A Plan for Wound Care


5 steps to ensure your patients can care for their wounds at home.

When your patients leave your facility, they should know all the do’s and don’ts of wound care.

If their wound is changing colors, they should know what that means, and if it starts to feel dry, they should know who to call. They need to understand that a dip in the hot tub is a never event while their incision is healing.

“For surgical wounds, it’s the patient and caregiver who have to do the management,” says Kathleen Heneghan, PhD, MSN, RN, PN-C.

“There’s very little to help guide the family in doing that.”

Patients yearn for guidance to care for their surgical wounds, says Dr. Heneghan, assistant director for surgical patient education for the American College of Surgeons (ACS). But the resources to help them navigate their care can be hard to find. Even if they have a visiting aide or nurse checking in during the week, patients still need the basics to navigate those post-op days of recovery at home.

Here are 5 ways you can send your patients home with confidence.

1. Educate patients before surgery

The education on wound care shouldn’t start in the recovery room. Patients do better when that discussion starts during the appointments leading up to surgery, says Nancy Strand, MPH, RN, ACS manager of surgical patient education. She says it’s not ideal to give that information at discharge.

“They are dealing with so much emotional and physical strain and stress, cognitively it’s not a time for learning or remembering,” says Ms. Strand.

Get the ball rolling early and have a caregiver in the room during the wound care instructions, says Kathy Gallagher, DNP, APRN-FNP, CMC, UMC, BC, WCC, CWS, FACCWS. Patients struggle to retain all the information that’s thrown at them, so it helps to have an extra pair of ears listening in. This is the time to learn about a patient’s background and to tailor advice to their needs. Smokers, for example, should be told to stop using tobacco products after surgery because it can slow their healing.

“Patients want to do what they can to help themselves heal,” says Dr. Gallagher, coordinator of the Acute Surgical Wound Service at Christiana Care Health Services in Newark, Del. “When they do, it goes really well.”

It’s easy to miss the little details. Dr. Gallagher has run into patients who were surprised to learn they could have showered the morning of a dressing change. When patients are in the shower, Dr. Gallagher notes, they need to avoid perfumed soaps that will irritate the wound.

“It’s huge to follow the instructions pretty precisely,” says Dr. Gallagher.

2. Practice makes perfect

If you want to teach someone to swim, you have to get them into the pool. The same is true of changing a dressing, says Dr. Heneghan. Before surgery, the patient and caregiver should come into the office to see how it’s done.

“Just giving verbal instructions is not sufficient,” says Dr. Heneghan.

Starting early gives patients and their caregivers time to prepare. In the lead up to surgery, give them homework to watch videos about changing dressings and cleaning wounds. The ACS has created a home skill tool kit (osmag.net/p8DVdQ) and a step-by-step checklist (osmag.net/BWNfp9) that helps caregivers assess their skills.

Having this pre-op practice time leads to fewer surgical site infections and hospital admissions, says Ms. Strand. It gives caregivers confidence when it’s their time to shine after surgery.

“If you can give this [confidence] to them before the patient has the procedure, that’s the ideal world,” says Ms. Strand.

3. Dressing decisions

Not all dressings are created equal. In fact, there are thousands of options from which to choose. Sometimes, patients will need a combination of products, and your patients will look to you for help picking the supplies from the pharmacy or medical equipment store.

The dressings serve different purposes to help heal a wound, says Dr. Gallagher. A foam-based dressing will absorb a heavily draining wound. Silver, which is known to have antimicrobial properties, and antibacterial dressings are designed to ward off infection. Some advanced wound dressings can stay on for 3 to 7 days.

Give your patients specific instructions about when they’re due for a dressing change and the supplies they’ll need, says Dr. Gallagher. Some make the mistake of doing a daily change when their advanced wound dressing can actually stay on longer. Every time a dressing is removed, notes Dr. Gallagher, it takes the wound about 4 hours to get back to the ideal temperature for healing.

“The idea is to keep a perfectly moist environment, not to be too wet and not to be too dry,” says Dr. Gallagher.

4. All the essentials

You don’t want to bombard patients in the recovery room, but there’s some key information they need to have when they leave your facility. Giving patients a form with their discharge plan can make their care feel more manageable. A good discharge form puts all the essential information in one place and gives patients a reference to lean on. Here’s a list of what your patients should know:

  • the surgeon’s name and contact information;
  • the home health nurse’s name and contact information;
  • how often they need to clean and dress their wounds;
  • when they should take their pain medication before cleaning a wound or changing a dressing;
  • their wound care supplies; and
  • specific instructions related to cleaning their wound.

During a procedure, patients face an onslaught of information, so it helps to break down care into its simplest terms. Never assume your patient has fully processed all their post-op directives. “They do miss basic instructions and education,” says Dr. Heneghan.

10 Signs of Trouble
KEEP IT CLEAN Conversations before surgery set patients up with the skills they need to care for surgical wounds at home.

Instruct your patients to call the surgeon should they see these worrisome wound signs:

  • 1. Increased drainage or bleeding that won't stop with direct pressure.
  • 2. Redness in or around the wound.
  • 3. A wound tissue that changes from pink to white, yellow or black in color.
  • 4. A foul odor or pus coming from the wound.
  • 5. Increased size or depth of the wound.
  • 6. Increased swelling around the wound.
  • 7. A fever of 101 degrees or shaking/chills.
  • 8. Pain at the wound site that does not go away, even after taking pain medicine.
  • 9. If the wound has split open.
  • 10. If your stitches or staples have come out too soon.

— American College of Surgeons

5. Call for help

Your patients should be able to identify when their wounds are showing signs of infection. Give patients a phone number for the provider they can call when they have concerns.

Warning signs include changes in the wound’s drainage, smell or color. Patients should know that fever could be a sign of trouble. A proactive response can make the difference between a wound that can be managed at home and one that requires hospitalization or becomes chronic.

Sometimes patients think their wounds are infected with pus when it’s actually the natural slough that’s produced during the healing process. A call to their follow-up provider can help sort out a crisis from a normal part of healing.

“You have to be experienced to know the difference,” says Dr. Gallagher. “Patients are happy when they think they have pus, but it’s actually just slough.”

A guiding light

A wound care plan that starts before surgery sets patients up for success when they head home. Prep your patient in advance, and they’ll leave your surgical facility with the confidence they need to take care of themselves. They’ll also make fewer trips to the hospital with infections.

“It makes a big difference,” says Dr. Heneghan. OSM

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