Receiving care from wound care professionals offered R hope that his wounds would heal and he would return to the activities he enjoyed. He noted that the education and support he received from the wound center staff made him feel more confident not only in caring for current wounds, but also in preventing wounds in the future. He also realized that prompt treatment for even the smallest of wounds was essential.
R was able to contact the wound center staff either by phone or by secure messaging e-mail anytime he had a concern or question. When he developed new foot wounds, he could contact the staff and be evaluated within 72 hours of notification. He noted that being able to talk with the staff as soon as a problem developed offered him reassurance that he was properly taking care of his feet.
During his treatment, R needed to wear offloading shoes to minimize the weight-bearing pressure.3 The wound center staff took care to ensure that R could ambulate safely with these shoes and avoid further injury. They also reinforced the importance of wearing these shoes, despite their unfashionable appearance.
Given the depth of some of R’s foot ulcers, the staff used negative pressure dressings to enhance healing. Negative pressure dressings provide a vacuum source to create continuous or intermittent negative pressure inside a wound to remove fluid, exudates, and infectious materials and prepare the wound for healing and closure. A mechanically powered, negative pressure dressing with a 125 mm Hg cartridge device was used during R’s treatment. This type of negative pressure dressing offered the benefit of dressing changes twice weekly vs 3 times weekly with other electric-powered negative pressure devices.4
Another important aspect of R’s care was the use of human amniotic tissue allografts. When R’s wounds did not show healing progression during the first 4 weeks of traditional treatment, amniotic tissue allografts were added to his plan of care. This type of product for the wound bed provides critical growth factors and collagen to promote effective, enhanced wound healing. Patient education again is critical when using human amniotic tissue allografts so that the patient learns to keep dressings intact and undisturbed.5
Future Implications
Diabetic foot ulcers are a preventable complication of diabetic peripheral neuropathy. Patient education about foot health should not only be incorporated in diabetic education, but also reinforced by the health care staff at each visit. When a patient presents with a diabetic foot ulcer, early, prompt treatment is vital to ensure a favorable outcome.
For health care providers, cognizance of the impact that wounds have on patients’ QOL is an essential aspect of care. Identification of factors that promote expedient and effective wound healing is vital. Patient education that is focused on engaging the patient to actively participate in the healing process is paramount. Involving R in every aspect of his care was the focus of the wound center staff. Explaining the purpose of each product used and why it was chosen was not only interesting for R, but also allowed him to actively participate in his appointments and care. As the leader of the wound treatment team, the NP may order, guide, and direct care, but empowering patients to be active participants in their care enhances adherence to the plan of care.6
Conclusion
Focusing on these critical aspects of patient-centered wound healing must be at the forefront when treating patients with diabetic foot ulcers. Although a price cannot be placed on QOL, the cost of diabetic foot ulcers and its complications is astounding. In 2007, nearly $116 billion was spent on diabetes treatment, and more than one-third was for the care of diabetic foot ulcers and complications from those ulcers.7
Finally, the incidence of T2DM is rising: The average age of patients at the onset of T2DM is becoming younger, the development of T2DM in children is rising, and treatment costs are rising.1 Given the alarming statistics of T2DM and its complications in the U.S., focusing on prevention, patient education, and effective treatment of diabetic foot ulcers is important.