How to do it ... wound care
Given the importance of treating sores and other open areas on the skin, there are countless possible approaches to managing wound care. No small part of the challenge for providers is making sure treatment steps are cost-effective. Experts tell here how providers can make sure they're spending their time and other assets wisely.
1 - Start by knowing what is causing the wound, experts emphasize.
“A wound will not heal if what has caused it has not been addressed, modified or eliminated,” notes Gail Dereczyk, RN, BSN, CDWOCN, Medline Industries.
Plus, know how to differentiate wounds properly. “Using incorrect treatments will waste products, time and may result in poor outcomes,” Dereczyk adds.
2 - Using proper wound care products, using them correctly and also knowing what is fair to expect from them will lead to more efficient care, Dereczyk reminds.
3 - Etiology is the key for Billie Jo Schwerin, RN, WCC, DWC, DermaRite Industries.
Without proper knowledge of a wound's origin, “You could be treating it way longer than you should,” Schwerin says. “A lot of times patients come to us without a history or physical. If they've been at home and developed these wounds, we don't always know their origin.”
4 - Know specific performance characteristics of any materials you use.
“We like foam because it's soft and comfortable, but if you have a wound with just a little bit of drainage, that foam will absorb all of that, and then you have a dry wound. Wounds need a moist bed,” Schwerin says. “Go low-absorbent first — it's cheaper. Then, if it isn't enough, work your way up to the foams. A lot of nurses just grab it for anything.”
The proper foam dressing should be good for “one to three days of wear time,” says Elaine McGowan, BSN, RN, CWCN, DermaRite Industries.
“The big red flag that would tell you you're not doing cost-effective wound care is if you're changing that wound dressing more than once a day,” she explains. “You need to know what the normal and expected frequency of a topical treatment would be,” she adds.
Know the cost of overall treatment vs. the cost of the dressing, advises Judy Boluis, Ferris Mfg. Corp. “A less costly, less effective dressing can result in significantly higher overall cost of treatments.”
5 - Following formulary options also is necessary, McGowan reminds.
“At several places we have physicians or nurse practitioners who do the wound care, consult and write orders for products not on the formulary,” she says. “We have to follow doctor's orders. If a nursing home doesn't have somebody qualified in house to do the wound care, and most don't, I think, then they have to work on a regular basis with outside practitioners.”
6 - Using too much product or material can be harmful, notes Paula Erwin-Toth, MSN, RN, CWOCN, CNS, a clinical consultant for MediPurpose and ostomy expert.
It's important to “fill the ‘dead space' of a wound without over-packing,” she says. An overpacked wound can lead to tissue damage and inhibit blood flow to the wound bed. The packing product should be removed easily and not leave non-biodegradable fibers, she warns.
7 - Getting what might be the right product but then performing the wrong care is a common problem, says Steve Warren, Skil-Care Corp.
“The missteps are spending a lot of money on sleeping surfaces and not really alternating or rotating patients right,” he says. “Don't drag patients across the bed because that creates shear forces.”
8 - Applying the proper redistribution and turning schedules is important, says Margaret Falconio-West, BSN, RN, APN/CNS/CWOCN, DAPWCA, Medline.
Recognizing the personal characteristics of an individual's skin, keeping nutrition levels appropriate and addressing comorbidities also are critical tasks for successful, cost-effective care, she adds.
Mistakes to Avoid
- Using wound care products without fully understanding the wound, or the product's capabilities.
product when a more
moderate one might do.
Practicing poor care habits, such as infrequent turning or rough handling, with patients.