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.