Diabetic Foot Ulcers Treatment and Its Improvement

Introduction

The current method of treating diabetic foot ulcers (DFUs) requires improvement as it is not as effective as needed. It is necessary to present a comprehensive and advantageous alternative solution to obtain the necessary approval and secure the support from the organization’s executives and personnel. Considering the current situation in the area of DFUs treatment, the paper describes the current problem, the proposed solution, and the rationale concerning its implementation, provides the appropriate evidence of the solution effectiveness, determines the implementation logistics, and lists the required resources.

Approval

The best method of obtaining approval is to demonstrate the advantages of the proposed solution. It has to be more effective than the conventional methods, and it should provide the patients with better results than moist dressing does. The results should be objective and credible. Therefore, it is necessary to implement the program of experimental treatment of DFUs using both methods. Two control groups of patients will get conventional and VAC-based treatment respectively. The results of the treatment course are to be compared and analyzed. It is clear now that VAC-based treatment is more perspective than moist dressing. However, statistical data is necessary to get the required empirical data that can be presented to the senior management and colleagues as evidence of the improved effectiveness of the VAC-based method if compared to the conventional moist dressing method.

The results of the experiment should be analyzed by an independent group of professionals to avoid bias and eliminate potential subjectivity. The experiment should be performed two times with a monthly break to track the positive or negative dynamics of wounds’ healing after both treatment methods. The obtained results should provide the necessary data regarding the need for further extensive treatment and the number of treatment sessions a patient must-have. The obtained data must be presented in the appropriate form and supported by the reports of the independent analysts.

Current Problem

Currently, moist dressing is used to treat wounds caused by diabetic foot ulcers (DFUs). However, this method has the problem with control of the moisture amount applied to a wound and surrounding skin. The issues emerge when the wound is under or over moisturized. It is possible to control the volume of fluids during the process by adding or removing the layers of the absorber, but it creates a substantial discomfort to patients during care (Huang et al., 2014). It should be noted that it is necessary to apply extra efforts to control the process that affects the performance of the relevant personnel in a rather negative manner.

The process of moist dressing in the cases of DFUs takes too much time, and it is usually performed in the form of series of procedures, requiring the sequential use of several ‘dressings’ that have to be chosen according to the current wound condition. It makes the process of moist dressing not very effective, effort- and time-consuming, and cost-ineffective (Huang et al., 2014). The modern healthcare system cannot afford ineffective procedures since the number of patients with diabetic foot ulcers only increases, and the current trend shows that the situation will not change in the nearest future (Huang et al., 2014). A more effective solution is required.

Proposed Solution

The proposed solution that should be used instead of moist dressing is vacuum-assisted closure (VAC) that is also known as “microdeformational wound therapy (MDWT) or negative pressure wound therapy (NPWT)” (Huang, Leavitt, Bayer, & Orgill, 2014, p. 301). It has the following mechanism of action. First, the treated wound is exposed to macrodeformation. It is the process, during which the wound shrinks due to the pores that collapse under the centripetal forces caused by negative pressure. The edges of the wound contract. Second, the microdeformation of the wound’s surface becomes possible due to the use of the material with the porous interface (foam). Third, the fluids are removed through the foam. Finally, in the fourth stage, the wound is stabilized via the alteration of its environment. The negative pressure causes the intake of fluids that increase the speed of the damaged tissue regeneration (Huang et al., 2014). The major benefit of the VAC-based method of wound treating is the effectiveness and reduced time of the necessary procedures.

Rationale

Open wounds such as ulcers are the classical wounds to be treated by VAC-based procedures. According to Huang et al. (2014), “In the treatment of pressure ulcers, serial randomized controlled trials (RCTs) demonstrated a reduction in wound surface area, volume and depth, improved granulation, and a reduced frequency of hospitalization in patients undergoing NPWT” (p. 315). The system for VAC-based procedures is rather compact and mobile to be used in the environment suitable for the patients. The majority of the patients with DFUs are elderly people, so the comfort of procedures’ performance is one of the issues to consider. The procedure does not require continuous control from the personnel performing procedures. The extra fluids are removed by the system automatically, which makes the application of different absorbents unnecessary as in the case of moist dressing procedure. It facilitates the process of the procedure and makes it more comfortable for the patients. The combination of compact size, mobility, automation of the process, and increased comfort for the patients makes VAC-based systems optimal to use for DFUs treatment.

Evidence

The relevant literature provides controversial evidence regarding the effectiveness of the proposed solution. Thus, the study of Dumville et al. (2013) showed that NPWT can be used to treat DFUs, but this treatment appeared to be less effective than conventional methods. On the other hand, there is a significant volume of studies that demonstrates results supporting the proposed solution. According to the research of Fraccalvieri et al. (2012), patients experiencing NPWT reported minimal pain in comparison to moist dressing procedures. It supports the idea that the proposed procedure should increase the patient’s comfort at the very least.

