Section on plastic surgery. (Abstracts of Scientific Posters).

PL1-E. BURN CARE AND THE HOME HEALTH PRACTITIONER John. F. Bishop, PA-C, MS, William L. Hickerson, MD, and Joseph M. Still, Jr., MD. Physicians Multispecialty Group, Augusta, GA.

Home health practitioners have been under attack with new federal regulations, decreased monetary compensation, and changing coding policies, yet they perform a vital part of the overall health care of burn survivors in the US today. The burn patient has many different concerns , which all must be addressed and attended to by the home health practitioner. The home health agency must attempt to coordinate several different treatment modalities with different time schedules, facilitate other practitioners, and frequently perform time-consuming and uncomfortable dressing changes. Unfortunately, the burn patient requires tremendous coordination of these benefits and becomes one of the most concentrated at-home consumers of health products. The burn patient may require twice daily bulky dressing changes, showering, premedication, application of topical antimicrobial agents, wound measurement and digital photography, evaluation of various skin substitutes, debridement of the wound, and re-dressing. Therefore, the r esponsibility of continuing medical education rests upon the home health professional, as well as the industry, to maintain a current understanding of wound healing and wound management intervention. Home health practitioners must adhere to certain basic concepts and tenants. A patient in pain must have relief. A wound that has necrotic and nonviable tissue will not heal. A skin graft that has mild to moderate microbial colonization in the immediate area is at risk for infection and subsequent loss. Not all burn wounds heal, and not everything that looks bad is necessarily bad. Malnutrition is now understood to be a driving force for wound healing failure. Given the current level of knowledge regarding the latest wound accelerants for active wound healing, perfusion reperfusion injury, the skin immune system, and other pathophysiologic mechanisms, the home health professional must stay current and knowledgeable. Adaptive-type dressings will give the professional an opportunity to interact on behalf of the hea ling wound. A working knowledge of the latest version of skin substitutes is now a must for the home health practitioner. Without specific protocols and a shortened learning curve, the home health professional will be underprepared and overwhelmed by these latest technological advances. The burn patient is a complex, multifaceted, multidimensional, injured human being, and should be treated appropriately. Home health practitioners must keep in perspective their ultimate goal: quality, knowledge-based, caring, affordable health care for all burn survivors.