Angel McGarrity-Davis, RN, CDONA, NHA

I am a new RN 3-11 shift supervisor, and new to skilled nursing. Can you please highlight what I should do to initiate a wound program? 

The first detail is to review the federal regulation for wounds, F-tag 314. If your state has the Quality Indicator Survey, you will want to review the clinical pathway for wounds and skin. 

Each facility is different, so be sure to review the policy and procedures for any skin/wound program. Use evidence-based clinical guidelines and have an understanding of Section M in the MDS. 

Following your review of the regulations, you should do an assessment of each resident’s skin, to ensure that you know EVERY skin impairment. If there is a unit manager on the respective units, make sure you include her or him on these assessments.  

Once you have done this and know every skin impairment in your facility, here is what you will want to review/assess to have in your documentation:  

Overview of the type of wound: Stage I, Stage II, Stage III, Stage IV,  Suspected DTI (Deep Tissue Injury), Unstageable. Other wound types can be venous, arterial and/or diabetic and other.

Remember, if it is not documented it is not done. Look at support surfaces, float heels, turning and repositioning schedules, cushions, etc.  

If the resident is non-compliant with their plan of care, it is up to us to ensure the resident and their family adhere to education. If the resident’s non-compliance results in a negative outcome, this could be detrimental to your facility.

Ask: How do you report new wounds? What other tools/forms do you have, and are they current with current F-314 regulations? 

Make sure nurses are competent to do the dressing changes. You don’t want to find out by a surveyor telling you a nurse failed the observation.