Inconsistency. It’s the bane of every care provider, but especially problematic when it comes to wound care.
There are more than 8.5 million individuals who suffer from chronic wounds at any given time. According to one study, one to two percent of people living in developed countries will experience a chronic wound during their lifetime. And it’s a costly problem, with $25 billion “spent annually on treatment of chronic wounds and the burden is growing rapidly due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide,” according to a report in Wound Repair and Regeneration.
“There is historic complexity and myriad challenges of managing chronic wounds, specifically in the home healthcare industry,” agrees Theresa Gates, the CEO of Beyond Home Health Care. “Wound care accounts for a small percentage of our patient population, but it takes up so much time.”
Care providers must assess what kind of wound they are dealing with -- there are four main categories of chronic wounds: pressure ulcers, diabetic ulcers, venous ulcers, and arterial insufficiency ulcers. Gates says it can take up to 90 minutes to assess and treat a wound in a homecare or hospice setting, with documentation taking up about 15 minutes of that time. Homes may not be set up for successful care, lacking lights, clean supplies, and involved family. In addition, nurses must work remotely with what is typically an interdisciplinary team, many of whom may not see the patient for long stretches of time.
It’s no wonder then that the methods and standards of care, as well as success rates, vary. When wounds are not treated uniformly changes – both good and bad – may fall through the cracks. The patient will suffer, and then the home health care agency or physician may be open to legal or disciplinary action. There’s also a risk that an agency won’t be paid for the visits that have already occurred. “If you can’t show improvement and accuracy [insurance is] going to deny payment,” says Gates.
However, there are strategies that every home healthcare and hospice agency can put into place to improve care and patient outcomes. Here are seven of the easiest and most significant changes to get into practice.
1) Put it in writing.
While it might seem obvious, agencies should create a standardized, written policy that gives care providers explicit instructions on caring for and documenting wounds. Monica Progar, wound care practice director at Amedisys, says that her organization asks that wounds be photographed at the start of care, anytime there is a positive or negative change, and monthly -- at a minimum -- going forward. The organization also uses a wound assessment tool that scores the predictability of wound progression and regression based on quantifiable characteristics and measurement standards.
2) Get your adjectives right.
Physicians and insurance adjusters need detailed descriptions of the wound and wound bed, says Patricia Irwin, an RN and clinical manager at Beyond Home Health Care. “You need to explain the quality of the wound and not just the size and depth. Is it red? Weeping? How does the edge look? Is it tunneling? There are characteristics of a wound that will help with care and home healthcare needs to explain them well.”
3) Gain consistency.
Gates says that one of her biggest challenges as a home healthcare operator is what her employees write down on “the little pieces of paper” that are typically used to take measurements and describe a wound. “You can have two different nurses using the same techniques and one is just going to be better than the other,” she says. “This is where we see a big potential positive from an app because even with different users the measurements are all going to come from the same place.” Craig Mandeville, founder and CEO of Forcura agrees, adding that there can be up to a 40 percent difference in measurements. “You want to shoot for less than 5 percent variation.”
4) Share information widely and well.
Communication between providers – whether it’s nurse to nurse or nurse to physician – is extremely important to the care of the patient. It also affects a provider’s ability to get services reimbursed by insurance. “A caregiver may not be communicating the right information to the doctor or explaining what the problems are completely,” says Nancy Morgan, co-founder of the Wound Care Education Institute (WCEI) based in Plainfield, Ill.
5) Don’t confuse length and width.
Experts agree that one of the main things even experienced nurses get wrong is documenting and conveying length and width. This is especially important since incorrect measurements can make it look like a wound is healing on paper but it’s not. Make sure you’re measuring in centimeters, and rounding up to the nearest tenth of a centimeter, too.
6) Document in words and photos.
The old adage that a picture is worth a thousand words applies to wound care since a series of photos can be compared and help identify issues or healing. Irwin says her agency takes photos on day one, day 30, and day 60. “It helps you because really, if the wound doesn’t show improvement you’re going to see it and be able to change treatment.”
7) Make the patient part of the process.
The patient and his or her caregivers can help the healing process along, says WCEI’s Morgan. “As care providers, we need to keep educating the patient and family members. If we can get them involved in care they can inform us if there’s a problem and help speed the healing process.” Morgan suggests using the teach-back method – showing the patients what they need to know and then asking them to repeat back or demonstrate the knowledge or techniques you have imparted. “Ask them, ‘Tell me the signs of infection. Show me where you need to be looking. Tell me what you should do if the dressing comes off or the wound is draining.’ You really have to make sure you take the time with them so you know the learning is there.”
All of these issues can be overcome using automated tools such as Forcura’s Wound Measurement app, which is designed to help home health and hospice agencies accurately measure and manage wound care. The app uses a camera to automatically measure the length and width of a wound and encrypts the photo and patient data so that is it secure on the device and in transit. It also eliminates the need to carry around multiple devices or expensive cameras.
“A wound measurement app can reduce time spent on a wound care case by 67 percent while improving treatment, reducing readmissions,” says Forcura’s Mandeville. “It gives you one platform for wound measurement, reporting, and predictive analytics all while being connected to the electronic health records.”