Hi-R-Ed Online

Background

What are chronic wounds?

-8.2 million people with wounds in the United States in 2018

-Costs for care estimates range from $28 billion to $97 billion

-Most expensive wounds: surgical and diabetic foot ulcer wounds

-Wound care product costs may reach $15-22 billion by 2024

Our skin protects us from the external environment and also helps to maintain our bodies. A break in the skin can compromise protection from external threats such as infection. Wounds can range from simple scrapes that heal quickly on their own, to deep tissue destruction that can threaten our survival.

Acute wounds include surgical or traumatic wounds, abrasions, and superficial burns that heal with time and are generally uneventful. Infections can complicate the healing progress of acute wounds and add a significant risk for mortality, increased wound care costs, as well as lead to chronic wounds.

This course will concentrate on chronic wounds, which are wounds that remain open for more than a month after failing to heal. About 2% of the total population may be affected by these types of wounds. While a healthy population should not have problems with chronic wounds, there are a combination of factors that predispose people to them--and an increasing incidence of non-healing wounds in the United States. These factors include:

-a growing population of aging adults,

-comorbidities of obesity and diabetes, and

-difficult-to-treat or infected wounds.

In fact, about 3% of the people in the United States over the age of 65 years have open wounds. With an increasing elderly population of about 55 million in 2020, the numbers are expected to increase and persist. And there are other factors which can increase the risk for non-healing wounds, such as malnutrition, metabolic syndrome, and stress.

The cost estimates for the treatment of wounds, both acute and chronic, is estimated at between $28.1 to $96.8 billion, with the costliest wounds being surgical wounds, followed by diabetic foot ulcers. Pressure ulcers, which affect about 2.5 million people per year, increase in incidence with aging. This may cost between $21,000 and $152,000 per individual or more than $11 billion per year. Diabetes and prediabetes, which also increase in incidence with aging, affects more than 100 million adults. While foot ulcers may affect 4-10% of the population, they may affect 15-25% of people with diabetes.

Because wounds are often treated in an outpatient setting, a larger share of the costs are associated with outpatient care. The costs for wound care products in 2014, the most recent year data is available, was $2.8 billion. The cost for wound care products alone are expected to range from more than $15 billion in 2022 to $22 billion by 2024.

As you may imagine, accurate, concise, and detailed documentation is critical to optimizing efficient and effective care to improve outcomes, control for preventable or unnecessary costs, and to assure accurate coverage of wound care costs to reduce any unnecessary financial burden on patients and their caregivers.

Learning Objectives

You may have heard the adage, “if you didn’t document it, you didn’t do it.” While that seems harsh and probably not really true, we hope that this course will provide information on both proper documentation and the reasons why documentation is a high priority in the care and treatment of wounds.

Upon completion of this course the participant should be able to:

1. List 3 reasons why proper wound documentation is important.

2. Describe 3 characteristics of proper wound documentation.

3. List 3 types of documentation beyond wound characteristics.

Now let's review some wound-related nomenclature.

-Strictly speaking, debridement is the removal of non-viable tissue or foreign objects from a wound. There are a number of types of debridement, which we will mention later in this course.

-A wound dressing may be any of a variety of materials that are applied to cover the wound to protect it, absorb drainage, and prevent infection, among other functions.

-The body produces liquid in response to tissue damage, which may require some intervention to control. The type of drainage or exudate can be thick or thin, clear to opaque, a variety of colors, and sometimes associated with odors.

-A dispensing order can be written or verbal and should contain a specific list of items along with other typical order details, such as beneficiary name, treating practitioner’s name, date or order, and signature (physician for written orders or supplier for verbal orders).

-A detailed written order or DWO outlining therapies and supplies is documented to confirm the treating physician’s verbal or written dispensing order. These orders are required by Medicare for any equipment or supplies--and must be signed by the treating physician.