In today's healthcare environment, where documentation and reimbursement go hand in hand, your assessment is critical to everyone, from the facility to the patient.

When charting a wound, especially for Medicare purposes, be sure to chart:

• Location of the wound
  

• Stage of the wound
  
• Size of the wound (length, depth, and width)
  
• Tunneling and/or undermining
  
• Wound bed characteristics (granulating, slough, eschar)
  
• Exudate, if any
  
• Bleeding, if any
  
• Peri-wound skin
  
• Wound care products you are using
  
• Progress or decline of the wound

Achieving consistent documentation, especially when more than one nurse cares for a patient, can be a challenge unless some guidelines are established prior to caring for the wound.  These should be:

• Position the patient consistently each time the wound is measured.
  

• Remove the old dressings
  
• Irrigate the wound with normal saline
  
• Measure the wound in centimeters
  
• Document the wound characteristics

For those who choose photo documentation, the very first step you must take to avoid invading the patient's privacy and opening yourself to litigation is to have the patient or guardian sign an informed consent.  This release should include an explanation of the intent of the photograph.

Now that we have our guidelines for documentation and measurement, do you know what the wound is telling you by its' shape?

Pressure ulcers are generally round and edges well demarcated.  As healing progresses, the ulcer will fill with granulation tissue symmetrically, unless another force intervenes.

A wound that becomes elongated head to toe is generally revealing friction and shearing.

Side to side elongation of a persistent wound may be the result of a "slinging seat" in a wheelchair.  An inexpensive solution to this problem is a firm base in the chair and the addition of a wheelchair cushion.

Please remember that nearly all pressure ulcers are avoidable.  With proper nutrition, daily wound care, and a good turning regimen, all pressure ulcers can be healed.

Accu-Ruler is the newest wound measuring tool on the market. It was designed by nurses, for nurses and other medical professionals. Accu-Ruler is entirely nurse-owned, and is the only wound measurement device approved by ALSNA (American Long Term and Subacute Nurses Association).

With Accu-Ruler, you can accurately measure the length, width, depth, tunneling, undermining, and peri-wound skin with only one instrument. Accu-Rulers are disposable, cost effective, and are packaged 100 to each resealable pouch. Their cost includes free shipping and handling, and a bi-annual newsletter, within the U.S. Accu-Ruler is approved by numerous nursing home chains and hospitals.

To request a free sample or place an order, email  Decubqueen@accu-ruler.com. You can also purchase Accu-Ruler through the phone or fax listed below.

Accu-Ruler
http://www.accu-ruler.com/
5145 - 33rd Terrace North
St. Petersburg, FL 33710-2111
USA

Phone: 1-888-418-4484
...........(8am-5pm EST)
Fax....: 1-888-798-2756
...........(24 hrs/day)