The Oct. meeting was held at Skobys Restaurant in Kingsport. The meeting was sponsored by Jamie Vance with Wellmont Health Systems and 1.0 CEU was obtained for attending.  Joseph Smiddy, MD of Pulmonary Associates of Kingsport was our speaker for the evening with the topic “Why Refer to a Wound Center?” We also had Matt Schaffer and Kent Davis discuss Shared Health clinical health record.  

PRESENTATION HIGHLIGHTS

  Definition:  Any lesion caused by unrelieved pressure resulting in damage of underlying tissue

  Can occur anywhere on the body

  Often a legal issue for hospitals and long term care facilities in bedridden patients

HEALING:

  Key is speed in which the ulcer is healed

  Depth and Staging

  persistent redness

  partial thickness skin loss

  full thickness skin loss of subcutaneous tissue

  full thickness skin loss—grafting possible  

CAUSES:

  Always look at initial underlying cause

  Don’t forget socioeconomic status in your evaluation

  Prolonged pressure and its duration and intensity

  Shearing (i.e. can be related to detergents and starches)

  Friction

ETIOLOGY:

  Deprivation of oxygen

  Cell depth

RISK FACTORS:

  Impaired mobility (including chair)

  Urinary incontinence

  Fecal incontinence

  Poor nutritional status

  History of previous pressure ulcers

  PVD or DM

PLAN OF CARE:

  Skin care

  Pressure reduction

  Nutritional assessment

  Rehydration

MANAGEMENT:

  Wound Care

  Debridement 

  Cleansing

  Dressing

  Adjuvant treatment (i.e. Wound vac)

  Pressure Reduction

  Address Risk Factors

  Continence care

  Nutritional improvement

  Mobility

  Operative Care

  WOUND CARE DONT’S:

  Betadine

  Hydrogen Peroxide

  Triple antibiotic therapy >3 days

DM FOOT ULCERS:

  Difficult to treat

  Prevention first (i.e. diabetic shoes)

  Trim callous around wound until reach the wound bed

  Take the pressure off (i.e. casting)

VENOUS STASIS ULCERS:

  Compression wraps provide dramatic treatment if not arterial

  Wick moisture off the wound

  Silver treatment

UNUSUAL HYPERBARIC USES:

  Comatose

  Diving accidents

  Infections and brown recluse spider bites

  Air embolisms

SHARED HEALTH

TN has connected all of the state

  Free to all clinicians ( paid by the State)

  Easy to use

  1.7 million patients on the program

  Information obtained from claims data

  Secure

  Must have informed consent

  Patients may opt out of the program

  Users must have their own number to access

  Access depends on level of the staff, clinical vs. non clinical

  Implemented by health staff in your office from Shared Health

PARTICIPANTS:

  Fully insured BC/BS commercial

  TNCare

  Nissan employees

INFORMATION PROVIDED:

  Insurance

  PCP and their address and phone number

  Medication history including number of pills filled, date filled, provider and pharmacy last filled

  Formulary coverage on their plan

  Drug interactions

  Encounter history including last visit, diagnosis and any procedures done

  Will print prescriptions

FOR MORE INFORMATION:               Contact 1-888-283-6691 or 1-865-588-4696               www.sharedhealth.com    

Business Meeting

  President Kathy Sharp opened the meeting by thanking our Wellmont sponsor and welcoming our speaker, Dr. Joseph Smiddy.   Secretary’s Report: Tracy Luther informed everyone to make sure that correct email addresses are listed on the sign in sheet and to check with her if they are not receiving email. Members were also instructed to check their SPAM boxes if the correct email address appears on the sign in sheet, but they are not receiving email. The minutes were posted on the website and emailed to all members. Motion to approve was given by Kay Bone and seconded by Paula Countiss. They were accepted as correct and approved with an unanimous vote.   Treasurer’s Report: Paula Countiss reported a balance in checking of $ 11,933.31.  

