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Wound Care: 3 Principles for Treating Complex Patients

One-third of all home care patients have wound care needs. We’ve used this statistic on the Aetonix blog before, but it bears repeating.

The demand for enterostomal therapy nurses (ENTs) is high. So high, in fact, that it’s outstripping the supply of trained specialists. This is bad news for patients—especially those who receive care at home.

Of course, it’s not only patients who struggle when there aren’t enough skilled providers. Generalist nurses want everyone who needs expert care to receive it. Wound care specialists (such as ENTs) want to see more patients—including those who are hard to travel to.

Now, let’s add complex care needs to the mix. A patient with multiple chronic diseases may have an extensive care plan. She may deal with dozens of medical practitioners and take many different medications. Under these circumstances, treating a wound is far from simple.

Many home care nurses struggle with wounds in these situations, and who can blame them? Likewise, specialists frequently find that they can’t be present to track subtle changes in their complex patients. All too often, serious wounds develop or worsen.

While these outcomes can’t always be avoided, care teams can improve the likelihood of positive outcomes. Focusing on a few basic guiding principles can help.


Patient-centredness is more than just a healthcare buzzword. It’s an approach that puts patients at the centre of their care. The results, in many cases, can include better healthcare outcomes and greater patient satisfaction. It starts with listening to the patient—at every step.

What are health care preferences? What are her goals for recovery and achieving a higher quality of life? What has she experienced in the past that may be impacting her health today? And what, exactly, is she feeling today?

In health care, asking these questions should always be a top priority. But when a patient’s condition is complex, it’s especially important to ensure that her voice is heard. When many practitioners are involved, it can be more easily drowned out.

Listening to wound care patients is critical. They can shed light on a wide range of factors impacting their wounds, including lifestyle, medical history, and mental health.

Consider the role nutrition can play. Who’s in the best position to tell you what the patient is putting in his body? Who (most likely) has control over what he’ll put into it in the future?

Likewise, who can tell you how intense his wound-related pain is, and when he feels it most? Who’s better equipped to describe his depressive feelings, which may be affecting immunity? Who’s most aware of the day-to-day support the patient receives from family, friends, and other caregivers?

In addition to providing vital information, patients should be central to setting their wound-related goals. Perhaps your patient hopes for fewer dressing changes. Maybe she would like to return to the day-to-day activities she can no longer perform. The only way to know is to listen.

Patient-centredness is always an important component of good wound care. But complex patients often have extensive medical histories; they may take numerous medications and have many care providers. There are more opportunities for something to go wrong with these patients, which is why listening to them is so critical.

Meticulous Ongoing Assessment

The significance of careful wound and patient assessment can’t be overstated. And in complex patients, thorough and continuous assessment is especially important. It goes without saying that having multiple health conditions can increase the risk of wound development and progression.

Consider how you might treat a patient with poorly-managed diabetes and a foot ulcer. Now think about how you might treat the same patient if she were undergoing radiation therapy and had an immune system disorder and liver problems. In the second scenario, courses of action would likely be followed by closer observation.

Documenting progress—both in a complex patient’s wound and general health—allows providers to spot changes and prevent negative outcomes. It’s also the only way to see what’s working.

When it comes to observing the wound, the patient’s care team needs to be aware of what to look for. If you’re a wound care specialist, you know what that means: selecting the right assessment tool. The most useful tool will be relevant to the patient’s circumstances and provide clear criteria against which to measure her condition.

The Braden Risk Assessment Tool, a straightforward scoring system that predicts the likelihood of pressure ulcer development, is one of the best-known examples. Of course, there are also scales that can help determine wound status and healing, along with levels of pain.

Assessment tools can help care team members recognize potential problems. They also highlight progress so that attendant practitioners know they’re on the right track. That said, these tools can’t take the place of clinical expertise.

No two wounds are exactly alike. And implementing best practices without the guidance of an expert isn’t always wise. This is part of the reason why careful documentation is so critical.

Photographs, videos, and written patient records should be created by those involved in a patient’s wound care. They should be made available to the entire care team, including wound care specialists. Armed with this information, experts can weigh in and provide guidance.

Continuous Communication

High-quality wound care requires cooperation across care environments and multidisciplinary teams. Wounds can worsen quickly, and not every team member will be trained to recognize the signs. For this reason, generalist nurses—those who usually provide the bulk of at-home medical care—require access to wound care specialists and other relevant practitioners.

This type of ongoing communication is also important for the circles of care that surround the most complex patients. The more treatments a patient has undergone, the more practitioners he sees and the medications he takes, the greater the need for his team to communicate. Unless everyone is in the loop, mistakes can occur.

For those with complex care needs, wounds are often one of many healthcare challenges. But given the extent to which they can impact quality of life, they’re rarely a small annoyance.

In order to provide the best outcomes, wound care planning has to be compatible with a complex patient’s larger care plan. All team members should have access to these plans. They should also be able to connect easily.

For example, the ENT nurse may need to consult with the pharmacist to understand the side effects of a medication, even if it’s not being used to treat a wound. It could still cause healing complications.

But how should communication occur?

Technology has the power to connect entire circles of care through easy videoconferencing. Practitioners working with the same patient should be able to find one another easily and initiate video chat sessions via their mobile devices.

The most relevant example is videoconferencing between nurses working in patient homes and wound care specialists. These sessions can turn into virtual coaching, which may make it possible for more at-home patients to benefit from wound-related expertise.

To aid in future decision making, nurses should create detailed documentation of the healing process. These wound-related records must be easily accessible to those who can properly interpret them. Ideally, individual pictures, videos, and text-based information should also be sent via mobile when time is of the essence. But be careful: complete security is rare when it comes to exchanging digital info. Finding a safe app is key.

Last, but certainly not least, wound care patients must always be included in care team communication.

Toward Greater Wound Care Advancement

The demand for wound care expertise is growing quickly. This demand is linked to a steady increase in patients with complex and chronic conditions.

Luckily, a wave of new knowledge and technology has risen to help fill the gaps. The next generation of practitioners will build on these advancements, making life better for patients with wounds.

That said, basic principles are not without value. Patient-centredness, careful assessment, and continuous care team communication will continue to successfully guide those who provide wound care in the years ahead.

Feature image courtesy of Andrew Magill

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