The study of Lone et al. (2014) demonstrated the comprehensive results of NPWT’s application and its positive effect on the condition of patients with DFUs. Additionally, the article of Seo et al. (2013) states that NPWT is among the most effective methods of DFUs’ treatment. The authors emphasize the role of granulation enhancing as the healing facilitator, inherent to NPWTs including VAC-based. Finally, the study of Yarwood-Ross and Dignon (2012) evaluates the influence of DFUs on mortality rates in the country, stating that NPWTs among the appropriate solutions for DFUs’ treatment.

Implementation Logistics

The implementation of VAC-based procedures should be performed in the nearest future to increase the effectiveness of care provided to patients with DFUs. The process of supplementing and eventually replacing moist dressing with VAC-based procedures should take from six to eight weeks. Considering the differences in the procedures, the personnel involved in the process of procedures’ provision must attend specialized courses for two weeks. The organizational structure will be changed as well as workflow because the instrument of procedures’ provision will be replaced, and it will allow increasing the comfort of caregiving. Nurses would be able to visit patients in their rooms to perform the procedures. The head of the relevant department will be responsible for initiating the change. The chief nurse will be responsible for educating the staff and overseeing the implementation process. In the case of the personnel’s opposition to changes, the additional training session should take place to explain the importance of the changes for the patients of the healthcare facility as well as for the facility itself. Motivational programs should be announced as the method of motivating employees to master the new procedures quicker.

After four weeks of using the proposed solution, the intermediate meeting of the head of the relevant department, chief nurse, and the Chief Physician should take place to review the dynamics of treatment and the results. Based on these results, the decision to implement minor or major adjustments to the procedure provision plan should be made. In eight weeks, the final meeting including the same executives should be held to see if the proposed solution is as effective as it has to be. Further decisions should be based on the results of the final meeting.

Resources

The process of implementation will require the participation of the nurses of the relevant department, chief nurse, and the head of the relevant department. Additionally, the help of three nurses having experience in performing VAC-based procedures will be needed to educate and train the personnel. The process of training will require handouts with the description of the procedures, posters with visuals for training sessions, and PowerPoint presentations, combining visuals, comments of the trainers, and videos of the procedures. The implementation process will require the appropriate assessment tools such as questionnaires and surveys to evaluate the effectiveness of the proposed solution in terms of the comfort of the patients. Pre- and post-tests will be required to provide the nurses and physicians with relevant data regarding the current condition and any positive or negative changes following the procedures.

The implementation process will also require the purchase of the VAC systems in the projected amount to cover the needs of the department. The funds provided by the healthcare facility should include the cost of two-weeks training (trainers’ fees), the expenditures on printing handouts, posters, and creating the relevant presentations by the supporters of trainers, and the development and printing the appropriate questionnaires and surveys to gather the data before, during, and after the final stage of the implementation process. As for the staff needed to initiate, control, and assess the changes, all parties involved will get additional payments for their efforts.

Conclusion

Summing, the paper described the current problem, the proposed solution, and the rationale of its implementation, provided the appropriate evidence of the solution effectiveness, determined the implementation logistics, and listed the required resources. VAC appears to be the most appropriate solution for treating diabetic foot ulcers (DFUs), providing the necessary level of convenience for both healthcare providers and patients, and effectiveness.

References

Dumville, J., Hinchliffe, R., Cullum, N., Game, F., Stubbs, N., Sweeting, M., & Peinemann, F. (2013). Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Systematic Reviews, 17(10), 103-112.

Fraccalvieri, M., Ruka, E., Bocchiotti, M., Zingarelli, E., & Bruschi, S. (2012). Patients’ pain feedback using negative pressure wound therapy with foam and gauze. International Wound Journal, 8(5), 492-499.

Huang, C., Leavitt, T., Bayer, L.R., & Orgill, D.P. (2014). Effect of negative pressure wound therapy on wound healing. Current Problems in Surgery, 51(7), 301-331.

Lone, A., Zaroo, M., Laway, B., Pala, N., Bashir, S., & Rasool, A. (2014). Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: A prospective case-control study. Diabetic Foot Ankle, 5(10), 34-41.

Seo, S., Yeo, J., Kim, I., Kim, J., Cho, T., & Lee, D. (2013). Negative-pressure wound therapy induces endothelial progenitor cell mobilization in diabetic patients with foot infection or skin defects. Experimental and Molecular Medicine, 45(11), 62-71.

Yarwood-Ross, L., & Dignon, A. (2012). NPWT and moist wound dressings in the treatment of the diabetic foot. British Journal of Nursing, 12(21), 26-32.