As a wound care expert, you’re probably consulted for every eruption, scrape, and opening in a patient’s skin. Occasionally during a patient assessment, you may scratch your head and ask yourself, “What is this? I’ve never seen anything like it.”
Most wound care experts want to help heal everyone, and most of us love a challenge. But when should we step back and consider referring the patient to another clinician?
In a recent conversation, a healthcare clinician told me about the “magic” protocol she uses at the outpatient wound clinic where she works. A patient came to the clinic complaining that the current ostomy skin barrier kept leaking and wouldn’t stay in place longer than 2 days. The clinician started the patient on her protocol, which involves multiple ostomy products, some of them off-label, along with a heating pad to achieve an ostomy skin barrier that stays in place for at least 3 weeks with no change required.
For 3 weeks? Wow! The clinician was so proud she was saving the patient money. But by asking a few questions, I found out that:
• the skin barrier manufacturer recommends a maximum 7-day wear time for the product
• the clinician learned about the protocol from another clinician, who’d heard about it from a patient
• none of the clinicians involved had ostomy management training
• the patient now has severe denuded skin around the stoma.
Moral of the story: Even though this clinician had good intentions, she should have referred her patient to an ostomy specialist. She still would have saved her patient money and time and would most likely have prevented the peristomal skin breakdown.
When encountering a skin or wound problem for the first time, we need to look beyond just the local wound bed and complete a holistic, detailed review of the patient’s clinical history, including systemic, local, and psychosocial factors that affect wound healing. If you can’t determine an obvious cause or you lack the knowledge or experience to deal with the patient’s problem, initiate a referral immediately. For wounds on the lower extremities, refer the patient to a vascular surgeon or specialist or to another wound specialist; for a diabetic wound or toenail complications, refer the patient to a diabetic specialist, podiatrist, or another wound specialist; for an unknown rash, skin eruption, or allergic reaction, refer the patient to a dermatologist; and for ostomy or stoma-related problems, refer the patient to an ostomy specialist or surgeon.
Don’t let pride get in the way of doing what’s best for your patients. To paraphrase Karen Marie Moning, author of Dreamfever, Strength isn’t about being able to do everything alone. Strength is knowing when to ask for help and not being too proud to do it.
Donna Sardina, RN, MHA,WCC, CWCMS, DWC, OMS
Editor-in-Chief, Wound Care Advisor
Cofounder, Wound Care Education Institute