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.
Using a Structured, Computer-Administered Questionnaire for Evaluating Health-Related QOL with Chronic Lower Extremity Wounds
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39 Abstract: Patients with chronic wounds of the lower extremity (CWLEs) often experience functional disability and emotional distress; incorporating health-related quality of life (HRQoL) measurements in clinical practice may improve understanding of chronic wound patients’ healthcare needs. A computer-administered instrument that measures HRQoL variables in patients with CWLEs was developed to overcome common limitations to assessing HRQoL in this population. Face validity of the questionnaire variables assessing physical, social, emotional, and functional well-being was obtained and a computer application to display the structured questionnaire on an electronic kiosk with touch-screen interface was developed. All patient responses are stored in the clinic’s electronic health record system (EMR systems). To evaluate use of this system in a wound care clinic, 66 consecutive patients were asked to complete the questionnaire; of those, 64 participated. Internal consistency of the instrument across responses was estimated by the Kuder-Richardson formula 20 as 0.79. None of the patients requested help completing the questionnaire or working with the touch-screen interface. Patients most frequently reported frustration (63%), trouble sleeping (48%), anxiety (42%), and impaired mobility (41%), confirming that CWLEs negatively affect patient quality of life. These findings suggest that additional validation and reliability studies, including research to evaluate the relationship between HRQoL, protocols of care, and wound outcomes, are warranted.
Key Words: healthcare quality, electronic records, evaluation, quality of life, wounds and injuries
Please address correspondence to Thomas I. Sherman, 100 Leverington Avenue, PH 15, Philadelphia, PA 19127; email: tis26@drexel.edu.
The lived experience of chronic wounds evokes powerful emotional issues; more than 25% of patients report symptoms of depression or anxiety.1,2 In a large sociodemographic study3 of 120 patients with venous ulceration, 16% were out of work and 49% were disabled in terms of work tasks. Notwithstanding these circumstances, most clinical assessments of wound healing focus on healing rates and/or morbidity (eg, delayed epithelialization, limb loss, and/or infectious complications). Assessment of functional status and quality of life is fundamental to the care of patients with chronic wounds of the lower extremity (CWLEs) and should not be overlooked.
Health-related quality of life (HRQoL) evaluations examine the psychosocial stresses faced by patients with chronic conditions. HRQoL assessments offer important information throughout the wound care continuum because efforts to improve quality of life and relieve suffering are integral to all wound treatment regimens. The importance of quality of life measurement for patients with CWLEs is gaining recognition.4-6 However, as with other areas of healthcare, progress in this area has not been accompanied by widespread implementation and testing for several reasons.
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