Wound Care

Both home health agencies and hospices may care for patient wounds in the course of their work.  Wound care may involve treatment of ulcers, burns, pressure sores, open surgical sites, fistulas, tube sites, and tumor erosion sites as well as other types of wounds.  The challenges of wound care include several factors—accurate assessment of the wound, provision of wound care per physician/allowed practitioner orders, and ongoing documentation of progress or deterioration of the wound.  The Medicare Benefit Policy Manual, Chapter 7 for Home Health Services states medical necessity for wound care must include documentation of the size, depth, nature of the drainage, and condition/appearance of the skin surrounding the skin.  The use of objective data descriptions on a regular basis (e.g., weekly) and when problems arise are imperative to demonstrate the patient’s continuing need for skilled care.  In this age of electronic documentation using checkboxes, home health and hospice organizations may struggle with this aspect of care.  As a result, many agencies and hospices utilize photographs of the wound on a periodic basis.  This requires written consent of the patient and measures to protect protected health information.  However, it is an effective documentation tool.  Finally, clinicians must provide wound care according to the physician or allowed practitioner’s most recent orders—a task easier said than done when orders change on a frequent basis.  Wound care may, at first glance, appear to be a straightforward clinical skill.  However, organizations may need to review the common pitfalls to survive medical review and/or state surveys. Utilize our Wound Care tools and personalized OASIS training on wounds at your agency.