Teaching and When to get out

we are suppose to stay in for 3 weeks after the wound is healed, again many factors contribute to this (type of wound, payor source, patient, etc)

We stay in until wound is healed, going out 1xweekly for skilled observation.

For the most part until the wound is healed or no longer requires skilled care (DSD, Neosporin, ace wraps, etc). But there are some situations/occasions where if the wound is chronic and/or the caregivers are independent and/or they are being seen regularly by docs/wound clinics - we do discharge. Our goals of the patients being independent with their health care/management have been met. Depends on the situation.

my experience is that the RN teaches and observes until the family is safe and competent in care of the wound. the goals and POC are generally written to include that type of language. if the patient remains homebound even though they are independent in the care of the wound it may be possible to continue visiting if you can identify other skilled care that the nurse can perform. otherwise, once they meet the goal for independent, safe, competent delivery of wound care the goals are documented as met and the patient can be discharged from nursing service. the SN visits are generally frequency heavy in the beginning and light toward the end as you document their progress and success.

having said that, there are clearly differences in agency and physician expectations. if you are expected to continue visiting, make sure that you have a documented nursing POC which covers your skilled function in the home.

Here's a question: When you go in to do wound care teaching, and the pt and caregiver become competent, how long do you stay in? We have mixed ideas here, (a small rural agency). Some of us feel that once pt and caregiver competent it's time to get out, others think we need to stay in 1-2 x/wk until wound COMPLETELY healed which can take months (or years). Please weigh in, I would be interested in your rationale as well. I know some of this depends on payment source and physician preference but what is your "usual". Thanks.

Well i would think that that would depend case by case....For instance are u talking an 86year old diabetic with a tunneling stage 3 or 4? Or a simple post-op wound like from a hip surgery?

I feel that if everything goes well with healing as expected then you could probablly get out once u see competency from the client, BUT, if the case is complicated then nursing assessment skills can be invaluable to prevent complecations..and how do you teach that?? For someone who has one of those Extremely SLOW healing wounds, couldn't you just do monthly visits once the situation stableizes and PRN if necessary? Just my thoughts...i have no idea how the billing works and all that..wish i did.

How long to stay can vary, depending on the POC which is suppoed to be individualized with agreed upon and obtainable goals. You would already know the goal(s) for the wound. 1. When the pt/cg is able to demonstrate wound care, correctly. 2. When pt/cg understands s/s of infection and to report to physician. 3. When pt/cg verbalizes and demonstrates infection control, proper diposal of hazardous waste material. 4. Also, when the wound bed is responding well to the wound care treatment that was ordered.........THEN........RUN FOR YOUR LIFE.......NO...LOL