Wound Assessment and Documentation

Holly Hovan MSN, GERO-BC, APRN, CWOCN-AP

Pain has been a prevalent health care challenge in the United States for some time, with data from the Centers for Disease Control and Prevention showing that approximately 16% of men and 20% of women experience pain on most days or even every day.

Chronic wound care is challenging for the entire healthcare ecosystem, from clinicians to patients, and COVID-19 has only exacerbated those challenges. Patients are delaying primary care provider and wound clinician visits for ongoing guidance and therapy to reduce possible exposure to the virus. This is understandable, as many chronic wound patients are in the high-risk category if they become ill with COVID-19.¹ They are also putting off elective surgeries, annual physicals, and basic preventive care, which can negatively affect long-term outcomes.

By Holly Hovan MSN, GERO-BC, APRN, CWOCN-AP

Lower extremity wounds manifest in a multitude of ways, with numerous causative or trigger factors. These types of wounds are often costly to treat, are frequently refractory, and have a high risk for recurrence. A comprehensive assessment and an evidence-based treatment plan, along with ongoing patient education and routine follow-up, are essential components of an effective plan of care.

By Dianne Rudolph, DNP, GNP-bc, CWOCN

In evaluating a patient with a wound on the foot, a question that often comes to mind is whether that wound is caused by pressure, diabetes mellitus (DM), ischemia, trauma, or a combination. For example, a patient with DM who happens to have an ulcer on the foot may have a diabetic foot ulcer (DFU) or possibly something else. One of the bigger challenges that many clinicians face is trying to determine the etiology of a foot ulcer. There has been a great deal of debate about DFUs and pressure injuries (PIs) on the feet of patients in terms of how to appropriately assess, classify, and treat them. The confusion and lack of evidence in differentiating between these two types of foot ulcers, particularly on the heel, can lead to misdiagnosis, which can increase both financial and patient-related costs.

By Steven A. Kahn, MD

When treating severe burns, surgeons generally consider eschar removal to be the major factor and the top challenge in both initiating and planning for the optimal course of treatment for each patient. Before grafting, all devitalized tissue must be removed, leaving a wound bed of only healthy tissue. Some burn wounds are clearly full-thickness on initial examination, and some are clearly superficial, with relatively straightforward decision making. However, some wounds have an indeterminate depth and are more challenging. Deep partial-thickness, indeterminate-, and heterogenous-depth wounds require more complex decision making and/or a protracted interval to allow the wound to declare. Eschar removal is sometimes necessary to allow surgeons to assess the wound bed and confirm the depth and severity of certain burns. This, in turn, provides the insights a surgeon needs to determine the best course of treatment, including whether a patient must be treated with an autograft to cover a wound area.

Selection of a wound dressing requires a multifaceted approach. Currently, no dressing can meet all needs of a wound (infection prevention, promotion of re-epithelialization, moisture balance, etc.).¹ Clinicians must weigh the benefits and drawbacks of the dressing or dressings chosen, to optimize wound healing. However, one aspect that is common to most wound dressings is the need for moisture balance to promote wound healing. To achieve this balance, an appropriate dressing must be chosen.

The digital age is upon us, like it or not, ready or not. For the past few years, payers have incentivized, encouraged, reimbursed, and adopted various digital, remote monitoring systems and devices as a way to encourage providers to adopt more digital, remote methods. Although complete telehealth services were not reimbursed in all care settings in all Zip Codes by all payers throughout the United States at the beginning of 2020, many of the restrictions and barriers to provide nearly complete digital services were suddenly released in response to the needs of a nation in the throes of a pandemic.

By Girisha Maheshwari, Pavan Mujawdiya, and Shivani Gupta

Chronic wounds and their management pose a serious challenge to clinicians worldwide and are one of the major public health challenges faced by developing countries. Worldwide, over 40 million people develop chronic wounds, which adversely affects their quality of life. However, epidemiological studies concerning chronic wounds and their management are limited, especially in developing countries. According to the largest community-based epidemiological study on wounds in India by Gupta et al., the estimated prevalence of chronic and acute wounds is 4.48/1000 and 10.5/1000 in India. This study is more than a decade old, and there is no recent data available in the public domain. The lack of organized wound data makes it difficult to formulate new therapeutic strategies, create effective health care policies, or offer efficacious treatment options. Complex wounds take time to heal, and if they are not identified at the earliest stage, the treatment process may be complicated.

By Holly Hovan MSN, APRN, GERO-BC, CWOCN-AP

Wound care and healing require an evidenced-based, interprofessional approach, following standards of care, and treating the whole patient, not just the hole in the patient. Often, wound care clinicians are consulted for recommendations on the treatment of chronic or non-healing wounds, as well as other wound, ostomy, and continence issues. Treating a wound and successfully healing a wound require a holistic approach for the best outcomes.

As health care professionals monitor the wound drainage of a patient, it is critical to be able to recognize the different types of wound drainage. Open wounds and incision wounds may both present varying types of exudate, some of which are perfectly healthy and others that can signal an infection or slow healing. Identifying wounds that need a change in care can speed the healing process. Here are the four main types of wound drainage health care professionals need to know: