• Insulin Resistance Syndrome
• Quantitative Debridement Evaluation
• Wound Care Charting
• Internet Update
• Wound Product Guide
• Oucomes In Wound Care
• Varicose Vein Insufficiency
• Hyperbaric Oxygen Therapy
• Hyperbaric Oxygen Chamber
• Collagen Treatment of Post-Amputation Wound
• Electrical Stimulation

ANALYZING OUTCOMES IN WOUND CARE

By: Glenda Motta, RN, MPH, ET

Outcomes established for wound care should direct the treatment plan and provide a mechanism for evaluating the patient's progress and change in status. They are simply a picture of the destination of the patient so that we can evaluate the effectiveness of our interventions. Outcomes provide feedback during the process of care as to whether or not changes must be made to the professional care being provided.

Outcomes for wound care should be patient-oriented. In addition, outcomes should be realistic. Wound healing may be an unrealistic outcome if a patient is not compliant or unable to comply. A good example is a treatment regimen that includes compression therapy for a venous stasis ulcer. Some patients simply will not use the compression garment or device, others are unable to use compression because other problems, such as arthritis or excessive edema, make their use difficult or impossible.

We must also be certain that outcomes are measurable and observable. Words like understand and appreciate should be avoided. Instead of "caregiver appreciates the need to use prescribed compression," a more appropriate outcome is "caregiver demonstrates proper application techniques necessary to achieve appropriate compression."

The chances of patients achieving desired outcomes are enhanced if they are included in the planning process. Setting mutual goals with the patient allows for active participation and good communication of what the healthcare professional expects. Establish a policy of asking the patient to sign the plan of care, signifying agreement with the outcomes. If the patient cannot participate, include a family member or significant other.

The clinician evaluates the patient's progress toward attainment of outcomes by:

• conducting systemic and ongoing evaluations;
• documenting the patient's response to care interventions;
• evaluating the effectiveness of interventions in relation to outcomes;
• using ongoing assessment data to revise outcomes and plan of care as needed;
• documenting revisions to the outcomes and the plan of care; and involving the patient, a significant other, and healthcare providers in the evaluation process.

The following are some examples of expected outcomes related to wound care:

Problem: High risk for infection; post debridement Outcome: Patient remains free of infection as evidenced by healing wound free of redness, swelling, purulent drainage, normal temperature.

Problem: High risk for impaired home maintenance Outcome: Patient/family verbalize and demonstrate wound care.

Problem: Existing wound Outcome: Patient experiences healing in wound; e.g., elimination of necrotic tissue; increase in granulation tissue.

Problem: Diabetic ulcers; high risk for infection Outcome: Patient remains free of local or systemic infection, as evidenced-by absence of copious, foul-smelling wound exudate, normal body temperature.

Clinical wound assessments done at least once weekly are also indicated to avoid ineffective treatment. Benchmarks for wound healing should be identified. For partial-thickness pressure ulcers and wounds these include. epithelial maturation in 10-14 days after resurfacing.

For full thickness wounds, the following outcomes are indicators of healing:

• reduction of surrounding tissue erythema, edema, or induration;
• removal of eschar and necrotic debris;
• initiation of granulation tissue ingrowth;
• wound margin undermining more evident;
• drainage/exudate less purulent and malodorous and more serous in nature;
• surface area of wound (length and width) increases;
• granulation tissue base becomes well established and wound depth is reduced;
• wound contraction begins; surface area reduces;
• surrounding erythema, edema, and induration continue to decrease;
• exudate is serous or serosanguinous with no odor;
• wound margins attach and undermining is reduced;
• granulation tissue ingrowth is completed;
• epithelialization occurs, particularly at margin attachment and granulation in growth;
• wound margins attach and exudate decreases;
• wound contraction and resurfacing are complete.

Ongoing assessment of all therapeutic interventions is essential to evaluate if the patient is achieving the desired outcomes. If the care plan is not bringing the patient closer to these goals, then changes in the interventions are necessary. Wound reassessment should be done weekly and progress toward healing should be seen within 2 weeks. Appropriate management of patients with wounds involves optimizing the treatment plan, charting progress toward healing, and aggressive intervention when needed.

Return to Main Page, Wound Care Institute Newsletter, Fall 1996