How to do it... Wound care

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Have you ever met a surveyor who wasn't very interested in your wound care practices? Didn't think so. In fact, there are signs that surveyors are looking at them with deeper interest than ever before. That means write-ups for those who don't take heed and prepare properly. Whether it has to do with properly assessing wounds (actual or potential), treatment, monitoring or nutritional needs, providers need as much information as possible to keep surveyors satisfied. Experts offer their top tips here.

1. Before a surveyor ever enters the building, a sound wound care program should be in place. That starts with giving someone the lead role in organizing and emphasizing the facility's wound care protocols.
"You can save a lot of headaches if you have a designated person responsible for your wound care program. And that designated person needs some specialized additional training in wound and skin care," says Debra M. Thayer, RN, MS, CWOCN, a technical service specialist for 3M Health Care.

2. Dr. Roger Schechter, med-
ical director for Palomar Pomerado Health Wound Management in Utah, takes it a step farther.
"At least one person on every shift should be the designated 'skin champion,' so to speak. Whenever there's a new arrival, the first thing that needs to be done is look at the patient head-to-toe, front-to-back, because (wounds) can be such a significant factor," he says.
"It seems like common sense, but a lot of times because staffing issues get in the way, skin surveys fall by the wayside until some time after a resident gets in a facility. As a consequence, long-term care facilities often get blamed for ulcers that occurred in another environment."

3. Once you have someone to do assessments, it is critical they do them accurately. Otherwise, you may be setting yourself up for failure.
"Not every ulcer is a pressure ulcer," notes Mary Ann Smeltzer, director of clinical services for Net Health Systems Inc., maker of WoundExpertâ„¢ software. "If you identify every ulcer as an acquired ulcer and don't specify the etiology behind it, you could have problems. Things like venous ulcers, which are known to be recurrent, don't come under the same requirements as pressure ulcers do."
In other words, the assessor has to know what she is looking at.
"Being able to assess properly upfront will put you in a much better starting position than if you were sloppy with your assessment. It happens a lot," Smeltzer adds. "You could be setting yourself up for a review that wasn't necessary."

4. Once wounds do develop, they must be constantly monitored, and this is where many providers find trouble.
"If you're not doing systematic assessments and recording them, once again you might be opening yourself to scrutiny that might not be necessary," Smeltzer says.
Adds L. Jean Fleming, RN, MPM, CIC, an infection control expert with Professional Disposables International (PDI), "All caregivers must have in-service training and annual competency review documented in prevention and management. Long-term care facilities must have written protocols for wound care and these protocols must be 'working' documents, not just a policy in a book that left unattended on a shelf."

5. Protocols should include wound-dressing changes as seldom as possible, says 3M's Thayer.
"I still find providers operating with protocols that demand every day dressing changes. In this day and age, that's not necessary any more," she says. "When you adopt extended wear dressing protocols, it decreases supply costs and nursing time."
Clear or transparent dressings can be helpful if they "minimize the peek factor" by allowing caregivers to view healing without removing anything, she added.

6. Focusing on prevention of skin breakdown is critical, experts point out.
"We've really come to understand that what we often call Stage II pressure ulcers really have more to do with friction and moisture, and less with pressure ideology," Thayer says. "Many times it's simply promoting skin integrity, and preventing friction and moisture. When friction and moisture interact, frictional forces are doubled. And fifty percent of nursing home residents are incontinent."