WOUND OSTOMY CONTINENCE NURSES SOCIETY

President: 
Kathleen McLaughlin RN, MSN, CWOCN, CNS
110 Morgan Road
Aston, PA. 19014
484 565 1485
jkpjb@aol.com

President-Elect (VP):
 Jamie Tamburino RN, CWOCN
2361 Wintergreen Lane
Jamison, PA. 18929
       215 481 7978  
jtamburino111@comcast.net

Treasurer:
Maureen Ingram RN, BC, MSN, CWOCN
Delaware County Memorial Hospital
501 North Lansdowne Avenue
Drexel Hill, PA. 19026
610 284 8503
maureen.ingram@crozer.org

Corresponding Secretary:
Katharine Lowe BSN, RN, CWOCN, HN-BN
 302 428 2686

Recording Secretary:
Kristin Linkewich RN, MSN, CWOCN
215 938 3170

Recording Secretary:
Theresa O'Connor RN, BSN, CWOCN
215 938 3170

Affiliate Trustee:
Rosemary Kates RN, MSN, CRNP, CWOCN
111 Courtlane Road
Cherry Hill, NJ 08034
 215 441 6823

1. MARCH 10    WEDNESDAY     7:30AM       HOLY REDEEMER HOSPITAL
2. APRIL 22       THURSDAY         ALL DAY   VIRTUA DVWOCN DAY
3. MAY 11         TUESDAY            2:00PM        PRESBYTERIAN HOSPITAL
4. JUNE 30        WEDNESDAY      5:00PM        ABINGTON HOSPITAL
   
5. NATIONAL CONFERENCE JUNE 12-16, 2010
   
6. SEPTEMBER 21  TUESDAY         7:30AM   MERCY PHILADELPHIA HOSPITAL
7. OCTOBER 13      WEDNESDAY  2:00PM   NAZARETH HOSPITAL WCC
   
8. NERWOCN CONFERENCE OCTOBER 22,23,24, 2010
   
9. NOVEMBER 10  WEDNESDAY   5:00PM    DOYLESTOWN HOSPITAL
10. DECEMBER 01   WEDNESDAY   2:00PM    CHRISTIANA HOSPITAL

PRESIDED BY Kathy McLaughlin RN, CWOCN, President
PLACE: VIRTUA VOORHEES - DVWOCN EDUCATION DAY
HOSTS: KATHY JUDGE, ROSEMARY KATES, SUE BELL

Attendance:
Nancy Bates
Susan Bell
Linda Berti Hearn
Brenda Bradley
Dawn Carson
Marsha Davidson
Jeanette Delaney
Joann D'Italia
Rosemary Fallon
William Fallon
Nancy Fonte
Theresa Grace
Alexander Carnevale
Bethanne Taylor
Patricia Zielinski
D. Johnson
Mary Anne Griffin
Maureen Ingram
Kathleen Judge
Rosemary Kates
Rosemary Kelly
Kristin Linkewich
Katherine Lowe
Kathleen Lynch
Kathleen McLaughlin
Susan Mikolon
Arlene Peahota
Michelle Quigel
Susan Hermida
Renee Hart
Gillian Reene
Caren Dubell
Julianne Rece
Nancy Schueftan
Joanne Shoaf
Janet Slaven
Allison Smith
Laurie Stelmaski
Cindy Stuller
Nancy Tomaselli
John Wood
Laine Woodhead
Christa Weeb
Marlo Thomas
June Partyka
T. Maria Jones
Dawn Caldarulo
Judy DiPerri
Sandy Cochran
Joyce Beck
Sara Web
Christine Midiri
E. Sgrillo
Tom Kopec


EDUCATIONAL OFFERING AND SPONSORS:
Thank you to Kathy Judge, Sue Bell and Rosemary Kates for organizing the DVWOCN Day.
IT WAS GREAT!!!!!!!

NEXT MEETING:
Next meeting will be Tuesday May 11, 2010 at 2:00 pm, Presbyterian Hospital, Host Dawn Carson.

