Wound Assessment and Documentation

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

There has been much discussion surrounding unavoidable skin breakdown; however, the exact etiology remains unknown. Experts have discussed hypoperfusion and multiorgan system failure as contributing factors. Unavoidable pressure injuries typically have clinical features that distinguish them from true pressure injuries. These features include butterfly, pear, or horseshoe-shaped discoloration (maroon, red, purple, black), which quickly develop on the sacrum, buttock, spine, and extremities in the absence of external pressure. These areas of breakdown can evolve in hours, from intact skin to a deep wound exposing muscle, bone, or tendon, and they often develop in months, weeks, days, or hours prior to death.

The National Quality Forum (NQF) introduced the term never event in the early 2000s, and it refers to a preventable error that may represent fundamental issues with the quality or safety of care within a medical setting. This wording was initially selected because these events are situations that should never happen to any patient, such as surgery to the wrong leg or leaving a sponge in a patient after surgery. In recent years, the NQF has adopted the term serious reportable events (SREs), but in many instances, the term never event is still used.

Even before the onset of COVID-19 and certainly since, health care facilities have faced challenges related to resources, staffing, and infection control. However, telehealth resources can aid across the care continuum. These resources can facilitate patient data dissemination to the multidisciplinary team. For example, a telehealth encounter may help determine the need for an in-person appointment, thus minimizing the amount of travel required by staff and patients to uphold a certain level of care. Mobile technology can also involve patients in their care in new and innovative ways, potentially increasing adherence and optimizing wound care outcomes in the face of evolving obstacles.

Wounds, including chronic and complex wounds, represent a tremendous challenge to the US health care system. In the United States alone, chronic wounds impact approximately 6.5 million patients, and the treatment of these wounds is estimated to cost $25 billion per year. Trauma, burns, skin cancers, infections, or underlying conditions, such as diabetes, can all contribute to a wound’s development and course. If one looks at the structure of wound terminology, they could ascertain that wound care is usually considered comorbid, defined by terms like diabetic foot ulcer, venous leg ulcer, and pressure injury.

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

In chronic wound management, clinicians often see and treat both partial- and full-thickness wounds. These wounds may present as pressure injuries or other wound types, including, although not limited to burns, trauma wounds (skin tears, abrasions, lacerations), vascular wounds, diabetic wounds, and surgical wounds. It is vital to differentiate partial- versus full-thickness wounds for a multitude of reasons, such as to understand how they heal, guide treatment, and ensure clear accurate documentation, to name a few.

Wound care professionals should review clinical workflow regularly to provide effective and efficient wound care. If changes occur in your organization or the field, this review may prove vital in the face of growing patient numbers and high staff turnover. Improving the efficiency and effectiveness of clinical workflows can improve both cost-effectiveness and employee satisfaction. Because of this dual purpose, quantitative and qualitative assessments should be considered when evaluating clinical workflows.

Jobs in the field of medicine are notoriously demanding. However, many factors are converging to exacerbate this problem, and clinician burnout poses a large threat to the health care system in the United States. Unfortunately, this problem does not impact a single segment of specialists but is systemic at many health care facilities.

Electronic Medical Record (EMR): A digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of each patient in the practice.

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

Chronic wounds impact more than 8 million Americans in a multitude of ways ranging from affecting quality of life along to creating a significant economic burden, with the estimated cost of care in the United States currently at 30 billion dollars. As technology and medicine continue to advance, our aging population continues to grow, and those impacted by chronic wounds are likely to increase. This blog will take it back to the basics—using our senses to guide wound assessment and management—while incorporating technology/telemedicine and wound photography to guide treatment and track progress.

Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN, UTHSCSA

Dealing with patients who can’t or won’t participate in their care can be a challenge for health care providers across all settings. In wound care, this lack of participation can result in great financial costs, diminished quality of life, and suboptimal clinical outcomes. This is part 2 of a 2-part series on noncompliance in wound care patients. Part 1 addressed possible reasons for noncompliance. In part 2, strategies to address these issues and increase patient participation are discussed.
Part 1 of this blog discussed factors that impact a patient’s ability to adhere to clinician recommendations for care. Consequently, the most appropriate term to use when dealing with patients facing these obstacles is nonadherence. This term tends to be less value laden and more objective than noncompliance. Some of the reasons for nonadherence are voluntary and some are involuntary, or beyond the patient’s control. To review briefly, these reasons may include gaps in knowledge about the implications or severity of a chronic wound, limited recommendations or education by clinicians, perceived disadvantages to treatment, psychological factors, cultural factors, and social or financial constraints. Additionally, in some cases, alcohol or drug dependence can impact the patient’s ability to participate fully in their care.