Health care delivered in the home or outpatient setting has continued to increase. According to the latest figures in 2018 and 2017, over 11,500 home care agencies treated 4.9 million individuals in the United States.1 As the aging population increases, the nuances of optimal wound care delivery in the home health setting should be examined.
As in all wound care settings, care within the home setting begins with a thorough head-to-toe assessment of the patient and the wound. This assessment is followed by closely monitoring the wound during each home care visit. Handheld electronic wound measurement devices and digital photographs are useful tools for wound evaluation and monitoring in a home care setting because of their accuracy, portability, and ease of use.2
In addition to monitoring the wound, clinicians must strive to prevent any onset or spread of infection. In the home care setting, thoroughly washing one’s hands is the first step. The presence of certain devices, such as Foley catheters or IV lines, may put patients at a higher risk of infection.3 Various care items—such as a computer/tablet, bag, or other supplies—that wound care professionals carry with them may become infection vectors. To prevent contamination between homes, providers might place a barrier down before setting an item in the patient’s home. To further minimize risk, wound care professionals may also switch the order in which they visit patients. For example, a nurse may visit a patient with a weakened immune system before they visit a patient with a severe infection.3 It may also be wise to familiarize oneself with safe and effective disinfecting methods for such equipment to use between home visits. In the home health setting, patients or caregivers may have a larger role in the care plan than in inpatient settings. They may find themselves changing bandages, for example. For this reason, patients and caregivers should receive education on proper hygiene practices associated with wound care.3
The following issues, although not exclusive to wound care across settings, are particularly essential to successful wound care in the home care setting:
The home care setting has several clinical and logistical advantages and disadvantages. One advantage is that patients don’t have to travel to receive care. This setting minimizes environmental stressors, which is especially vital for patients with obstacles to mobility or transportation. Home care also gives wound care professionals a unique window into the patient’s world that may provide a deeper understanding of the patient’s preferences, lifestyle, and circumstances. One disadvantage of wound care in the home setting is that it may be challenging from a clinical standpoint. Some of these obstacles to clinical wound care may include the following:
Wound care professionals must be prepared if the above issues arise and resolve them as flexibly as possible. To list another disadvantage, clinicians must bring all supplies needed for each visit and supplies to be left when applicable with the patient for self-treatment between visits. The patient or caregivers may have difficulty with that intervisit care and may need additional monitoring, possibly through telehealth or a modified wound care plan.
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Wound care professionals should take a holistic approach, bearing in mind the adage, “treat the whole patient, not the hole in the patient.” A wound does not exist in isolation, so it is essential to ask open-ended questions, actively listen to the patient, and carefully consider their responses empathically. This process may take time because some patients may be unable, reluctant, or simply too exhausted to engage right away. The following information, which may already be included in the patient’s electronic health record, should be documented. It is vital for the provider to consider the unique applications of each of these topics to the patient's home care plan, as they can impact coverage of services, available treatment options, available ancillary services, or the necessity of additional professionals on the team.
Patient engagement promotes a positive wound care experience, and this is where a solid patient-provider relationship is invaluable.6 Clinicians should use all the tools at their disposal to help patients understand their wound. Different strategies, like using various devices and/or photographs mentioned earlier, are beneficial for this purpose, and telehealth can be a great resource between in-person visits. Wound care professionals should explain all aspects of the care plan at each phase of the healing trajectory and empower patients to be informed participants in their wound care decisions.6
In home wound care, providers and patients are partners. Wound care professionals can work together toward healing by respecting the patient’s autonomy, using clinical expertise, and exhibiting agility in a unique setting.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.