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How to write effective wound care orders

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Writing effective orders for wound care is vital to ensure patients receive the right care at the right time, to protect yourself from possible litigation, and to facilitate appropriate reimbursement for clinicians and organizations.
Below are some overall strategies you can use:
• Avoid “blanket” orders, for example, “continue previous treatment” or “resume treatment at home.” These types of general orders lack the specificity clinicians require to deliver care the patient needs and can be easily misinterpreted. For instance, treatments can change multiple times, and someone could pick a treatment from an incorrect date.
• Use generic terminology, for instance “transparent film dressing.” That allows the supplier or healthcare facility to provide any product in that category, which can be an important consideration for patients with financial concerns.
• If, however, you want the patient to have a specific brand, include it in the order, for example, “3M™ Tegaderm™ Transparent Dressing.” In this case, the supplier or healthcare facility may not substitute another product unless you’re asked for a new order for the substitute product.
• To ensure Medicare Part B reimbursement for wound care dressings (referred to as “surgical dressings” by Medicare and insurance companies), make sure the treatment order includes at least the following information:
• type of dressing
• size of dressing
• number/amount to be used at one time
• frequency of dressing change
• expected duration of need.

For a comprehensive treatment order that will promote consistent care, include all of the following:
• Wound location
• Cleansing solution
• Primary dressing to be applied to wound bed
• As needed, a moisture barrier for the periwound area to prevent maceration)
• As needed, a secondary dressing to be placed over the primary one
• As needed, secure with _____
• Frequency of dressing change (follow manufacturer’s guidelines or change more often based on exudate amount)
• Expected duration of need.

Here is an example of a treatment order:

“Cleanse right plantar ulcer with 30 mL of normal saline. Pat periwound dry with 2 dry gauze 4 × 4s. Apply Cavilon™ no-sting barrier to wound perimeter. Apply Santyl® ointment to nickel thickness on wound bed. Loosely fill undermined area and dead space with 3 fluffed, saline-moistened 4 × 4 gauze dressings. Cover with 6 × 6 composite dressing every day and p.r.n. if loose or soiled × 14 days.”

Following these guidelines will help ensure orders are carried out correctly.

Donna Sardina is Editor-in-Chief of Wound Care Advisor and cofounder of the Wound Care Education Institute in Plainfield, Illinois.

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3 Thoughts to “How to write effective wound care orders”

  1. Ekaete Etuk

    I have used hydrofera blue for chronic leg ulcer upward of 6months now. The ulcer was clean and healing nicely when suddenly the the peri wound bed started degenerating due to moisture absorption by surrounding skin. A new ulcer opened up that soon became as large as ab initio. So discouraged.
    A). How do I protect the peri wound underneath the foam dressing?
    B). How do I encourage wound closure of a clean wound bed after using the hydrofera until there seems to be no more improvement?

  2. Sharon Troy

    Our wound care physicians are sending orders to our home health agency that include only the product to use on the wound bed; however, they do not write product to cleanse or irrigate wounds or what to cover the wound with. For example: “SN to apply aquacel AG to wound bed”. Should the agency be responsible for writing clarification orders that will include the cleansing and dressings to cover the wound. We are a Texas home health agency. Thank you.

    1. Donna Sardina

      Sharon,
      You are correct, the clinician receiving the order is responsible for obtaining clarification. This is true for any health care setting.

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