve as your documentation safety net.

Remember to document EVERY break in the skin WEEKLY.  Implementing appropriate wound care treatments, along with monitoring, is what State surveyors are looking for. Fastcare delivers the “true” wound healing snapshot in your facility.

National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury

This just in…

FOR IMMEDIATE RELEASE
April 13, 2016

Washington, DC – The term “pressure injury” replaces “pressure ulcer” in the National Pressure Ulcer Advisory Panel Pressure Injury Staging Systemaccording to the NPUAP. The change in terminology more accurately describes pressure injuries to both intact and ulcerated skin. In the previous staging system Stage 1 and Deep Tissue Injury described injured intact skin, while the other stages described open ulcers. This led to confusion because the definitions for each of the stages referred to the injuries as “pressure ulcers”.

In addition to the change in terminology, Arabic numbers are now used in the names of the stages instead of Roman numerals.  The term “suspected” has been removed from the Deep Tissue Injury diagnostic label. Additional pressure injury definitions agreed upon at the meeting included Medical Device Related Pressure Injury and Mucosal Membrane Pressure Injury.

The updated staging definitions were presented at a meeting of over 400 professionals held in Chicago on April 8-9, 2016.   Using a consensus format, Dr. Mikel Gray from the University of Virginia adeptly guided the Staging Task Force and meeting participants to consensus on the updated definitions through an interactive discussion and voting process.  During the meeting, the participants also validated the new terminology using photographs.

Dr. Laura Edsberg from Daemen College in Buffalo, NY and Dr. Joyce Black from the University of Nebraska Medical Center in Omaha served as co-chairs of the Staging Task Force appointed by the NPUAP Board of Directors. Task force members included Margaret Goldberg, MSN, RN, CWOCN from Delray Wound Center, Florida, Laurie McNichol, MSN, RN, CWOCN, CWON-AP, from Cone Health in Greensboro, NC, Lynn Moore, RDN, from Nutrition Systems, Mississippi and Mary Sieggreen, MSN, CNS, NP, CVN, from Detroit Medical Center.

Pressure injuries are staged to indicate the extent of tissue damage. The stages were revised based on questions received by NPUAP from clinicians attempting to diagnose and identify the stage of pressure injuries.  Schematic artwork for each of the stages of pressure injury was also revised and will be available for use at no cost through the NPUAP website in approximately 12-24 hours (http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations/).

The updated staging system includes the following definitions:

Pressure Injury:
A pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.

Stage 1 Pressure Injury: Non-blanchable erythema of intact skin
Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.

Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis
Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel.  This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).

Stage 3 Pressure Injury: Full-thickness skin loss
Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds.  Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Stage 4 Pressure Injury: Full-thickness skin and tissue loss
Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss
Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.  If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e. dry, adherent, intact without erythema or fluctuance) on an ischemic limb or the heel(s) should not be removed.

Deep Tissue Pressure Injury: Persistent non-blanchable deep red, maroon or purple discoloration
Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin.  This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface.  The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Stage 3 or Stage 4). Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic conditions.

Additional pressure injury definitions.

Medical Device Related Pressure Injury:
This describes an etiology.
Medical device related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure injury generally conforms to the pattern or shape of the device. The injury should be staged using the staging system.

Mucosal Membrane Pressure Injury:  Mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury. Due to the anatomy of the tissue these injuries cannot be staged.

More information will be forthcoming on teaching points for the new stages and the rationale for some of the changes in the staging system.

The National Pressure Ulcer Advisory Panel is a multidisciplinary group of experts in pressure injury. The NPUAP serves as the authoritative voice for improved patient outcomes in pressure injury prevention and treatment through public policy, education and research.

Measuring wound exudate has always been a subjective “guess” by the clinician documenting a wound, but identifying the correct amount of exudate is important as it qualifies the type of dressing and frequency of dressing changes that are appropriate in managing the wound. Changes in exudate amount and consistency can also indicate problems such as infection and can slow down or prevent cell proliferation.

Terminology is important in quantifying the amount of exudate/drainage we document in a wound. The simpler, the better: the standard terminology is: “None”, “Light”, “Moderate” or “Heavy.”

Consistency is also important: your facility should be using THE SAME terminology when documenting exudate.

How to accurately define wound exudate with a visual inspection

“Light” Exudate

Less than 5cc of wound fluid within a 24 hr period
Front and back of Gentell’s Waterproof 4×4 foam dressing

5cc = 1 teaspoon

“Moderate” Exudate

5cc – 10cc of wound fluid within a 24 hr period
Front and back of Gentell’s Waterproof 4×4 foam dressing

Note minimal strike-through on back or dressing (right)

“Heavy” Exudate

Greater than 10cc of wound fluid within a 24 hr period
Front and back of Gentell’s Waterproof 4×4 foam dressing