Continuity of care has always been the heart of practicing medicine and is especially important for wound care. Continuity of care in wound management equals better outcomes, cost-effectiveness, and satisfaction rates from patients. In providing continuity of care, wound care providers face...
By Aletha Tippett MD
What steps should be taken the first time you encounter a patient with a wound? Here is my list of priorities when I assess a wound:
- Look at your patient—are they old and frail or young and vigorous? How easily do they move around? Are they showing signs of discomfort? How is their odor?
- Talk to your patient—what kind of wound do they have? How long have they had this wound? What has been done to treat their wound? What do they want to happen? What is the main problem they are having because of the wound?
- Check your patient’s vitals—this includes blood pressure, pulse rate, respiratory rate, oxygen saturation, weight and height, BMI. You can infer a lot about your patient just from these simple tests, including respiratory status, cardiovascular status and nutritional status.
- Look at the wound—note the location, size, characteristics. Try to determine the type of wound and thus the cause. Is this a pressure wound? Ischemic? Malignant? Stasis? Surgical?
- Check your patient’s vascular status—this means an Ankle Brachial Index (ABI). Do they have critical limb ischemia? Are they normal? This is important to guide you in how you would treat and wrap wounds.
- Check your patient’s nerve status—even if you don’t have nerve conduction testing you can easily do a filament test, and/or a proprioception test. These will tell you if neuropathy is a problem or not, which will impact wound healing.
- Now that you know the type of wound and complicating factors you are ready to treat the wound—your first step is to eliminate the cause of the wound, if possible. If this is a pressure ulcer, you need to relieve pressure. This means knowing what your patient is using now, and what should be changed. Engage your patient in this decision and choice. If it is an ischemic wound, does the patient need referral to vascular surgery? Now consider what your goals are. What does the patient desire? What resources are available? These are all factors that will determine your treatment.
- Engage your patient in the wound treatment—can they do the treatment? Can a family member do the treatment? Do they have a home nurse who will do the treatment? Who will do the treatment, and how often they can do it, will set some parameters for your choice of treatment. In general, keep treatment as simple as possible.
- Determine follow-up needed—does your patient need to be seen daily, weekly, monthly or when? If closure is your goal you need to measure the wound weekly and determine if it is progressing within two weeks. If your goal is pain relief, that can be followed up even with a phone call. How hard is it to see your patient—do they have to come to you in a transport that schedules fixed times? Do you need to do rounds at their facility? Who all is helping in the care of this wound?
Following the above steps should simplify the management of your patients’ wounds and help you avoid issues that may otherwise occur in the treatment process.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.