By Paula Erwin-Toth MSN, RN, CWOCN, CNS
I hope this missive finds all of you safe and warm. For many, this has been an exceptionally brutal winter. Blizzards, ice storms, avalanches and a drought. All that is missing are zombie snowmen and a plague of locusts.
Early in my career I served as a home care nurse. My district was in a rural area of northeast Ohio in the snowbelt. Most of my clients were farmers, and most of the farmers had retired and were living on the farmstead they had inherited from their parents and in a few cases their grandparents. I learned to shovel coal when family members did not make it over in time to add coal to the furnace. That was in my job description under ''other duties as assigned"! I also learned to not always believe them when I called ahead to see if the road and driveway were accessible. Everything looks passable from your living room!
Remind your patients and their families to use space heaters safely. Make sure they have working smoke detectors and an escape plan should the unthinkable happen. Hundreds of lives have been lost this winter due to accidental fires, and most of the victims were children and disabled elders.
Patient safety is a critical component of regulatory standards. For those of us involved in wound management, changes in balance, ambulation and pain management may have an impact on patient safety in a variety of health care settings as well as the patient's home. Offloading may be required as part of the wound management plan, and yet can pose major difficulties for the patient in adjusting their daily activities. Add in the difficulties presented with an icy, snow covered sidewalk, and just getting into and out of the car may seem like an extreme sport to someone with mobility problems.
National initiatives such as the Center of Medicare and Medicaid's (CMS) Patient Safety Initiative and Patient Centered Medical Home (PCMH) are designed reduce patient complications and improve outcomes while reducing health care costs. Wound management is intricately linked to the aforementioned initiatives. The benefits of specialized wound care services are undeniable, but such focused care can pose challenges for the patient and health care provider alike.
Electronic medical records (EMR) within an integrated health care system can be extremely helpful. However, nothing can take the place of the one-on-one attention, interviewing and observation skills of an experienced clinician. Many times the most vital information comes from what we observe, not what the patient says. The patient may relate what they think we want to hear, not what is really happening.
Non-adherence to the plan of care may not be due to unwillingness to comply with the wound care regimen, but rather financial concerns or lack of a consistent, competent caregiver. Have you noticed a change in the patient's personal hygiene? Do they have a different person (or no one) accompanying them to their visits? What is their demeanor? Do they seem depressed or fearful?
We have a wonderful opportunity to get to know our patients well and our health care 'antennae' can pick up safety concerns not easily quantifiable. Making sure we act on that information is as, if not more, important as what we put on the wound.
About The Author
Paula Erwin-Toth has over 30 years of experience in wound, ostomy and continence care. She is a well-known author, lecturer and patient advocate who is dedicated to improving the care of people with wounds, ostomies and incontinence in the US and abroad.
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.
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.