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Reducing Cost and Risk: Regular Bedside Wound Care as an Alternative to Wound Care Centers

Skilled nursing facilities (SNFs) do not typically have in-house wound specialist physicians. Instead, SNF residents suffering from chronic or non-healing wounds usually visit outpatient wound care centers. Although wound care centers have skilled physicians and offer advanced treatment options, commuting for care can be costly and dangerous to ill and elderly patients and can hinder effective communication within the care team. 

 

A valuable alternative to these commutes is providing SNF residents with bedside wound care services and regular access to wound specialists. When SNFs partner with Vohra Wound Physicians, the nation’s leading wound care specialty practice, our skilled physicians conduct weekly visits and provide bedside care and procedures to reduce the risk of transporting patients to wound care centers—all at no cost to the facility.

 

Editor’s Note: Vohra Wound Physicians would like to offer your facility a complimentary 15-minute wound care consultation to discuss how we can help reduce operating costs, prevent hospitalizations, and reduce the risk of COVID-19 exposure by managing patients in-house – all at no cost to you. Schedule a Free Wound Care Consultation for your SNF Now.

Wound Care for SNFs

Providing bedside wound treatment improves continuity of care, increases wound care knowledge within SNF nursing staff, and enhances communication between all members of the interdisciplinary care team. SNFs with exemplary wound care programs can also become Vohra Centers of Excellence, a valued distinction that differentiates SNFs and demonstrates their dedication to exemplary patient care.

To improve understanding of wound care management and demonstrate the value of the bedside care model versus traditional wound care centers, the experts at Vohra Wound Physicians have put together this article explaining important considerations regarding wound patients residing in skilled nursing facilities.

Background on Wound Care Management 

Wounds result from internal or external breaks in body tissue, typically as a result of falls or accidents. The underserved geriatric population is at particularly high risk for the development of wounds due to age-related skin changes, comorbid conditions, and various medications.

Depending on healing progression, wounds are classified as acute or chronic. Acute wounds, which follow normal healing progression, include burns, surgical wounds, and traumatic wounds. Chronic wounds, which are non-healing or improperly healing wounds, include ulcers (most commonly pressure ulcers), infectious wounds, and worsening surgical wounds.

When is specialized care needed for wounds?

Specialized care is required when wounds become infected or chronic. Wounds become infected when pathogenic organisms invade the damaged tissue, causing pain and inflammation. This is most often the result of a puncture wound by a foreign object or an improperly cleaned wound. Chronic wounds are those that fail to heal properly or within the expected period of time. Infected and chronic wounds require comprehensive assessment, specialized treatment plans, and expert care.

How do you identify a wound infection?

Infected wounds can be identified by observing patient symptoms and considering relevant risk factors. Wounds are at risk for infection when they result from a puncture with a foreign object (such as nail or piece of glass) or a bite, when they are not properly and regularly cleaned, and when they contain dirt or saliva. Elderly patients and those with pre-existing conditions such as diabetes, alcoholism, or weak immune systems are also at higher risk for infection.

Once an infection has developed, the first indicators are pain and swelling. There will also be increased temperature at the site of the wound, pus leaking from the wound, and slowed or halted healing. If not treated, infection can spread or worsen.

Wound Care for SNFs

How do you prevent a pressure ulcer?

There are several important strategies that can be employed to prevent pressure ulcer development. The first is establishing a facility-wide prevention plan and educating facility staff about the importance of pressure ulcer prevention. The second is conducting regular risk factor assessments on all patients using a validated assessment tool such as the Braden Scale. Identifying these risk factors early enables the wound nurses to take preventative measures. 

Regular skin care is another important component of pressure ulcer development. Regularly cleaning and moisturizing patient skin can help prevent injuries and allows staff to identify symptoms early. Maintaining appropriate patient nutrition, particularly sufficient Vitamin C, Vitamin A, and zinc, can also support effective wound healing. Lastly, regular repositioning and mobilization for immobilized or bedridden patients can prevent undue stress or friction on skin and reduce the risk of pressure ulcer development.  


How do you keep patients compliant with treatment?

The most important strategy for maintaining patient compliance is effective communication and patient-focused care. In addition to regularly assessing changes in patient status and treatment effectiveness, the care team must ensure that the patient and their family understands how and why the treatment is taking place and the importance of patient compliance. The patient should also be assured that their care plan will be adjusted as needed and that their healing is top priority. 

Specialized Wound Care

If wounds are infected or non-healing, they require specialized care by an expert wound physician. This care can be provided by wound specialists at outpatient wound care centers or preferably by a wound physician inside the facility, following a bedside care model.


What is a wound care specialist?

Wound care specialists are physicians with advanced wound care training or significant clinical wound care experience. These physicians may be from many specialty backgrounds, but they typically have an interest in procedurally-focused medicine and providing ongoing care. Vohra physicians typically come from family medicine, internal medicine, or surgery backgrounds (general or specialty).

Wound Care for SNFs

How can you get wound healing treatment?

