Assessment

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.

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.

Standards of care and evidence-based guidelines should lead our wound care practice to ensure the best possible outcomes for our patients. There are often prewritten algorithms or first- and second-line therapies, along with outlined treatment plans and guidelines established based on evidence. These guidelines can be adjusted to meet each patient’s specific needs.

A pressure injury (PI) is defined as a localized injury to the skin and/or underlying tissues caused by pressure either alone or in combination with shear. Hospitalized patients worldwide frequently present with PIs, and these injuries can lead to prolonged hospital stays, increased medical expenses, and decreased quality of life. Often, the injuries can be preventable, and the use of a structured, validated risk assessment tool is an important initial step in PI prevention.

The management of wounds, especially complex and chronic wounds, is a daunting clinical challenge. Achieving progress toward wound closure often depends on the right selection of treatment modalities for the wound and acknowledgment of any other underlying clinical considerations that present barriers to healing. However, before treatment selection, a full and accurate wound assessment must be completed. Without analyzing all variables that impact wound healing, clinicians may be unable to identify the proper treatment course.

I’m sure we’ve all hit that point in our wound care careers where we’ve had that one patient who’s wound just doesn’t seem to respond to any treatment. You’ve tried everything that you can think of—state-of-the-art dressings, advanced cellular products, regular debridement, and even hyperbaric oxygen. But despite all of this, the wound seems stuck. This is what’s known as a recalcitrant wound, a wound that fails to progress through the phases of wound healing in a typical timeline and becomes “stuck.” A wound that does not decrease in size by 30% in 3 weeks or by 50% in 4 to 5 weeks is considered recalcitrant. This is significant because wounds that don’t show improvement in size by 50% in 4 weeks have a 91% chance of not healing in 12 weeks.