Wound Treatment: 3 Questions to Help You Determine Appropriate Care

wound treatment

How many times have you wondered, or questioned, whether an ordered wound treatment was appropriate? 

I would not be not surprised if you said, “More often than I would like.” Unfortunately, that is the reality for wound care specialists today.

According to a 2018 BMJ Open article, nurse researchers found an overuse of wound treatments with limited evidence and low value. They also found an underuse of evidence-based treatments.

Since we live during a time when people have walked on the moon and some cars are driverless, treating wounds with approaches that work are a no-brainer. 

The wound treatment knowledge gap

So why is that often not the case? A lot can be attributed to the continued lack of knowledge of modern wound care among clinicians providing treatment.

The good news is a simple solution improves the implementation of evidence-based wound care.

Over the years, I developed three litmus test questions to guide me.

If you apply them to your wound treatment plans in a methodical manner, they can keep you on track to practicing evidence-based wound care. 

Here are key questions that put our treatment plans to the test.

1 — What is the rationale for treatment?

Answering this question involves using medical common sense and logic. Here are a few examples that explain. 

A common wound treatment I have seen ordered and heard from colleagues is the use of negative pressure wound therapy (NPWT) on wounds with 50% or more necrotic tissue. 

NPWT therapy is known for promoting tissue growth and healing. But the device is not marketed as a wound debridement method. If the wound is mostly necrotic, what would the rationale for using NPWT be since it cannot heal a necrotic wound? 

Another example is the use of topical antibiotics on a wound with no signs and symptoms of infection. The use of antibiotics prophylactically is not an appropriate approach.

A basic understanding of the correct rationale for use of these products should lead you to realize the two examples are not logical.

2 — What does the science and evidence say?

If you can make the logical case for a treatment, you also are responsible for determining if there is any science or clinical evidence that supports the efficacy of the wound treatment.

Using the previous examples, let’s see how it looks if we applied this question.

The case could be made that NPWT can promote autolytic debridement, especially with new instillation devices available on the market. However, there is no evidence the device debrides or is a cost-effective option for wound debridement.

Though the use of topical antibiotics is warranted with infections in acute wounds, the evidence does not show the same efficacy in chronic wounds. 

3 — Can you defend the care plan in court?

This is an obvious concern when treating a patient.

Ask yourself, “Am I practicing standard-of-care treatments based on sound medical rationale, science and clinical evidence?”

But the statistics do not bear that out. According to a 2017 journal report, plaintiffs are awarded settlements up to 87% of the time in wound care malpractice lawsuits.

That seems like a high number. But those numbers are the result of using minimal evidence and low-value instead of evidence-based wound treatments, according to the BMJ Open report. You might have a difficult time justifying your approaches in court if wound experts testify against you. 

Always practice wound care based on sound medical rationale backed by solid science and clinical evidence. This will enable you to defend your wound treatments in court. Plus, your patient outcomes will be significantly better. 

Until next time … heal on!

Get certified in wound care today!

wound care

Bill Richlen, PT, WCC, DWC, is a clinical instructor for the Wound Care Education Institute. As a licensed physical therapist, Richlen has experience in advanced wound care consultations in long-term care, outpatient, skilled rehabilitation and home health. He has served as a clinical instructor for physical therapy students, been the director of several large rehabilitation departments, and has been providing multi-disciplinary wound care education to nurses and therapists for more than 17 years. His expertise in diverse settings enhance his role as a clinical instructor. His dynamic and captivating teaching style keeps attendee’s attention throughout each course.

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