Facilitating Improved Documentation In Wound Care

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Clinical Editor: Kazu Suzuki, DPM

   Dr. Suzuki says at each visit, one should ask and document the wound pain, which is a vital sign that indicates the status of the wounds being treated, while being the major factor in each patient’s quality of life.

    “The rest pain from critical limb ischemia may be mistaken by the patient as wound pain while the neuropathic ‘non-painful’ wound can turn painful when it gets infected,” emphasizes Dr. Suzuki.

Q: What dressings do you use and how do you document them?

A: For most wounds, Dr. Suzuki uses foam dressings as well as “shower-proof” bordered foam dressings. He prefers non-adherent dressings with silicone-based adhesives. Dr. Suzuki says these dressings do not cause additional skin tear upon removal.

   He combines the foam dressings with film dressings such as Opsite (Smith and Nephew) or Tegaderm (3M). He secures them with elastic wraps, elastic nets and/or cohesive wraps. Dr. Suzuki also uses alginates for highly draining wounds and hemostasis as well as hydrogel for moistening dry wounds and eschars.

   Although physicians know that a moist wound healing environment results in the least painful and the fastest healing results, Dr. Suzuki says there are very few randomized controlled trials on which basic type of dressing facilitates healing better than others. He notes that dressing choice comes down to personal preference, given what is available in the clinical setting.

   Occasionally, Dr. Suzuki will use silver antimicrobial dressings including Mepilex AG (Molnlycke), Silvercel (Johnson and Johnson) or Aquacel AG (Convatec). However, when it comes to justifying the cost of silver dressings, he notes an absence of definitive clinical evidence regarding whether silver dressings heal infected or critically colonized wounds faster.

   At Dr. Suzuki’s facility, there is a cabinet full of dressing samples and starter kits for the new patients to take home. He says most patients ask for “extra dressings” before he can dispatch a home health nurse or send a Medicare-supplied dressing by a third-payer company.

    “These come from the bottom line of your practice but I consider it is necessary as most pharmacies do not carry these specialized wound dressings,” says Dr. Suzuki.

   One should document primary and secondary dressings as well as the frequency of change and the duration, according to Drs. Wu and Fife. If the patient gets a new dressing, Dr. Fife says one should state why the patient received a new product. It may be due to maceration, dryness, pain, patient preference, etc.).

   Dr. Wu’s center has a list of primary and secondary dressings so the clinician can save time by ticking off what he or she used. This also allows clinicians to track the length of time the patient has been using a specific product.

   For example, she says if a patient has been using a particular product for more than four weeks, given that all other factors are well controlled, then the clinician should try another product or an advanced wound healing modality. With this list of dressings, one can also track whether he or she has used the wound product before. With so many dressings to keep track of, Dr. Wu says the doctor can become confused.

   Dr. Wu also arranges the delivery of wound products to patient’s homes. The nurse can easily help refill the wound care product (provided that the clinician does not wish to make any changes) based on the tracking sheet of what the doctor previously ordered. She says the tracking sheet also provides documentation of what the doctor has been using so one can continue the same therapy if it is working well for the patient.

Dr. Fife is an Associate Professor in the Department of Medicine, Division of Cardiology at the University of Texas Health Science Center in Houston. She is the Director of Clinical Research at the Memorial Hermann Center for Wound Healing and Hyperbaric Medicine.

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