Historically, SNF residents with wounds have been transported to Wound Care Centers for wound healing treatment. However, with Vohra’s pioneering bedside care model, many SNF residents now receive expert care without the risk associated with commuting. Vohra physicians make weekly visits to partnered SNFs to see patients and lead care teams. They provide bedside care, perform procedures, develop treatment plans, and provide care continuity as patients progress through the healing process. Vohra physicians are able to partner with SNFs at no cost to the facility. 


What do wound specialists do?

Vohra wound specialists oversee wound healing from start to finish. In conjunction with the SNF care team, Vohra physicians perform a wound assessment, including classification and measurement, and develop a specialized care plan. Vohra physicians then regularly follow up to track healing progress, update the treatment plan, and communicate with the care team and the patient, both in person during weekly visits and via telemedicine when appropriate.

Wound specialists at wound care centers also develop and oversee wound healing and treatment. However, due to stricter scheduling and patient commutes, visits can be briefer and more sporadic, and the physician may not have the opportunity to communicate with the patient’s entire SNF care team. 

Alternatively, receiving bedside treatment from a wound specialist ensures continuity of care and easy and effective communication within the interdisciplinary team. Vohra Wound Physicians are able to provide many of the services of a Wound Care Center from the bedside at both SNFs and at home via partnership with Home Health Agencies. They perform procedures, offer advanced treatment options, and provide telemedicine support through the Vohra@Home program. They can also improve the wound care knowledge of the SNF staff. Vohra also offers a wound certification program for those interested in improving their wound care expertise.

Wound Care Certification

For many patients, commuting for care can be a difficult and painful process, particularly if the visit includes a procedure such as a biopsy or debridement. Traveling to a care center also increases the risk of patient infection, which can put an entire SNF at risk. With Vohra, procedures can be performed from the comfort of a patient’s room, and weekly follow-up visits ensure continuity of care and proper wound healing trajectory. Vohra physician documentation also ensures that the facility has comprehensive charting for CMS State Surveys and can avoid F686 regulations. In addition to providing comprehensive wound care, Vohra physicians are prepared to advocate on behalf of their partnered SNFs.

Understanding Chronic Wound Care

Wound physicians often treat chronic wounds, or wounds that are non-healing or are not properly progressing through the stages of healing. Common chronic wounds include pressure ulcers, diabetic foot ulcers, and infectious wounds.


How do you treat a chronic wound?

Chronic wound treatment begins with comprehensive assessment of the wound and the development of a corresponding treatment plan. This plan depends upon patient risk factors, such as comorbidities or mobility limitations, and often includes preventative strategies. Depending on the nature of the wound, several treatment options may be utilized. Common procedures include debridement, cauterization, and skin biopsies. In some cases, hyperbaric oxygen therapy, negative pressure wound therapy, and the use of advanced wound dressings may be applied.


What is combination therapy in wound healing?

Combination therapy is treatment with two or more drugs or therapies simultaneously. When properly implemented, combination therapy can speed up wound healing and improve patient quality of life. In wound care, combination therapy is often a mix of dressings, medications, skin procedures, and repositioning. Strategic combination therapy can be valuable in the treatment of chronic wounds and can assist in preventing rehospitalizations.

Wound Care for SNFs

What are the different types of wound care dressings?

Wound care dressings primarily differ due to gauze type and wrapping method. Depending on the nature of the wound, physicians will choose gauze based on breathability, flexibility, and absorbency. The type of wrap is also important: the number of layers and type and amount of compression needed depend upon the location and type of wound. 

When visiting SNFs and providing bedside care, Vohra physicians easily provide optimal dressings using our Dressing Delivery Program (DDP). With DDP, our physicians identify and prescribe appropriate surgical dressings at the patient’s bedside, and they are delivered to the SNF within 24-48 hours.

Effective Wound Care with Vohra

Millions of patients suffer from wounds each year, often requiring care from expert physicians. Although wound care centers were historically an option for specialized wound treatment, currently, bedside care at SNFs is the ideal treatment option to improve continuity of care and mitigate the risk of patient injury and illness during transport. Vohra Wound Physicians pioneered the bedside care model, and our physicians provide onsite treatment for SNF residents across the country. For SNF residents in need of wound care, Vohra is the solution.

 

Vohra Wound Physicians is the nation’s most trusted wound care solution. Founded in 2000, Vohra works with nearly 3,000 skilled nursing facilities and uses innovative, proprietary methodologies and technologies to provide superior wound healing to patients.

Physician Careers

Wound Care Certification

Wound Care for SNFs

Telemedicine
at Home

Author: Dr. Japa Volchok, DO

Dr. Volchok is the Vice President of Operations at Vohra Wound Physicians. Trained as a vascular and general surgeon he joined Vohra in 2009. Dr. Volchok is currently responsible for Vohra’s telemedicine program, legal and regulatory matters, and physician recruitment. He completed an executive management program at the Harvard Business School.

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