Documentation

The National Quality Forum (NQF) introduced the term never event in the early 2000s, and it refers to a preventable error that may represent fundamental issues with the quality or safety of care within a medical setting. This wording was initially selected because these events are situations that should never happen to any patient, such as surgery to the wrong leg or leaving a sponge in a patient after surgery. In recent years, the NQF has adopted the term serious reportable events (SREs), but in many instances, the term never event is still used.

Avoidable pressure injury: The development of a new pressure injury or the worsening of an existing one that results from a failure of the facility or caregivers to adequately identify, prevent, or manage the patient using acceptable care standards.

Wounds, including chronic and complex wounds, represent a tremendous challenge to the US health care system. In the United States alone, chronic wounds impact approximately 6.5 million patients, and the treatment of these wounds is estimated to cost $25 billion per year. Trauma, burns, skin cancers, infections, or underlying conditions, such as diabetes, can all contribute to a wound’s development and course. If one looks at the structure of wound terminology, they could ascertain that wound care is usually considered comorbid, defined by terms like diabetic foot ulcer, venous leg ulcer, and pressure injury.

Holly M. Hovan MSN, APRN, GERO-BC, CWOCN-AP

In chronic wound management, clinicians often see and treat both partial- and full-thickness wounds. These wounds may present as pressure injuries or other wound types, including, although not limited to burns, trauma wounds (skin tears, abrasions, lacerations), vascular wounds, diabetic wounds, and surgical wounds. It is vital to differentiate partial- versus full-thickness wounds for a multitude of reasons, such as to understand how they heal, guide treatment, and ensure clear accurate documentation, to name a few.

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.

Jobs in the field of medicine are notoriously demanding. However, many factors are converging to exacerbate this problem, and clinician burnout poses a large threat to the health care system in the United States. Unfortunately, this problem does not impact a single segment of specialists but is systemic at many health care facilities.

Electronic Medical Record (EMR): A digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of each patient in the practice.

Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN, UTHSCSA

Dealing with patients who can’t or won’t participate in their care can be a challenge for health care providers across all settings. In wound care, this lack of participation can result in great financial costs, diminished quality of life, and suboptimal clinical outcomes. This is part 2 of a 2-part series on noncompliance in wound care patients. Part 1 addressed possible reasons for noncompliance. In part 2, strategies to address these issues and increase patient participation are discussed.
Part 1 of this blog discussed factors that impact a patient’s ability to adhere to clinician recommendations for care. Consequently, the most appropriate term to use when dealing with patients facing these obstacles is nonadherence. This term tends to be less value laden and more objective than noncompliance. Some of the reasons for nonadherence are voluntary and some are involuntary, or beyond the patient’s control. To review briefly, these reasons may include gaps in knowledge about the implications or severity of a chronic wound, limited recommendations or education by clinicians, perceived disadvantages to treatment, psychological factors, cultural factors, and social or financial constraints. Additionally, in some cases, alcohol or drug dependence can impact the patient’s ability to participate fully in their care.

Wound management is a tremendous clinical challenge for many health care professionals. The World Health Organization has recognized that wound management is a worldwide public health issue best managed by an interprofessional team. This interdisciplinary approach has been shown to increase healing and decrease wound recurrence. However, it requires shared decision making with many clinicians to create an optimal care plan.

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.