Conservative Sharp Debridement

[thulchatt]

I am in the process of writing a policy for CWOCN use of Sharp Debridement in my hospital. I called the state board of nursing (Tennessee) who stated it was on a hospital by hospital basis and the state did not regulate that specifically. So, anyone care to share their hospital's policy on this subject for me to take a look at? It would be so appreciated!

[CWONgal]

I'd share but our hospital has a policy that the we can't do it although the state doesn't have an issue with it if you are trained.

[mommy.19, MSN, RN, APRN]

I offer consultation services to facilities for policies and procedures such as this, as do many CWOCNs/CWSs. Most will not provide them for free simply for that reason. Also, some facilities have their own subset of policy that governs whether or not their Chief of Surgery even wants to be responsible for overseeing nursing's utilization of CSWD. What is your state BON's stance on RN CSWD?

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[carl5480]

My hospital allows CWOCNs to do bedside debridement, as well as physical (and sometimes occupational) therapists. In Texas, any nurse is technically allowed to debride. However, there are strong warnings that you are probably not legally protected if you haven't been through a formal debridement course (with clinical/lab), so it's pretty much unheard of outside of wound care specialists. Our CWOCNs have a protocol they follow, on which excisional debridement (I think this is the new terminology we're supposed to be using now) is listed.

Having said that, we don't get as much reimbursement for bedside debridement as physical therapy does. In fact, there is zero reimbursement for us unless we 1) say "excisional", 2) describe exactly what level of tissue we are debriding, and 3) describe what instruments we use. Even then, no reimbursement unless the physician states in his notes that the wound care nurses are performing excisional debridement. For this reason, we usually order PT to do debridements for us (the physician signing the order is his documentation, I think). The only exceptions are when it isn't feasible for us to track down PT - say in the middle of a wound VAC dressing change, or on the weekend.

[Davidaugustyn]

We have 3 WCC nurses at my facility including myself that have taken a "certification" for sharp debridement. (though not acknowledged by the state except as being educated)

We cannot technically do sharp debridement. I believe only because PT here does it and can charge for it. If you were going to do this right, you should get PT involved so you can bill. Sorry to say thats how it is. I will still cross-hatch and provide minimal sharps when I think it's necessary.

If you still want to have them do it, I would suggest a weekly debridement day and only remove minimally.

[mommy.19, MSN, RN, APRN]

There is no true certification in CSWD because to be certified in something, there must be a certifying body that provides a credential. I have been trained and received a certificate of completion of a CSWD course and have a physician that signed off on my skills at my facility, but I am not certified in CSWD (no one is). My state BON has a position statement on CSWD by RN's. You are correct, they are not able to bill for it. It is a very grey area and that is why many wound care RNs prefer not to perform CSWD. :/