Wound Assessment and Documentation

By Diane L. Krasner, PhD, RN, FAAN

Originally a poster first conceived in 2009, "Six Sticky Wickets That Commonly Occur in Wound Care Lawsuits" is as relevant today as it was a decade ago. In my review of wound care medical malpractice cases, I see these six difficult situations ("sticky wickets") occurring all too often. Strategies for avoiding the Six Sticky Wickets have been updated and are discussed here.

By Temple University School of Podiatric Medicine Journal Review Club

The advancement of technology and the introduction of the World Wide Web have allowed information to be a click of a button away for health care providers as well as patients. This advancement led to the demand and production of portal devices such as smartphones, which transformed many aspects of society today, including health care. Today, smartphone applications may aid health care providers in drug reference, diagnosis, treatment, literature search, and even medical training. In 2009, an estimated 6.5 million patients had chronic wounds and spent more than $25 billion dollars on wound care. In addition, rising costs of wound management have suggested the need for the use of mobile applications in treatment of wound care patients.

By Holly M. Hovan MSN, RN-BC, APRN.ACNS-BC, CWOCN-AP

Documentation is a huge part of our practice as wound care nurses. It is how we take credit for the care we provide to our patients and how we explain things so that other providers can understand what is going on with the patient, and it is used for legal and billing purposes as well.

By Heidi Cross, MSN, RN, FNP-BC, CWON

Ms. EB, a frail 82-year-old woman admitted to a long-term care facility, had a complex medical history that included diabetes, extensive heart disease, ischemic strokes with left-sided weakness and dysphagia, dementia, kidney disease, anemia, chronic Clostridium difficile infection, and obesity. Her condition was guarded at best on admission, and she had a feeding tube for nutrition secondary to dysphagia. Despite these challenges, she survived two years at the facility.

By Holly M. Hovan, MSN, RN-BC, APRN-CNS, CWOCN-AP

As wound, ostomy, and continence (WOC) nurses, and nurses in general, we are often so busy taking care of others that sometimes we forget to take care of ourselves. A wise instructor in nursing school once told me, "If you don't take care of yourself first, you won't be able to take care of anyone else." I am often reminded of this when I travel and the flight attendant says "Please secure your own mask first!" Hearing that simple reminder will always and forever remind me to take care of myself first to best take care of others.

By the WoundSource Editors

Diabetes is one of the most common and costly conditions encountered in the U.S. health care system. The condition impacts over 23 million people annually, for a total cost of $245 billion per year. Although surgical infections remain the leading cause of non-healing wounds, diabetic infections follow closely behind, and they impose a substantial financial burden on the U.S. health care system. Treatment of diabetic ulcers in the United States contributes an additional $9 to $13 billion to the direct annual costs associated with diabetes.

By Emily Greenstein, APRN, CNP, CWON

Recently I was able to attend the Spring Symposium on Advanced Wound Care (SAWC) in San Antonio, Texas. I attended many different lectures, presented, and sat on a few expert panels. The one recurring theme that kept echoing was the need to look at the whole picture. Often, as wound specialists, we get in the habit of looking just at the wound without taking into consideration the underlying comorbidities and potential causes of the wound in the first place. This got me thinking, how do I treat a new patient who comes into my wound center? I decided to put together the top five "tips" to remember to look at the whole patient, not just the hole in the patient (as originally stated by Dr. Carrie Sussman, DPT, PT).

By Holly Hovan MSN, RN-BC, APRN, ACNS-BC, CWOCN-AP

Wound assessment is one of the initial steps in determining the plan of care, changes in treatment, and which key players should be involved in management. However, wound assessment needs to be accurately documented to paint a picture of what is truly happening with the wound.

By Christine Miller, DPM, DMM, PhD, FACCWS

One of the gratifying aspects of being a wound care physician is the ability to develop such rich relationships with our patients. The frequent and consistent contact with the same provider lays a strong foundation of open communication and trust. I work in an urban safety net hospital’s ambulatory care center, which sees a high volume of high-acuity patients. It is not uncommon for me to see patients with venous leg ulcerations with concomitant uncontrolled hypertension or diabetic foot ulcerations secondary to uncontrolled blood glucose levels. Patient education is a vital part of my clinical encounters, particularly focusing on the systemic nature of wound healing. I always emphasize that while we are treating your wound, it is the full body well-being that is needed for ultimate success.

Paula Erwin Toth, RN, MSN, FAAN, WOC nurse

Northeast Ohio is now being enveloped by a polar vortex. The subzero temperatures put everyone at risk, but our patients with chronic wounds are especially vulnerable. Neuropathy can desensitize them to the cold and result in frostbite, inadequate shelter and heat, and an inability to go to health care appointments, shop for food, or pick up (or even afford) prescriptions and wound care products. This can have devastating effects.