What Wound Care Physicians Need to Know About Working in Long-Term Care

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By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

As a traveling wound care educator for physicians, I am observing many changes within the state survey process for long-term care. Wound care physicians working in long-term care are feeling the same anxiety that facility leaders and staff members are, as the time nears the window for an annual state survey.

How Long-Term Care Facilities Differ From Hospitals

As I educate wound care physicians, I notice there is actually somewhat of a learning curve and culture shock stepping foot in the long-term care arena for the first time. Being competent in wound care is not sufficient enough to work as a physician in this setting. The long-term care arena is surprisingly different than the hospital. Federal regulations must be followed accordingly or facilities are at risk for fines and penalties. Physicians must be compliant with the state survey process and associated wound care F-tags (F314, F385, F501).

I train wound care physicians to think like a state surveyor, and be the safety net for the facility. Pressure ulcer investigations are tough, and the documentation is reviewed with a fine-tooth comb. State surveyors are paying closer attention to wound assessment, prevention, treatments, and infection control. There are many state surveyors also obtaining wound care certification to become an expert. I have observed surveyors interviewing wound care physicians about the residents wound healing progress, treatment plan, and even have scheduled times to accompany the wound care physician during rounds. Surveyors are looking for discrepancies with documentation, pain management, and infection control during the wound assessment and debridement procedures, and that there was physician supervision (F385) throughout the wound healing progress. This is why I encourage long-term care facilities to have wound care physicians assess ALL pressure ulcer stages, not only the stage IIIs and IVs.

Get Compliant: Team Strategies for State Survey Preparation

A wound care or treatment nurse should always attend rounds with the wound care physician to help prevent discrepancies in documentation and recognize educational opportunities. State surveyors want to see the physician and nurse working together. Evaluate skill competencies with nurses and nursing assistants. Cover topics on infection control, treatment applications, mattress surfaces, turning and repositioning, risk assessment, skin assessment, and wound assessment.

I highly encourage facilities to design a collaborative mock survey team to assess your facility's survey readiness involving the wound care physician. The mock survey should include the same tasks performed by an actual survey team such as performing policy reviews, conducting interviews with residents and staff, conducting resident observations, assessing infection control, and reviewing medical records to identify potential trouble areas that need to be addressed for compliance.

About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.

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.

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