Non Pressure Wounds In Post Acute Care

Janet S. Mackenzie, MD, ABPS, CWSP, AAGP

5 years ago

Non Pressure Wounds In Post Acute Care

Janet S. Mackenzie, MD, ABPS, CWSP, AAGP
September 3, 2019

Pressure ulcers are often the highest priority type of wounds within long-term care for a variety of reasons. They have significant potential for both morbidity and mortality as well as being a high risk for litigation. These wounds are also carefully tracked through Minimum data set reporting (MDS) and are markers of quality as reflected in 5-star ratings. Both long term and short-term quality indicators exist for these measures. Non-pressure wounds as an aggregate occur more commonly than do pressure wounds but do not have any quality measures associated with them. The non-pressure category accounts for around 60% of wounds. Diabetic, arterial, venous and wounds caused by trauma are the most common. Other less frequent wounds are lymphedema related, neoplasms, autoimmune, burns,and post-surgical. MDS tracks arterial, venous, diabetic, post-surgical, burns and the category “open wounds other than ulcers, rashes and cuts.”

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Why the focus on pressure?

Pressure wounds have been a focus of regulatory, education, dressing innovation for several years while non-pressure wounds do not receive the same attention. They are less understood across all levels of long-term care and often receive less concern and inquiries from families. In addition,the general awareness created by organizations focused on quality in long-term care just doesn’t happened for these types of wounds the same as it does for pressure ulcers. One reason for focus on pressure ulcers is they are a “never event” for hospitals. As a result, all the focus goes toward pressure wounds while non-pressure is often ignored. Non-pressure wounds are often more complex and require higher levels of training and skill to properly diagnose and treat.

The challenges of non-pressure wounds

The challenge that non-pressure wounds present is that they often require special expertise to manage well and require a multidisciplinary approach that may need to involve physicians from multiple specialties. Access to both skilled experts and skilled care givers at the bedside are often a difficulty when treating these less common wound types. Take for example venous ulcers a condition that accounts for about 6% of wounds in long-term care. Proper treatment of these wounds often calls for bandages that provide gentle compression of the leg. Improper diagnosis, examination,or application of a compression dressings can have drastic consequences and can result in loss of the limb. Having a physician available that can properly diagnose a venous ulcer, examine and confirm adequate arterial blood flow, and having a nurse trained in application of compression dressings is often difficult to find. That is just one example of a non-pressure etiology that poses a challenge for long-term care.

How to fill the gap in care

When addressing this wide variety of wound etiologies, it is best to bring together a comprehensive wound care team. A team that is well coordinated and led by a physician with training and specialization in wound care is the ideal model. Having a nurse certified in wound care as part of the team is integral to its success. Improved clinical outcomes start with knowledge and education and it is important that these exists at all levels from physician staff to nurse assistants. When knowledge is lacking the prevention, diagnosis, and proper treatment of these types of wounds will suffer. When a multi-disciplinary approach to wound care is available infections, amputations, and hospitalizations related to wounds are reduced by nearly 90%. Vohra Wound Physicians offers the industry leading wound certification exam and free wound care education that can bridge many of these knowledge gaps. We have also developed world leading proprietary clinical intelligence tools to guide therapy and enable providers to excel.