Respectfully submitted,
Kristen Linkewich  RN, CWOCN, MSN

The conference was comprised of Mikel Gray as moderator and 23-24 experts, number varied during the day, and audience participants. The expert panel members represented academia, physicians, OR nurses, home care, palliative care, dietitians, physical therapists and NPUAP members. It also had a slightly international flavor as several members present were from Canada, Europe and Korea. The panel members where the only ones voting. To arrive at a consensus they had to reach 80 percent agreement. Audience input was invited and taken quite seriously.

The goal of the conference was to come to a consensus regarding definitions of avoidable versus unavoidable pressure ulcers. The answers arrived and will be put into a NPUAP white paper document, that will include a glossary of terms.

Questions answered during the morning session:

• Are there situations or conditions that limit prevention?  91% voted YES
• Should turning every 2 hours be standard? 74% voted NO
• Should turning/repositioning every 2 hours as clinically appropriate be a guideline?
  88% voted YES.
• Is turning every 2 hours feasible? This was deleted.
• Is turning every 4 hours feasible? This was deleted.
• When deciding on a turning frequency is it feasible to let a stage one ulcer develop
  first? 96% voted NO.
• Can a pressure redistribution surface replace turning and positioning?
  100 voted NO.
• Can pressure redistribution surfaces potentially influence intervals? 88% voted YES.
• Should the risk of reper fusion injury to tissue be a factor in turning intervals? Deleted.
• Does the proper and safe use of medical equipment override saving skin?
  58% voted YES and 42% voted NO. No consensus reached.
• Are all medical device related pressure ulcers avoidable? 92% voted NO.
• Is a solution to medical device related pressure ulcers to develop skin safe products?
  67% voted YES and 33% percent voted NO. No consensus.
  A member of the audience mentioned that the industry is already under scrutiny by
  the FDA to do just this.
• If a patient develops intraoperative complications, such as bleeding, is the pressure ulcer unavoidable? Decision to table this.

After much debate, it was decided that the definition of avoidable versus unavoidable
pressure ulcers needed to be reworked, so there was a one hour break. The remainder of
what is written here was completed after that.

Questions answered during the afternoon session:

• Definition of Avoidable Pressure Ulcers: The individual developed a pressure ulcer and
  the provider did not do one or more of the following, evaluate the individual's clinical
  condition and pressure ulcer risk factors, define and implement interventions that are
  consistent with the individual's needs, individuals goals and recognized standards of
  practice; monitor and evaluate the impact of interventions and revise the interventions
  as appropriate. 96% voted YES.
• Definition of Unavoidable Pressure Ulcers, Means that the individual developed a
  pressure ulcer even though the provider had evaluated the individual's clinical
  condition and pressure ulcer risk factors; defined and implemented interventions
  consistent with individual's, and the individual's needs, goals and recognized
  standards of practice; monitor and evaluated the impact of interventions and revise
  the interventions as appropriate. 95% voted YES.
• Are there situations that render Pressure Ulcers unavoidable? 100% voted YES.
• Are there situations where local tissue perfusion is so poor that any amount of
  pressure is sufficient to cause an ulcer? 82% voted YES.
• Can hemo-dynamic instability that is worsened by physical movement make a pressure
  ulcer unavoidable? 100% voted YES.
  The white paper will also include elevated intra-cranial pressure.
• Does the condition called a skin failure exist? 83% voted YES.
• Is skin failure the same as a pressure ulcer? 100% voted NO.
• Can voluntary refusal to eat lead to an unavoidable pressure ulcer? 96% voted YES.
• If an individual was unable to maintain nutrition, hydrational status and had advance
  directives prohibiting artificial nutrition/hydration could it contribute to unavoidable
  pressure ulcers? 100% voted YES.
• In a morbidly obese person or can the weight of a pannus or other skin folds
  contribute to unavoidable pressure ulcers? 96% voted YES.
• If the family are told that the patient's current non-adherence to the plan of care may
  lead to pressure ulcer development and all of the proper preventive care are being
  offered, could this make a pressure ulcer? 91% voted YES.
• Are all pressure ulcers unavoidable? 100% voted NO.
• If pressure was removed from the external body could the skin always survive?
  100% voted NO.