Keeping Careful Watch
Wound care is a serious issue, and it is the reason
why support surfaces are such a critical element of many
HME providers’ offerings. Unless a patient has the right
support surface, they can develop pressure ulcers that
could require extensive medical treatment. The exact
support surface is critical in ensuring that the patient’s
wounds heal completely.
Key in understanding what mattress solutions are
right for which patient is understanding pressure wound
staging. Here is a very basic review of wound care
- Suspected Deep Tissue Injury — A purple or maroon
area of discolored intact skin or blood-filled blister.
- Stage 1 —Intact skin with non-blanchable redness of a
localized area usually over a bony prominence.
- Stage 2 —Partial thickness loss of dermis presenting as
a shallow open ulcer with a red pink wound bed, but
- Stage 3 — Full thickness tissue loss with visible
subcutaneous fat. Slough might be present and the
wound might include undermining and tunneling.
- Stage 4 —Full thickness tissue loss with exposed bone,
tendon or muscle; slough or eschar might be present;
and will often include undermining and tunneling.
• Unstageable —Full thickness tissue loss in which the
base of the ulcer is covered, or eschar in the wound
Generally, the more severe a pressure wound, the more
complex the mattress that will be required. A patient
with a single stage 2 sore or less might simply need a gel
overlay, while a patient with multiple stage 3 or 4 wounds
might need a low-air loss, alternating pressure mattress.
But wound care through support surfaces is not a “fire
and forget” sort of process. It requires careful monitoring
and follow-up to ensure that the patient is either not developing
ulcers or that the patient’s wounds are healing.
First off, providers must undertake a solid assessment of the patient
and the care he or she is receiving and from whom. The provider must
know how much time a day the patient is spending sitting or lying
down, how much ability to move themselves, what the patient’s diet is like,
and whether or not incontinence is a factor. That initial assessment can tell
the provider a lot about how the patient might fare and what care challenges
might be present.
“It goes back to going in the home, assessing the situation they’ve
got,” explains Brad Heath, operations and compliance manager for Family
Medical Supply. “What kind of caregivers do they have? What’s the environment
like? What is their support system? You can go into the home, look at
the care the patient is getting, and kind of know what’s going to happen.”
Supporting a patient means partnering with them and their family members
and caregivers. While a provider can check in, the key is to give the patients
and the people caring for them the tools and information that can help
them ensure the patient is not showing signs of a pressure sore.
First and foremost, beyond anything we can put in the house, there’s the
caregiver,” Heath says. “Whether it’s the patient or someone else, it doesn’t
matter what we put them on if they are monitoring the situation themselves.
So providers need to be in a position where they can assess first-hand,
but also be able to communicate with physicians, patients and caregivers,
and ensure everyone is on the same page is critical, he says. This will help
the provider more quickly determine if changes need to be made. This
also presents the provider with not only an option to ensure the patient is
getting the right care, but the provider can demonstrate its expertise and
commitment to care, and if the support surface needs to be increased, then
the provider can gain additional reimbursement, as well.
Monitoring a patient with a phone call every 15, 30, 60 and 90 days to monitor
patient condition and progress is not only good policy from a care and
business perspective, but in the case of a Group 2 or Group 3 surfaces, then
the provider must be following up every 30 days from a compliance standpoint
in order to ensure proper documentation, notes and home health
notes, Heath says.
Incontinence and Diet
If a patient is incontinent, it is incredibly important for caregivers to be reliable
and properly educated on how to care for the patient and ensure he or
she is clean. Besides incontinence garments being regularly changed, the
provider must provide ample instruction on how to clean care for patients
that might not have any sensation in areas that need to be cleaned. This
can be particularly difficult for family members who might feel that they are
invading the patient’s privacy, so care must be taken to convey the importance
of this sort of care, Heath notes.
Likewise, diet is essential in proper healing. A low-sugar, high-vegetable,
high-protein and overall healthy diet will contribute greatly to a positive
outcome for the patient, Heath says. In many cases a home health provider
will offer diet support or a dietician. It might also work to the providers’
benefit to enlist the services of a dietician. At the very least, providers
should be offering instruction on baseline healthy dietary habits to the
patient and caregivers about the types of diet that can help patients heal.
Points to take away:
- The provider must start by assessing the patient’s current situation. That
will tell the provider much about what must be done, and how care will
- Patients and caregivers must be enlisted at the beginning of the process
so that they can be educated on how to assess and monitor wounds, and
communication must be regularly undertaken to monitor the process.
- When the patient is on a group 2 or group 3 support surface then monitoring
becomes a compliance requirement.
- Providers must ensure caregivers and patients are properly educated on
incontinence care and how it relates to wound care. Diet education is also
pivotal, since diet contributes greatly to the healing of wound.
Visit the National Pressure Ulcer Advisory Panel website to read complete
guidelines on staging pressure sores at www.npuap.org/pr2.htm.
This article originally appeared in the June 2012 issue of HME Business.