Old Business:

  DNP:  The DNP Medscape webcast aired October 6, 2006.  Please go to http://medgenmed.medscape.com/viewarticle/545076 to view the response NETNPA sponsored. Wendy Vogel has received 75 emails and only 5 have been negative.  The editor of Medscape has received so much email regarding her webcast that it has now become one of the top 5 topics.

  Fall conference:  Next week!!! Friday, October 27th.  Kathy Sharp has verbal confirmation of 7.5 CEU’s approved by TNA.  We have has some online registration problems, so if you have tried unsuccessfully to register, please just email your intent to attend to Kathy Sharp.

  TNA annual convention:  October 13-15, 2006 at the Franklin Marriott Cool Springs in Franklin, TN.  Kay Bone and Jennie Walls attended this conference and gave us a report on the highlights.  Kay was unable to present our resolution.  It was decided by the committee chair to attach it as an addendum to a current motion.  There was a record low of the number of nurses who attended the conference this year. Jennie encouraged everyone to join TNA if they are not already.  It is no longer a requirement that you also belong to ANA.  She discussed a couple of important issues that we need to pay attention to. The next TNA convention will be October 2007 in Knoxville, TN.

  National Nurse Act:  This is continuing to gain momentum.  Encourage your state senators to co-sponsor.  This Act if passed will allow for a nurse to sit as a Cabinet member for health policy decision making.  Kathy Sharp sent a letter on behalf of NETNPA to our representatives urging them to support and co-sponsor this bill.  Kathy has asked that all of the attendees visit www.nationalnurse.org for information and links to local representatives.  Kathy will be speaking to the health care liaisons for Sen Lamar Alexander, Rep William Jenkins, and Rep. Lincoln Davis in Washington D.C. on Monday October 23, 2006.

New Business:

We now have the state-wide salary survey available on-line.  This may be accessed via the TNA website at www.tnaonline.org.  The results will be available to us both as a state summary and in a regional breakdown.

  ETSU College of Medicine is offering the following CME events:

    Wednesday, Oct 25  Translating Research from Bench to Bedside at the Centre at Millennium Park in Johnson City focusing on translational research of new therapeutic targets for aging and immunity, depression, stress response, asthma and allergic inflammation, and rheumatoid arthritis. 4.0 AMA Category 1 Credits  

  Friday, Nov 3  Medical Challenges of an Aging Population at the Centre at Millennium Park in Johnson City focusing on female sexual dysfunction, overactive bladder, fibromyalgia, insomnia, restless leg syndrome, breast cancer, and osteoporosis 7.0 AMA Category 1 Credits  

  Wednesday, Nov 15   2nd Annual Jacob Francisco Memorial Lecture: Stanton-Gerber Hall on the VA Medical Center campus, Johnson City, E.coli: Pathophysiology of Human Infection by Phillip Tarr, MD, Washington University School of Medicine, St. Louis, MO 1.0  AMA Category 1 Credits     Visit their website at http://com.etsu.edu/cme for additional information on these and other educational opportunities or to register.  

Job Opportunities:

  Cardiovascular Associates, P.C. in Bristol has openings for 2 Nurse Practitioners

  ETSU College of Nursing is looking for a NP for the Mountain City Extended Hours Health Center.  Submit application to ETSU Office of Human Resources, Box 70564, Johnson City, TN 37614-1707 or call Nancy Alley, Executive Associate Dean for more information.

  Blue Ridge Medical Specialists in Bristol is looking for a NP for their endocrinology office.

  Dr. Kazmier, Kingsport Allergy and Immunology, is looking for a full time nurse practitioner.  New grads need not apply.  Must have experience as an NP.  If interested, please contact Bonnie Messerschmidt, NP at 246-6445 for details

Next Meeting: TBA-November 16, 2006   Please mark your calendars!  The Holidays are quickly approaching; therefore, the December meeting has been moved to the second Thursday due to the third Thursday falling so close to Christmas.  The date will be December 14, 2006 and the place will be announced later.