Inadequate wound management is one of the most common clinical complaints received by the Aged Care Quality and Safety Commission (the Commission).
Failure to implement effective and timely wound care, can lead to poor health outcomes for residents in aged care, in particular preventable wound infections that may then require antimicrobial treatment or hospitalisation.
Wound management mistakes
Common wound management mistakes the Commission has seen include:
- failure to adequately document the wound assessment process e.g. missing essential information such as wound dimensions, wound bed appearance, amount and type of discharge and signs of infection
- infrequent wound assessments, including not re-assessing the wound when it deteriorates
- failure to update treatment plans, including documenting reasons for treatment changes
- failure to document the goals of treatment e.g. whether the goal is to heal, or to manage the wound if it is assessed as unlikely to heal
- inadequate pain management e.g. not using an appropriate pain assessment tool, not scheduling dressing changes/treatments around the administration of pain medication and not documenting pain management strategies
- poor quality photographs which fail to show the condition of the wound
- not escalating a deterioration in the wound to the resident’s GP in a timely manner.
To ensure good wound management, providers and their staff must start with an initial comprehensive assessment of the resident’s wound. This assessment should be documented and guided by contemporary wound management guidelines. It should consider all factors that affect wound healing, including the resident’s age, health status (e.g. poor circulation, diabetes etc.) and nutritional status.
Treatment plan
Once assessed, a treatment plan should be developed for ongoing monitoring and management of the wound. The plan should include comprehensive wound treatment details (including pain management strategies) and the goals of treatment e.g. healing the wound, or ongoing management if healing is unlikely. This plan should be reviewed and updated regularly.
If the wound is more serious, or is not healing, providers should seek external support from a wound specialist. The resident’s GP should also be notified.
Monitor and analyse
Providers should monitor and analyse their own data under the National Mandatory Quality Indicator Program to understand where improvements can be made and, help monitor consumers and review their care processes including pressure injuries which is a common cause of wounds.
Part B of the Quality Indicator Manual also provides helpful information about preventing and managing pressure injuries.
