Developing an Evaluation Plan
This paper is devoted to the creation of the evaluation plan and the disseminating evidence of the results of the project. In particular, the paper develops the assessment plan of Vacuum-Assisted Closure (VAC) treatment that appears to be the most appropriate solution for treating diabetic foot ulcers (DFUs).
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It is necessary to note the fact that, under certain localization of chronic wounds, the use of the standard debridement method is impossible. However, the decision to provide a vacuum therapy requires confidence in the purity of wounds, the absence of necrotic areas, and the depth of the wound. In order to evaluate the efficiency of the VAC and forecast possible results with some degree of confidence, it is worthwhile to use the variables specified below:
- State of the wound;
- The general condition of the patient;
- Medical staff and equipment.
It is important to assess regularly the size of the wound. In the case, if the healing rate is 15 percent within 1-2 weeks, the therapy should be continued. The re-evaluation of the wound is required after each subsequent week of the therapy. If the condition remains the same or deteriorates, it is significant to interrupt the vacuum therapy for the alternative treatment with a possible return to it at another stage of the treatment (Ali et al., 2015). There are the following positive indicators of chronic wounds: termination of the growth of the size of the wound and appearance of the thin white epithelium in the marginal zone of the wound.
In assessing the effectiveness of the use of the VAC method, one should take into account not only its direct impact on the rate of healing of the wound but also on changes of the patient’s quality of life, whose disease requires continuous and complicated treatment (Hafeez, Rashid, Khani, Kumar, & Kumar, 2014). Such evaluation could significantly reduce the duration of the hospitalization and reduce the intensity of the potential pain syndrome. Moreover, it seems of great importance to control the patient’s mood and meet all his or her physical and psychological requirements.
The effectiveness of the proposed VAC therapy is also determined by such factors as the duration of treatment, experience, and professionalism of the medical personnel in carrying out such type of treatment (Mermerkaya, Bekmez, Alkan, Ayvaz, & Tokgozoglu, 2014). What is more, the appropriate equipment along with the contact between the doctor and the patient are necessary to take into account. Finally, the evaluation of the economic treatment efficacy defined in the reduction of the duration of inpatient period treatment, reduction of labor costs, and the improvement of the clinical outcome of the disease would contribute to the concise and detailed assessment of the VAC treatment.
Therefore, the use of the vacuum therapy should promote marked cleansing of wounds, reduction of the wound area and its depth, the formation of granulation and epithelialization of the edges as well as the decrease of the cost of products for the wound care.
According to the presented variables, there are some methods of evaluation.
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First of all, it is necessary to develop a complex of instruments aimed at the evaluation of the VAC treatment including questionnaires, surveys, teaching materials, presentations, and others. Each of the stages should be clearly discussed and understood by every member of the staff. It is important to point out that the awareness of the medical staff is crucial in the treatment of diabetic foot ulcers as some patients tend to feel depression or even panic (Moghazy, Ellabban, Adly, & Ahmed, 2015). At the same time, proper and timely explanations of the treatment process would, perhaps, improve the patient’s emotional state affecting the physical one as well.
Second, in order to assess wounds, it seems appropriate to develop criteria corresponding to the improvement of the wound. For example, the appearance of the following aspects would indicate successful treatment:
- Satisfactory arterial blood supply to the wound as much as possible;
- The patient’s medical indexes are normal, namely, blood chemistry, blood pressure, blood glucose, and others;
- The wound has a healthy granulating surface;
- The absence of severe concomitant diseases;
- The patient is psychologically adapted;
- No tendency to the deterioration.
In addition, VAC equipment might be supplemented with a small flash memory card to monitor the effectiveness of the device (Lerman, Oldenbrook, Ryu, Fong, & Schubart, 2010). Recorded data would be loaded after the investigation into the computer, and the analysis would allow setting the total duration of operation of the device, levels of the negative pressure, the suspension of the unit on or off, and the volume of air leakage in the clinical use of the device.
The initial evaluation would include the determination of demographic data, history, and information about the patient’s surgical intervention as well as the condition of the wound. To determine the effectiveness of the treatment, daily inspections consisting of the definition of the necessary procedures, and the preservation of the vacuum bandage tightness control. The state of the wound should be examined daily and pictures made during each ligation during the treatment period with determining the amount of discharge, clinical signs of infection, and condition of the skin around the wound.
Thus, the best solution concerning the evaluation plan is complex assessment steps that involve the evaluation of the wound, patient’s general condition, and awareness of the medical personnel.
This part of the paper presents the results of the project. The target audience is key stakeholders and the greater nursing community as the project revealed a range of significant issues. First of all, the research stated the basic description of the problem pointing that neuropathy is the principal determinant of diabetic foot ulcers among the elderly. The impact and gravity of the problem reflected that the population of diabetic patients globally is expected to reach 366 million adults by 2030 (Krug et al., 2012).
After that, the study focused on the best solution to the problem considering the moist dressing of the wound and VAC method. After that, the research focused on the implementation plan consisting of the approval, proposed solution, evidence, implementation logistics, and resources. During the study, it was revealed that the current situation needs to be improved by means of the most relevant and effective treatment. Examination of a number of studies detected that VAC is the most appropriate treatment of diabetic foot ulcers among the elderly as it contains a set of measures devoted to the treatment of the wound resulting in the effectiveness and reduced time of the necessary procedures and personnel. It was also stated that the staff should attend specialized courses for two weeks.
Motivational programs should be announced as the method of motivating employees and periodic meetings should be conducted. Besides, such resources as audio-video facilities were recommended to educate the personnel. Finally, the evaluation plan presented a detailed and complex assessment was suggested. It included variables and methods of the evaluation – state of the wound, general condition of the patient, and medical personnel and equipment and educational programs, flash memory card to monitor the effectiveness, and criteria eligibility respectively.
Ali, Z., Anjum, A., Khurshid, L., Ahad, H., Maajid, S., & Dhar, S. A. (2015). Evaluation of low-cost custom made VAC therapy compared with conventional wound dressings in the treatment of non-healing lower limb ulcers in lower socio-economic group patients of Kashmir valley. Journal of Orthopaedic Surgery and Research, 10(1), 1-10.
Hafeez, K., Rashid, H., Khani, G. M., Kumar, D., & Kumar, S. (2014). Vacuum Assisted Closure – utilization as home based therapy in the management of complex diabetic extremity wounds. Pakistan Journal of Medical Sciences, 31(1), 95-99.
Krug, E., Berg, L., Lee, C., Hudson, D., Birke-Sorensen, H. & Depoorter, M. (2012).
Evidence-based Recommendations for the Use of Negative Pressure Wound Therapy in Traumatic Wounds and Reconstructive Surgery: Steps towards an International Consensus. Injury, 42(1), 1-12.
Lerman, B., Oldenbrook, L., Ryu, J., Fong, K. D., & Schubart, P. J. (2010). The SNaP Wound Care System: A Case Series Using a Novel Ultraportable Negative Pressure Wound Therapy Device for the Treatment of Diabetic Lower Extremity Wounds. Journal of Diabetes Science and Technology, 4(4), 825-830.
Mermerkaya, U., Bekmez, S., Alkan, E., Ayvaz, M., & Tokgozoglu, M. (2014). Evaluation of vacuum-assisted closure in patients with wound complications following tumour surgery. International Wound Journal, 7(2), 1-12.
Moghazy, A. M., Ellabban, M. A., Adly, O. A., & Ahmed, F. Y. (2015). Evaluation of the use of vacuum-assisted closure (VAC) and platelet-rich plasma gel (PRP) in management of complex wounds. European Journal of Plastic Surgery, 38(6), 463-470.
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