Introduction

Patients with wounds are cared for according to the scope and standards of practice, which are used to guide nurses and other members of the interprofessional wound care team. An intricate network of physicians, medical researchers, government regulators, and medical journal contributors helps develop the standard of care. Standards are not enacted like laws; rather, they arise naturally as a result of research investigations, existing physician practices, and technological advancements. Standard of care in the health care profession is sensitive to time, place, and person. The wound care standard must be carried out in accordance with accepted wound treatment standards that are evidence based.¹

Wound Management Standard of Care

To detect signs of healing progress, wounds are assessed on a weekly basis and are handled in accordance with the standard of care. Every assessment and encounter should have the goal of healing wound characteristics while suppressing the development of adverse wound characteristics. This applies to situations where there are no signs of healing progress after two weeks, in which case it is vital to reconsider the treatment plan. Critical steps in the wound healing process include:

• Tissue management
• Inflammation and infection treatment
• Maintenance of a moist wound healing environment
• Epithelial advancement
• Regeneration and repair
• Social factors

It is critical to identify and address the underlying pathophysiological characteristics of the wound, as well as optimize the microenvironment for healing.² It is estimated that most chronic wounds exhibit biofilm, which inhibits or stalls the wound healing process during the inflammatory phase. One method for combating biofilm in chronic wounds and accelerating healing is to use a combination of debridement methods. The most aggressive approach is sharp debridement.³

Good wound cleansing aids in decontamination of the wound, disruption of biofilm, and promotion of healing. It is critical to clean the wound bed surface, periwound area, and surrounding skin thoroughly with noncytotoxic treatments. Additionally, bacteria are frequently found in undermining and tunneling areas.³

Patient-centered Approach

Patient care must always be centered on the patient as a whole, by taking into account not only the specific injury for which the patient is receiving treatment but also any other aspects that may have an impact on the patient's overall well-being.

It is sometimes difficult to perform certain aspects of wound bed preparation and treatments because of patient preferences, religious beliefs, pain, mental illness, diabetes, anemia, malnutrition, immunodeficiency, age, obesity, substance abuse, or smoking. Clinicians should involve patients and caregivers in their care and closely examine variables such as social, psychological, physical, nutritional, and lifestyle factors while treating patients. Failure to pay attention to one of these critical areas may result in nonadherence on the part of the patient and may thus lead to a chronic wound that does not heal properly.^4,5

Documentation Standard of Care

Documentation of a wound assessment is a vital component of the standard of wound care. Your documentation should adhere to your facility's documentation guidelines. Accurate documentation contributes to improved patient safety, outcomes, and care quality. To avoid litigation, support reimbursement claims, and communicate among health care professionals, wound care documentation must be consistent.

When the clinician provides documentation, it acts as the primary means of communication among the various members of the team, it validates medical necessity, and it serves as a way to determine whether a wound is improving or deteriorating. Photographs, graphs of healing times, automatic measurements, and written descriptions are commonly used to document wound care. Advances in digital technology have had an enormous impact on streamlining this comprehensive process precisely.⁶

Advanced Wound Therapies

Hard-to-heal or chronic wounds can be assisted by advanced wound therapies such as growth factors, bioengineered tissue, and negative pressure wound therapy. However, to get the most out of innovative wound care technologies, proper wound bed preparation is critical. Advanced wound therapies are typically introduced after standard of care approaches fail to result in progress toward wound closure.

Conclusion

Nonhealing and chronic wounds continue to be a major health care concern. However, proper preparation of the wound bed is essential to any treatment plan's success. For wounds to heal, they must be treated in a structured manner. Understanding the biological processes that occur in the wound bed while adhering to standard wound care can assist clinicians in optimizing these conditions and selecting compatible advanced therapies as needed to overcome the challenges that delay the healing of hard-to-heal and chronic wounds.

References

1. Grady A. The importance of standard of care and documentation. Virtual Mentor. 2005;7(11):756-758. doi:10.1001/virtualmentor.2005.7.11.hlaw1-0511. Accessed May 2, 2022. https://journalofethics.ama-assn.org/article/importance-standard-care-a…
2. Ousey K, Gilchrist B, Jaimes H. Understanding clinical practice challenges: a survey performed with wound care clinicians to explore wound assessment frameworks. Wounds Int. 2018;9(4):10-15.
3. Murphy C, Atkin L, Swanson T, et al. International consensus document. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care. 2020;29(suppl 3b):S1-S28.
4. Myers B. Wound Management: Principles and Practice. 2nd ed. Pearson Prentice Hall; 2008.
5. Halim AS, Khoo TL, Saad AZ. Wound bed preparation from a clinical perspective. Indian J Plast Surg. 2012;45(2):193-202. doi:10.4103/0970-0358.101277
6. Langemo D, Hanson D, Anderson J, Thompson P, Hunter S. Digital wound photography: points to practice. Adv Skin Wound Care. 2006;19(7):386-387.

Suggested Reading

1. Grey JE, Enoch S, Harding KG. Wound assessment. BMJ. 2006;332(7536):285-288. Accessed March 31, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360405/