Like all nurses specializing in wound care, I’ve seen many changes in our profession over the years. Perhaps the most meaningful are the influences that breakthrough technology and products have had on our profession.
To fully appreciate their scope, we need to recall recent history. Not long ago, a diabetic foot ulcer that wouldn’t heal often led to complications and possible amputation. Additionally, to track the healing trajectory of a wound, measurements had to be completed manually with rulers, a subjective measurement process prone to variations among institutions and even individuals.
One thing that hasn’t changed over my 35-year career is defining the etiology of wounds. A pressure injury (PI) is caused primarily by pressure and a diabetic foot ulcer is an open wound on the foot of a person with diabetes. And while the pathogenesis and assessment of PIs are well documented, despite best efforts, many patients continue to develop them for a myriad of reasons.
The ongoing need to combat chronic wounds is one reason the changes we are seeing today, the innovations in best practice, products, technology and workflow, are so important.
Promising changes in technologies and products
Consider the impact technology and innovation have had on wound care. There are several I think are especially notable.
- Telehealth. Since COVID, we’ve shifted the way we care for our patients by pivoting to telemedicine and redesigned workflows when providers were unable to care for patients in person. Telehealth services are convenient, efficient, liked by patients and providers alike and likely to stay a fundamental part of our workflow.
- Cell and Tissue Products. We’ve also seen innovations in therapies to treat wounds. One of the most promising is in cell and tissue products (CTPs), used as skin substitutes for chronic wounds or burns to reinitiate the healing pathway. Those advancements are inspiring to me because they are life-changing for patients.
- 2D and 3D Imaging. On the technology front, who would have thought that smartphones would one day be used to provide highly accurate 2D and 3D images of wounds and wound-specific measurements? And that organizations could take that information and seamlessly integrate it into the electronic health record (EHR), saving us all countless hours and giving us time back to spend on patient care?
- Adjunctive Therapies and Products. Expanding knowledge is especially vital as we continue to battle COVID and emerging variants. COVID has taught us a lot about wounds. Because of the pandemic, we now better understand the important role oxygen levels play in healing PIs. We know adapting to new roles and the use of proven adjunctive therapies and products are necessary to slow the spread of the virus. It is important to stay abreast of best practice guidelines for PIs, such as the COVID 19 resources from the National Pressure Injury Advisory Panel (NPIAP) to help ensure optimal care for wound patients.
Importance of documentation and workflow
Emerging technologies and products, not to mention expanding knowledge, continue to pressure wound care providers, particularly nurses and providers at skilled nursing facilities (SNFs). Wound care is a complex area of healthcare. Patients are elderly, often have multiple comorbidities, and wounds can be frustratingly difficult to treat. Therefore, it’s critical to devise plans that meet patient needs and workflows that meet the needs of stressed providers.
As if that wasn’t enough, government and payer regulations and oversight have also increased significantly over the past decade. For example, under the CMS’ Patient-Driven Payment Model (PDPM), PIs/wounds qualify a patient for the clinically complex category, which mandates numerous guidelines and penalties.
With the scrutiny of CMS and requirements under PDPM, documentation is essential to avoid under-reimbursement. Assessment and coding accuracy are key, starting with the Minimum Data Set (MDS), which has become more complex under PDPM.
For busy SNF nurses, it’s critical to streamline MDS reporting, which captures patients’ clinical characteristics and services rendered, so that the SNF organization can deliver the best outcome to receive appropriate reimbursements. Good communication and interview skills, combined with proven wound-specific measurement devices and documentation methods, can make this process integrate smoothly into a nurse’s workflow.
More wound care innovation on the horizon
There’s so much more to say about wound care today. It’s impressive to see how far the field has come since I first became a wound care nurse. It’s even more remarkable to consider how far we’ll go in the coming decades. While nurses in SNF units today face challenges, there are solutions, tools, resources and innovations that can help us reach our goals of providing optimal patient and wound care.
Cathy Thomas Hess, BSN, CWCN, is the Vice President and Chief Clinical Officer for Net Health Wound Care, where she oversees clinical and professional services. She has over 35 years of experience in wound care, has authored hundreds of journal articles, spoken at both national and international events, and has authored book chapters and the best-selling handbook titled Product Guide to Skin and Wound Care which has been released in its eighth edition.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
