7 tips to Manage Caregiver Noncompliance with Wound Care

 

One of most difficult tasks in home health care is finding a willing and able caregiver, to perform wound care. The lack of a caregiver often leads to noncompliance with dressing changes, which increases the chance of a declination of the wound.  Caregivers often find the task of performing wound care daunting, intimidating, a burden, or just downright gross. As a home health nurse your goal is to not only  teach the patient and/or caregiver how to perform wound, but to also make it more manageable.  Here are seven  tips from us to avoid non compliance:

1.) On admission, start of care, recerts, resumption of care, and etc make it known, on DAY 1,(unless otherwise specified by physician) that there is to be a willing and able caregiver and that caregiver must perform wound care, when the  nurse is not in the home. Document.

2.) Teach the caregiver how to perform wound care. Have them return demonstration, and document a successful return.  If they are not successful, it is your responsibility, as the patient's nurse and advocate to continue to  educate and demonstrate until the caregiver is competent.  Once competency has been verified, make it clear that the nurse will assess the wound and change dressings on visit days,  but on all other days the caregiver is responsible. Have the caregiver verbalize understanding. Document.

3.) Mark, on a calendar, days that  wound care is to be performed and have caregiver and patient initials those days once wound care is complete.  This is an excellent way of tracking compliance and accountability. Document.

4.) We all know that we will have caregivers marking the calendar, right before the nurse is to visit, although they haven't performed wound care. An excellent (and sort of tricky) way to see if this is happening is to mark the inside of the dressing with the date and time of your dressing chang. Be sure to initial. When you return, to the home, and remove dressing,  if your markings are still present, then  you know that there is a compliance issue. Document.

4.) Document each episode of non compliance, contact the physician, and notify the caregiver that not only is noncompliance grounds for discharge from the agency, but it is also detrimental to the healing process of the wound and can lead to declination and infection. 

5.) Each visit ask the patient and caregiver if wound care is being performed and if they have any issues or concerns. Address thesw issues and concerns. On random visits, have caregiver  to perform wound care and document competency. 

6.) Praise the caregiver for their compliance, eagerness to learn, and the excellent job they are doing on wound care.  This will ease any concerns or doubt  the patient may have.  

7.) Take pictures weekly. This is an excellent way to show progression, as well as to prove noncompliance. 

Noncompliance is a huge issue, in home health. We hope that these seven tips will help you, your team, and your patients to a better healing future. 


4 comments

  • Padma,
    I appreciate the conversation. That’s what this blog is for! I am very open to learning new methods, to better serve my patients. I will try to be less subjective. Thank you, for your knowledge and expertise. I will put it to great use!

    Portia
  • Hi Portia,
    I did not intend to be offensive and I appreciate your response. I did not intend to attack you, though I see how what I wrote could be seen in that light. I found myself reflecting on the term “non-compliance” and looking at it from the client’s point of view. The distinction is subtle- between “non-compliance” and “pt did not perform the prescribed care because….” It is as if we in the medical world have the one way to do things and if another does not follow it, we call it non-compliance. Documentation is essential, and oftentimes the language we use reflects our unconscious bias. I worked in hospice home care for years, and stopped using the term because of the subtle distinction. The medical community advise, “doctors orders” are one of many possible approaches and the client/patient always has options to follow those suggestions, orders, prescriptions or not. Thanks for giving me the opportunity to articulate this topic more clearly. Padma

    Padma Dyvine
  • Padma,
    Thank you for comment. However, se do not feel that this article is hierarchical, condescending, or punitive. Home health nurses are putting their license in jeopardy each time they enter a home. Non compliance is simply something that hh nurses deal with. Documenting noncompliance not covers the nurse and agency, but it also helps the nurse to be an advocate for his or her patient. Tip #5 covers inquiring why the wound care is not being completed. The nurse will then address those issues. The purpose is of home health is to educate and to get the patient back to a functioning independent role, or as much as possible. Your comment was very helpful. Thanks

    Portia Wofford
  • I have been thinking about the words, “non-compliance”. What I notice in this article is the importance of documentation, trying to make sure that the wound is cared for, and that the caregiver understands what is expected. The tone however, of this approach is a hierarchical, condescending and punitive. I am sensing the frustration because the care is not happening. I am missing a friendly, collaborative and exploring sense of working with the patient and caregiver. If the wound is not being cared for as wished, there must be a reason and it might take some patience, deep listening and understanding to ferrit it out and help the caregiver with the obstacles to performing the wound care. Hope this is helpful, With love, Padma

    Padma Dyvine

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