Archive for the ‘Wound Assessment & Documentation’ Category

Legal Case Highlights Importance of Wound Care Documentation

Wednesday, November 4th, 2020

We have discussed the importance of nurse expert testimony in cases alleging professional negligence against you.

One blog addressed a breach of your standard of care when providing wound care.

A second reviewed the importance of your wound care documentation in the patient’s medical record.

This article takes a look at the 2016 case, Henson v. Grenada Lake Medical Center, to underscore both of these important points.


Wound Treatment: 3 Questions to Help You Determine Appropriate Care

Thursday, September 24th, 2020

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.


Nursing Documentation in Wound Care Is a Key Factor in Determining Liability

Thursday, August 13th, 2020

The medical record is an essential piece of evidence in any legal case alleging professional negligence against wound care nurses and others.

As you know, one of the purposes of the medical record is to reflect what nursing care was given to the patient. The entries speak to the quality of the care given.

The entries are supplemented by oral testimony at trial of those whose notations are in the medical record. A jury then decides if care was given that meets the standard of care in the situation or if the caregiver failed to meet his or her legal obligation.

The following 2020 legal court decision (Nixon v. The Brookdale Hospital Medical Center, Parkshore Health Care, LLC, Four Seasons Nursing and Rehabilitation Center, and the New York Community Hospital of Brooklyn, Inc.), illustrates the importance of nursing documentation and potential liability for patient injuries and death.


Learn How to Determine What Wound Exudate Is Telling You

Wednesday, July 1st, 2020

An integral part of a wound assessment includes analyzing the type and amount of wound exudate coming from the wound.

Knowing how to correctly make those observations and documenting accordingly is critical to a comprehensive assessment. Ultimately, we want a wound with an optimal level of moisture to support healing and not an overly moist or dry environment.

However, as wound care specialists or experts, we need to take it one step further and ask a few more questions.

  • Is this the type and amount of drainage I expect to see based on the wound’s current healing path? 
  • If it is not, why is the exudate presenting this way? 
  • How do we correct that? 

A good wound care clinician does more than just make observations and note them. They are continually critically thinking and asking “why” and seeking solutions. 


Telewound Sessions: Best Practices When Conducting Virtual Appointments

Wednesday, June 24th, 2020

With the COVID-19 pandemic, telehealth and telewound services are in high demand.

For many wound care clinicians, providing telewound services may be a new addition to their practice.

We spoke with two telewound experts to help you learn more about best practices and possible glitches when conducting a telewound session.


Prior Authorization: New Rule in Effect for Pressure Reducing Support Surfaces

Wednesday, February 26th, 2020

Clinicians caring for Medicare beneficiaries who need pressure reducing support surfaces when discharged home are adapting to a new rule.

Those clinicians now need to submit a Prior Authorization Request for Pressure-Reducing Support Surfaces, said Cynthia Broadus, BSHA, RN, CHCRM, LNHA, CLNC, WCC, DWC, OMS, executive director at the National Alliance of Wound Care and Ostomy (NAWCO) in Somonauk, Ill.

The Prior Authorization Request for Pressure Reducing Support Surfaces is a rule established by the Centers for Medicare and Medicaid Services (CMS) that took effect Oct. 21, 2019.

Submitting the preauthorization documentation will identify the need for the pressure reducing support surface and provide the supporting documentation, according to Broadus.

“The authorization must be submitted before the support surface is supplied to the patient and before a claim can be submitted for payment,” she said.


Is the Ankle Brachial Index for Compression Therapy Necessary?

Thursday, September 19th, 2019

If you are OK with the status quo, then do not read any further. 

However, if you want to look at whether guidelines that have been established and promoted for years are based on evidence and science, then read on. 

For years, clinicians (including myself) have been using the ankle brachial index (ABI) as a guide to determine whether a patient is a candidate for:

  • High (therapeutic) compression
  • Low-level compression
  • No compression

It was only after listening to a colleague’s lectures on myths in wound care that inspired me to look deeper into this practice. 


What Happened to Practicing Wound Care Basics?

Tuesday, April 30th, 2019

Having been involved in wound care for about 25 years, I have seen many changes in our understanding of wound healing, research evidence and technology.

As I hear my students describe common practices today and the many myths of wound care, I’m led to wonder, “What happened to starting with wound care basics for healing?”

A colleague of mine once stated there are basically two fundamentals to healing wounds: a healthy patient and a healthy wound environment. Once those are accomplished, topical treatments will not make that big of a difference.

However, clinicians often cling to some “holy grail” treatment in the form of a dressing or adjunctive modality that will somehow overcome the need to practice solid, evidence-based wound care.


The Head to Toe Search for Wounds

Tuesday, June 12th, 2018

A comprehensive skin assessment should look for more than just wounds because many medical problems have telltale signs that are easy to see if you know what to look for.

POA. These three little letters have become very important in wound care because we must document any wounds present on admission (POA). By doing so, we are saying that these wounds began somewhere else—maybe at home, maybe in another care setting, but definitely not while under the present facility’s care. This distinction of origin has great implications both financially and legally.


Stinging. Burning. Painful. Wounds Hurt!

Saturday, March 10th, 2018

Wound pain is sometimes difficult to quantify, but if a patient complains of pain, this requires effective and timely pain management. In the midst of the war on narcotics, that might mean looking for alternative pain management techniques and learning new approaches.

Several months ago, I was attacked by the most venomous scorpion in North America, the Arizona bark scorpion. This stealth attack happened while I slept in my own bed at home in our southern Nevada desert home. I woke up with a jolt knowing that something was terribly wrong with me, but not quite sure what was happening. I felt a fiery tingling pain in both my hands and my abdomen, yet at the same time I also had a total loss of feeling in those areas. I remember yelling to my family that I was paralyzed, but they were confused because I was running around and frantically waving my arms obviously not paralyzed at all. We only figured out what had happened when I tried to crawl back into bed and saw the scorpion on my pillow.

My scorpion stings were an indescribable sensation and unlike any type of pain I had ever experienced. Even today, I am struggling to find the words to tell you what it felt like. All I knew was that it hurt and was unlike any pain I had previously experienced or could even compare it to. For the record, I did some research afterward—people describe it as feeling quite similar to being electrocuted. Luckily, I can say that I was never electrocuted, but that is how people describe it.

Just as luckily, I have never had a pressure injury or a diabetic foot ulcer, so I am not really sure what those feel like either. My patients tell me they hurt. Some patients seem like they are in extreme pain, while others seem to have only mild pain. How do we quantify wound pain, and more importantly, how do we manage it effectively?