Wound Care in the Home Setting

      My favorite thing about home health care is wound care. I love it. It excites me. Others may find it revolting, whereas I find it extremely interesting. It amazes me how a body can repair itself. However, wound care in the home setting, does have it difficulties. You are hindered by inadequate lighting. Burdened with pets running rampid, in the home, causing your clean or sterile field to become contaminated. Home health nurses deal with wounds on every part of the wound spectrum, from skin tears to burns. The biggest obstacles is finding a willing and able caregiver to teach.

 Here are some tips to enable you to better care for your wound care patients, in the home setting:

  • Nurses typically use a clean versus sterile technique. Call the patient before you visit and ask them to put away any pets. There's nothing like placing a wound vac, on a wound, only having to remove it because cat hair has gotten into the transparent draping.  Having pets contained lessens the chances of stray hair flying everywhere.
  • Make sure that the patient has a clean place to store supplies. This place should be away from pets, children, and etc. Advise them to purchase a plastic tote if neccessary.
  • Have all supplies readily available before beginning treatment.  Gather all your supplies and arrange them on a plastic draping. Make sure you have disposable bags to properly dispose of soiled dressings and supplies.
  • Designate a specific place where treatment should take place. Advise patients to keep this area as clean and clutter free as possible.
  • Take clear pictures of wounds, keep good measurements, and document well. 
  • Measure using the same type of tool, using same method of measurement, and same way. If you used centimeters, measured from head to toe, with an "L" shaped disposable ruler, on admission, then continue to use the same until the patient is discharged.
  • "Measure Every 7 days.                  Length x Width x Depth in centimeters Head to toe direction, clock face. Measure undermining and tunneling @ deepest point. Document +8 if cotton tip applicator doesn’t reach. NEVER APPROXIMATE MEASUREMENT."(Cheryl Carver-LPN,WCC,CWCA,FACCWS,DAPWCA,CLTC, Founder of Wound Care Education Consultants, LLC)
  • Encourage the patient and caregiver to be involved in wound care.  The purpose of home health is to TEACH! The patient and caregiver should be knowledgeable of wound care(step by step guide to treatment, how often to change, etc) signs and symptoms of infection, proper nutrition to aid in wound healing, and have an idea of what necrotic tissue looks like. 
  • Develop a trusted bond and rapport with the patient's physicians.  This means all physicians. A diabetic patient may be under the care of a surgeon, for his wounds; however, it may be imperative to consult with his endocrinologist  or primary care physician to adjust his insulin or diabetic agent, as high blood sugar will delay wound healing.
  • Order supplies before you run out....self explanatory.
  • Be your patient's advocate. Some physicians may not be up to date on the latest wound care. If a wound is not showing improvement within 3 weeks, it may be time to try something else. Call the physician. This is where your notes and pictures become handy. Paint a picture and relay to the physician that the wound is stagnant or declining.  An example would be silver wound dressings. Although, they are antimicrobial and have their advantages, studies have shown that using silver for extended periods (greater than two weeks) offers little clinical benefit. Yet, we still find cases where silver is being used for months and months. Educate yourself! 
  • Warm cleaning solutions and ointments before you apply them. It makes wound care more comfortable for the patient, but also aids in speeding healing.

  • Get creative when applying dressings. "A wound care expert shared advice for dressing a sacral wound, a notoriously problematic area for caregivers. Turn the dressing so the corner of the dressing is in the gluteal fold — corner down, so to speak,” explains Derma Sciences clinical specialist Ann Avery, RN, CWCN, LNC. “This will allow the dressing to stay on longer as the seal stays more intact and doesn't allow incontinency to travel up the gluteal fold under to the dressing to contaminate the wound bed.” (www.mcknights.com)

  • Don't be afraid to ask for help. In hospital and long term care facilities some wounds require two sets of hands. Home health is no different. Ask that another nurse be sent, with you, until you can properly teach the caregiver to aid you, in wound care. This will save you valuable time, as well as increase comfort for the patient. 
  • Use proper body mechanics.  Position the patient so that the wound is clearly exposed and easy to get to. You may want to have the patient purchase pads( some purchase puppy pads because they are inexpensive) to use during wound care, to avoid making a mess. At the least, use a clean towel. 
  • Be confident. Your lack of confidence in your skills will show. It will make the patient uncomfortable and can cause you to second guess and miss something vital.
  • Remember to address the whole patient, not just the hole, in the patient. Teach the patient proper nutrition, proper hydration, the importance of maintaining a therapeutic blood glucose level, avoiding alcohol, repositioning, smoking cessation, and etc. 

 


4 comments

  • Isn’t it amazing that there are so many more steps to consider when working with a patient in the home!! I found this super interesting. Things that we don’t even think about… like having a clean place to store supplies. My eyes were truly opened when I visited over 40 homes in the Baltimore area during a research study on medication adherence. Yikes!

    Elizabeth Scala
  • This is an excellent article, very comprehensive. I worked for 20 years in Home Care, and if I were still doing that I would make sure all my students and new nurses I mentored got a copy. Definitely will share with my former colleagues.

    Debby
  • When I worked in home health, I loved wound care, but sometimes found finding a clean or sterile field difficult. Had to be very creative in some situations!

    Nurse Born Products
  • Just want everyone to know that the nurse who is starting this HOME HEALTH WOUND CARE is the best you will ever find. She really knows more than the Dr’s know, actually one time she recommended a change in my WOUND CARE and the Dr changed the order to what she recommended. We IMMEDIATELY SAW RESULTS. I give her a 12 out of a 10! Her bed side manor is one that no other can match! Also so trust worthy we even unlock the door for her so she can come into the house. 100 percent PROFESSIONAL.

    Jay

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