Wound Care Feature: Get it in writing
As treatment options and regulations have expanded, so has the documentation need for care teams trying to deliver wound care. Nancy DeFranco can look back with a bit of a wry grin now, but there was nothing funny about it when it was happening.
A veteran director of nursing, DeFranco was incensed over the wound-opening rate at her facility, Little Flower Manor Diocese of Scranton, in Wilkes-Barre, PA.
"We were having areas open up a few weeks after admission. I'm all over my staff, thinking their interventions are not in place, that they're not moving people properly," she recalled. "We later found that 99% of our residents coming from the hospital had fluid under the skin not visible to the naked eye. But the damage was done. If you didn't put certain measures into place, an area would open up and then you would have problems."
With pressure ulcers, all kinds of challenges are possible, of course. For residents. From family members. Surveyors. Lawyers. Insurers.
DeFranco got around some of her problems by taking a chance on a relatively new piece of technology: a portable ultrasound scanner that can detect pre-emergent wound beds and other trouble spots. She said a one-month test period eventually led to the outright purchase of a unit about three years ago.
"If you look at the cost of it up front, it will stop you," she said. "However, if you look at the potential of what it can do, I don't see why you wouldn't have the equipment in a facility."
Within a year of buying the ultrasound scanner, Little Flower recouped its investment of about $30,000 -- on treatment-product savings alone, DeFranco said. (The scanners also can be leased for about $600 per month.)
Such innovations may be a wave of the future, not only with regard to wound and skin care but also the all-important information gathering around it.
For example, Longport Inc.'s Episcan I-200 handheld Doppler scanner will record a history of residents' scans electronically. The soft savings in note-taking and filing alone can be substantial.
And that is what providers are looking for in this age of increased regulation. With new F-tag guidelines for wound care out and new incontinence guidelines expected at press time, documentation has become a bigger concern than ever before.
Telling the story
"Documentation is definitely going to be more critical," said Jay Heitz, the long-term care systems director for Healthpoint LTD, which produces drugs to treat wounds.
Experts have numerous recommendations on how to handle the new data loads, as well as surveyors.
Many providers simply have to make sure they fully note what they've been doing.
"The good news is most of the good nursing homes are doing so much, they take it for granted and aren't articulating it in their nursing notes," said Patrick Swindell Tyson, a national accounts manager with Smith & Nephew. "Now they're going to have to show their plan is based on assessments and determinations of what intervention is needed. The documentation needs to support what they're doing. They've taken something that may have been a mystery, if you will, and are bringing it down to a science."
Nurses, including aides, will have to be able to intelligently discuss care plans. With the revised F-314 now in play, that's going to mean more individualized assessments, re-assessments and treatment plans. Further plans have to be changed if a certain treatment isn't working.
Little Flower's DeFranco has totally revised her wound-care program, based on the new guidelines. She's trying some new products and using ultrasound scans more – up to 100 or more a day in her 133-bed facility.
Every resident is checked four times the first month after admission. Nurses also scan bruises and newly closed wounds to assess what's going on beneath the skin.
The burden on admissions nurses has grown, noted Dr. Dennis Drennan, president of heel-lift maker DM Systems, Evanston, IL.
"There's an upgrade of skin being placed on the same level as heart and lungs, as far as attention goes," he said. "And it has to be repeated for four weeks to meet the letter of the law."
For the record
Keeping track of everything is the key.
"We're really focused on the fact that documentation is a tool for you to use to communicate