What exactly are “the rules”?

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Editor-in-Chief

During a recent wound care presentation, an audience member jumped up to contradict the speaker. “That is incorrect,” she asserted. “The rules state….” When someone asked her what rules she was referring to, she replied, “The government’s rules.”

On the surface, that might seem like a straightforward answer. But when you stop to think about it, what government did she mean? Federal? State? Local?

With so many rules, regulations, and guidelines out there, you might have trouble figuring out what “the rules” really are. For wound and ostomy clinicians, they may vary from one care setting to another. However, the clinical practice guidelines (CPGs) are the same. Many different organizations have released CPGs on various skin and wound care topics. Here are some of the most quoted CPGs in our field:

American Diabetes Association: Comprehensive Foot Examination and Risk Assessment

Association for the Advancement of Wound Care (AAWC) venous ulcer guideline

Healthcare Infection Control Practices Advisory Committee

National Pressure Ulcer Advisory Panel: 2014 Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline

Wound, Ostomy, and Continence Nurses (WOCN) Society: Guideline for management of wounds in patients with lowerextremity neuropathic disease

WOCN: Guideline for management of wounds in patients with lower-extremity venous disease

WOCN: Management of the patient with a fecal ostomy: Best practice guideline for clinicians

Other rules, regulations, and policies

Beyond CPGs, other rules, regulations, and policies affect wound and ostomy care, including those of reimbursement agencies, insurance companies, and quality organizations. See the following websites:

American Nurses Credentialing Center’s Magnet Recognition Program®

Centers for Medicare & Medicaid Services: Long-Term Care Facilities

Health Insurance Portability and Accountability Act

The Joint Commission

And don’t forget about rules related to safety for you and your coworkers, such as those from:

Occupational Safety and Health Administration

Of course, you also need to follow your employer’s policies, protocols, and rules. Finally, be sure to abide by the scope of practice and state practice acts that govern your professional licensure. Remember—basic licensure rules supersede other regulations, especially if CPGs or reimbursement or quality guidelines recommend skills and tasks to be completed that aren’t within your scope of practice. Refer to the links below:

State boards of nursing

State boards of physical therapy

State medical and osteopathic boards

Finally, if you enjoy reading guidelines or need something to do in your spare time, I can recommend a WOUNDerful website: www.guideline.gov. Here you’ll find all the guidelines you need to keep your wound and ostomy practice safe and up to date.

Even though “the rules” can seem frustrating and overwhelming, patient safety is a theme common to all of them. (“First, do no harm.”) I’m thankful for the rules because they help us keep our patients safe.

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


Wound Care Advisor

Cofounder, Wound Care Education Institute

Plainfield, Illinois

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