I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
A Quasi-experimental Study to Assess the Effect of Technology-Assisted Training on Correct Endorsement of Pressure Ulcer Prevent
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Abstract The two-fold purpose of the Detroit Medical Center (DMC) Braden Scale Training Module is to teach nurses to use the Braden Scale to correctly assess pressure ulcer risk and to effectively plan risk-based prevention interventions. A pre-test, post-test, two-group, quasi-experimental study was conducted to evaluate the effect of web-based DMC Braden Scale Training on staff nurses’ ability to correctly endorse the use or non-use of 10 commonly-used risk-based pressure ulcer preventive interventions for patients at different levels of risk for pressure ulceration. “Regular” or “new” users of the Braden Scale from three hospitals assessed 102 patients. On eight out of 10 preventive interventions, the percentages of correct endorsements were higher for patients at extreme levels of risk (generally not at risk or high/very high risk) than they were for patients at midlevels of risk. Correct endorsement of prevention interventions was unaffected by group membership. Training substantially improved ability to correctly endorse interventions, but for new user only. Importantly, patients at midlevels of risk may be more vulnerable to pressure ulceration than their risk assessments indicate simply because nurses have great difficulty determining which preventive interventions should be implemented for this group of patients. Alternative approaches to training are needed to ensure that regular users of the Braden Scale are adequately prepared to use risk-based information to effectively plan pressure ulcer prevention.
The potential for pressure ulcer formation threatens patient safety across all care settings. Although pressure ulcers are more prevalent in long-term care settings, pressure ulcer incidence (the proportion of new ulcers acquired among persons at risk) has been found to be greater in acute care settings (0.4% to 38%) than in long-term care settings (2.2% to 23.9%).1 Failure to prevent hospital-acquired pressure ulcers adds to patient pain and suffering,2,3 increases hospital length of stay,4 increases care costs,5-7 may contribute to premature mortality in some patients,8 and can have important and potentially costly legal implications for both hospitals and healthcare professionals.9-11 Thus, it is not surprising that hospital executives,12 regulatory agencies,13 third-party payors,2 and healthcare practitioners10,14,15 are giving greater attention to pressure ulcer prevention in acute care settings.
Vigilance in preventing hospital-acquired pressure ulcers requires careful adherence to best-practice guidelines.16-19 To date, best practice guidelines uniformly recommend early identification of at-risk hospitalized patients followed by early and aggressive implementation of preventive interventions. Typically, it is recommended that pressure ulcer risk assessment occur within 24 hours of admission to an acute care facility and then daily thereafter or when there has been a substantial change in the patient’s health status.18,20 The National Quality Forum21 designated the practice of initial pressure ulcer risk assessment and regular pressure ulcer risk reassessment as safe practice for the nation’s health. 
The National Pressure Ulcer Advisory Panell recommends using knowledge of individual risk factors to direct implementation of specific pressure ulcer preventive interventions.
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