ࡱ> \^[q` bjbjqPqP .R::4 (!!!!!!!!R(T(T(T(T(T(T($)h+|x("!!""x(!!($$$"^!!R($"R($$$!! ! "#:$.$$(0($m,\#m,$m,$!""$"."!!!x(x($ !!!("""" $ $0 Nurse Competency in Conservative Sharp Debridement of Non- Viable Tissue in Wound Care Objective: Provides safe and competent nursing assessment and instrument debridement technique for patients with non-viable tissue in wounds. The Louisiana State Board of Nursing, Nursing Practice Committee deliberated and formed the following opinions: In reference to agenda item 4.4, it is within the scope of practice for registered nurses to perform sharp wound debridement provided said nurses have advanced specialized education (beyond basic) and technical skills documented in their files, and validation of technical skills on an annual basis. November 6, 1992 In reference to agenda item 6.1, that it is within the scope of practice for a registered nurse to perform bedside mechanical hydrodebridement with pulsed lavage (with pre-set psi range) when prescribed by a physician or other authorized prescriber, provided that the registered nurse has the necessary knowledge, skills, and abilities with documented competency to said registered nurses file. August 26, 1998 Debridement Competency for Lucretia German RN, C, CWOCN met not met N/A 1. Identify the patient.2.a. Patient Assessment: Identifies the components of history pertinent to the wound and procedure to include: type and duration of the wound and or presence of necrotic tissue, underlying disease/condition, bleeding problems and allergies.2.b. Determines the location of the peripheral pulses: femoral, popliteal, dorsalis pedis, posterior tibia and radial pulses.3.a. Wound Assessment: Describe the wound/surrounding skin to include; color, size, drainage, odor, undermining, wound margins, location and depth.3.b. Recognize abnormal values, findings, and clinical manifestations: cellulites, pain and wound infection4. Photograph wound (optional)5. Verify physician orders/referral/clinical judgment.6. Explain the debridement procedure and purpose7. Determine if pain medication is needed8. Assemble necessary equipment9. Position the patient.10. Provide for adequate lighting11.Wash hands12. Prepare sterile field and equipment.13. Don gloves.14. Remove existing wound covering and discard.15. Cleanse area with appropriate cleanser16. With pick-up forceps and scissors, lift the necrotic tissue and remove it in layers with sharps. 17. Remove as much necrotic tissue as possible.18. Recognize two types of bleeding to fear19. Describe at least 3 methods to stop bleeding to include; pressure, silver nitrate sticks and topical agents. 20. Determine the aggressiveness of debridement to include: amount of necrotic tissue present, pain tolerance, fatigue and bleeding.21. Determine when to stop debriding: i.e. impending exposure of tendon or bone, location of fascial plane, location of named structure, if field is obscured or bloody, when you get nervous.22. Request re-evaluation from a physician when: patient febrile, no improvement, cellulites, abscessed area, major vessel encountered, or extensive undermined areas.23. Post debridement care; Cleanse the wound with normal saline or cleanser and apply an appropriate dressing.24. Documentation post debridement: record in the patient record on progress notes summary of the procedure: date and time, condition of the wound, problems during debridement and type of dressing used ______________________________Wound Care Nurse Signature ________Date ______________________________Physician Validation Signature ________Date ______________________________Chief Nursing Officer Signature ________Date Z 6F hd5\hd5CJ \hdMYZY Z H I J $If$a$ keeee$Ifkd$$Ifl\P ,"064 la -./0keeee$Ifkd$$Ifl\P ,"064 la01keeee$Ifkd$$Ifl\P ,"064 la5678keeee$IfkdC$$Ifl\P ,"064 la89XYZ[keeee$Ifkd$$Ifl\P ,"064 la[\keeee$Ifkd$$Ifl\P ,"064 lakeeee$Ifkd$$Ifl\P ,"064 lakeeee$IfkdG$$Ifl\P ,"064 lakeeee$Ifkd$$Ifl\P ,"064 la789:keeee$Ifkd$$Ifl\P ,"064 la:;]^_`keeee$Ifkd$$Ifl\P ,"064 la`aopqrkeeee$IfkdK$$Ifl\P ,"064 larskeeee$Ifkd $$Ifl\P ,"064 lakeeee$Ifkd $$Ifl\P ,"064 lakeeee$Ifkd $$Ifl\P ,"064 lakeeee$IfkdO $$Ifl\P ,"064 la~keeee$Ifkd $$Ifl\P ,"064 lakeeee$Ifkd $$Ifl\P ,"064 lakeeee$Ifkd $$Ifl\P ,"064 laXYZ[keeee$IfkdS$$Ifl\P ,"064 la[\keeee$Ifkd$$Ifl\P ,"064 lakeeee$Ifkd$$Ifl\P ,"064 laOPQRkeeee$Ifkd$$Ifl\P ,"064 laRSkeeee$IfkdW$$Ifl\P ,"064 lakeeee$Ifkd$$Ifl\P ,"064 la=>kiiiiiiiiikd$$Ifl\P ,"064 la ,1h/ =!"#$% $$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554$$If!vh5555#v#v#v#v:V l0655554@@@ NormalCJ_HaJmH sH tH DAD Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List 6>@6 Title$a$ 5CJ \R z z0MYZYZHIJ-./0156789XYZ[\789:;]^_`aopqrs     ~  X Y Z [ \ O P Q R S =>!!!!!!!!!!!!!!4 YYYYY4 !!!!!!!!!MYZYZHIJ-./0156789XYZ[\789:;]^_`aopqrs     ~  X Y Z [ \ O P Q R S =>I0I0I0I0I0I0I0I0I0I0I0I0I0I0I0I0I0I0I0 I0 I0 I0 I0I0I0I0!I0I0I0I0J I0" I0" I0" I0" `J I0' I0' I0' I0' I0, I0, I0, I0, I01 I01 I01 I01 I06 I06 I06 I06 I0; I0; I0; I0; I0I0@ I0@ I0@ I0@  I0"I0E I0E I0E I0E !I0J I0J I0J I0J !I0O I0O I0O I0O !I0T I0T I0T I0T !I0Y I0Y I0Y I0Y I0^ I0^ I0^ I0^ I0c I0c I0c I0c I0h I0h I0h I0h I0m I0m I0m I0m I0r I0r I0r I0r I0w I0w I0w I0w I0| I0| I0| I0| I0 I0 I0 I0 I0 I0 I0 I0 I0I0I0I0I0I0I0I0I0I0I0I0I0  08[:`r[R  !"#$%&'( Om tKm9*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace 5Q*LO|14::::  } W \ N S d-./0156789XYZ[\789:;]^_`aopqrs     ~  X Y Z [ \ O P Q R S @ @@UnknownGz Times New Roman5Symbol3& z Arial"1hflfl,e ,e !24d3HX(?d2Nurse Competency in Lucretia.GermanBarbieOh+'0   @ L Xdlt|Nurse Competency in Lucretia.GermanNormalBarbie2Microsoft Office Word@F#@<@<,e ՜.+,0 hp|  G Nurse Competency in Title  !"#$%&'()+,-./012356789:;<=>?@ABCDEFGHIJLMNOPQRTUVWXYZ]Root Entry F6_Data *1Table4m,WordDocument.RSummaryInformation(KDocumentSummaryInformation8SCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q