Posted on Friday, October 14, 2016 8:22 PM
It’s essential to make sure a wound is measured correctly from the inside edge to successfully document the correct wound size and ensure that tunneling or undermining is evaluated. If a wound for size and depth is measured improperly, then it can result in worse quality outcomes and reduced payments.
If the wound is large and deep — to the bone, for example — clinicians are not going to be able to get proper dressings and devices covered, says Nancy Morgan, co-founder of the Wound Care Education Institute in Plainfield, Ill.
Measure Tunneling vs. Undermining
Clinicians frequently confuse tunneling and undermining. Tunneling is when wounds develop channels under the subcutaneous tissue. Undermining is damage near the wound margins. It’s important to know the difference between the two, because they are measured and documented differently, Morgan advises.
When measuring tunneling, clinicians should insert a cotton swab into the tunnel. The edge of the wound is then marked on the swab. The swab is then measured from the mark to the tip to determine the depth, Morgan says.
Clinicians must be sensitive to patient distress when measuring wounds with tunneling or undermining, making certain they are pre-medicated, says Cindy Garcia, Chief Operating Officer and administrator for Ideal Home Health Care in Westlake, Ohio.
“A wound with tunneling may not heal fully, have changes in granulation or may seem closed. They may get [a measurement] that goes from 6 cm to 2 cm, but it’s really a small area of healing. They can’t be afraid to really get in there,” Garcia says.
Clinicians often measure wound depth incorrectly, adds Barbara Dale, director of wound care at Quality Home Health in Livingston, Tenn. “Depth is an issue. People don’t understand that if the skin is gone, [the measurement] is at least a 0.1 cm,” Dale says.
Data Drives Documentation Improvement
“Having the same person at the same time and place helps with accuracy,” Garcia says.
“Another thing we are doing differently is providing in-depth bi-weekly training on accurate OASIS documentation. It is mandatory for OASIS clinicians,” Garcia says.
“They are currently putting together a ‘survival guide’ for nurses and patients to use as a tool in the healing journey — from shorter healing times to increased use of lab work and dietitians as well as close monitoring and changing of ineffective wound care products,” Garcia says. “We are hoping these endeavors further improve our OASIS documentation, scores and ultimately outcomes.”
The following tips are available to properly assess wound measurements:
• Have policies in place that direct the same clinician to measure wounds at regular intervals
• Make sure correct and adequate supplies are available for clinicians to perform measurements
• Develop a robust education program on proper measurement technique and documentation
• Review staff competencies annually
For the full article, please see the October 17, 2016 Home Health Line Edition.
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