How to do it...Wound care
Some of the most costly care in a skilled nursing facility involves wounds and skin breakdown. With so many deep or longstanding wounds in play, long-term care providers have a large stake in how quickly a resident heals, beyond basic professional pride. Experts here offer several recommendations for effective wound care.
1The most important issues that Rebecca McPherson, MSN, RN, sees when it comes to wound care strategies are education and evaluation.
“It seems like a lot of facilities don't use clinical studies as far as backing up their products,” said McPherson, the vice president of clinical services at Medline. “Have clinical studies behind them.”
2 Educational programs can lift even a veteran nurse's knowledge level by as much as a quarter, McPherson notes. The net result will be more efficient use of company resources, including products and staff.
“It's like anything else. You can buy a piece of gym equipment, but if you're not using it properly, you won't get results,” she says.
3 Things as basic as correctly using adult briefs can make a big difference in wound development and care, several experts pointed out.
“Sizing residents with certain briefs is important — it's not just one-size-fits-all. If they're sized inappropriately, you're risking that undergarment causing leakage and urine and stool on the skin, causing breakdown,” McPherson explains, reflecting again on the education component.
4Keeping high standards all around is critical,experts emphasize. Medline's Pressure Ulcer Prevention Program (PUPP), for example, emphasizes using products backed by solid research, along with intelligent staff decisions.
“To have the best outcomes, you want to provide education to do so, and have best-in-class products with the studies behind them, and that will help you sustain your outcomes,” McPherson concludes.
5 While misuse of products, unfortunately, is not uncommon, misperceptions also must be overcome to facilitate efficient wound healing.
“A lot of times caregivers don't realize the exact way to use a product correctly, so you're not getting the maximum benefit,” explains Medline's Jerreau Beaudoin. “That can lead to problems.”
McPherson recalled that when she first started in caregiving, “if we kept the patient clean and dry, we were solving the problem. That's not really the whole piece. There's also giving skin the nutrition it needs and putting the protection there.”
Preventive moisture barriers such as creams can prevent skin breakdowns. This basic component of wound care is often overlooked, she noted.
6 There are many dressing options for wounds, and they must be recognized for their strengths and weaknesses, experts remind. Pat Cropley, MSN, RN, CWOCN, of Illinois-based Ferris Manufacturing Corp., is a proponent of polymeric membrane dressings.
“Help improve blood flow and nutrient delivery to the wound through the use of polymeric membrane dressings, which have been shown to reduce swelling in and around the wound,” she counsels. They usually eliminate the need to cleanse wounds during dressing changes, and are non-adherent, she adds. This reduces healing tissue injury and procedural pain associated with the dressing change.
7 With the knowledge that “time is money and money is time,” providers must pragmatically weigh some treatment options. The resident's wellbeing comes first, but the caregiver also must make sure he or she is conducting sound business practices, numerous provider advocates reminded.
“The challenge is to strike the value balance so that you are getting improvement in a cost-efficient way,” says Rob Crousore, vice president, Global Wound Solutions, Joerns Healthcare.
“Healing a wound two days quicker, or in 88 days instead of 90 days, at a cost of $5,000 may make little financial sense if average daily wound care is just $100. But reducing healing time by 30 days for an extra $1,000 does make sense. So time is money, but only with a solutions-oriented partner can the right time-cost savings answers be provided,” he says.