Virtual Wound Assessment: Avoiding Delays in Appropriate Treatment for Pressure Ulcers/Wounds

Purpose:
Pressure ulcers present challenges to the patients who sustain them and the hospitals that provide for their care. Centers for Medicare and Medicaid, and The Joint Commission expect healthcare providers to accurately identify and stage pressure ulcers that are present on admission.

Significance:
The National Database of Nursing Quality Indicators suggests that pressure ulcer development is associated with substandard nursing care. Pressure ulcers that are present on admission, and therefore eligible for CMS reimbursement for their care, are also disqualified as hospital-acquired.

Strategy and Implementation:
Schools of nursing do not provide the level of education necessary for all nurses to possess the expertise required to precisely assess the level of tissue damage in staging pressure ulcers, as well as distinguish these wounds from those of origins that do not represent substandard nursing care. Additionally, incorrectly identifying and coding a venous stasis, arterial or diabetic ulcer as a stage 3 or greater pressure ulcer represents potentially fraudulent CSM reimbursement. The CODII method was developed to eliminate these obstructions. Computerized Online Diagnosing and Immediate Interventions empower the nurse to photograph the (paper centimeter ruler) framed wound and transmit the images over a secure website to a Certified Wound Specialist for immediate assessment and treatment recommendations. This innovation, utilized around-the-clock, has proven successful in avoiding inaccurate assessments and costly delays in appropriate, evidence-based wound treatment.

Evaluation:
A retrospective audit of records comparing the number of consults to successful assessments with recommendations revealed a 44% "missed opportunity" rate due to discharge or transfer. There was a 100% capture of all written consultation orders in November of 2010, utilizing the CODII Method.

Implications for Practice:
Patients are asked to sign a consent to wound photography for treatment and education purposes if there is any possibility for identifying the patient. Whenever possible, the CWS includes patient or proxy in the virtual consult. Many nurses may view the wound for teaching during the consultation.