The patient length of stay following elective inpatient orthopedic surgeries is approximately 4.2 days on average now.1 This means that following surgery the patient or their caregiver are in charge of the majority of their own wound care. Failure to provide patients with adequate information regarding how to properly care for their healing incisions and perform self-inspections can lead to infections and other serious post-surgical complications going undetected. The importance and fundamental concepts for ensuring patients have an adequate understanding of how to care for their wound will be discussed in this week’s blog post.
Educate Prior to Surgery
Patients are typically not in the right state of mind following surgery to learn and remember a lot of new information, especially when important information can be missed in the details. Because of this, it is more beneficial to begin wound care discussions during the appointments leading up to surgery.2This way the patient has time to become familiar with the information and ask any questions that arise prior to the date of surgery. Preoperative education also gives the patient an opportunity to gather needed supplies before they have mobility and driving restrictions that often accompany surgery.
If possible, having an additional family member, friend, or caregiver in the room during education on wound care is also preferable. Having this extra set of ears listening to the instructions helps ensure more of the information is retained.2
Demonstration and Practice
Verbal instructions can be a great place to start when it comes to educating patients on wound care, but without practice the patient or caregiver is unlikely to feel confident about cleaning and dressing a wound.3In-person demonstrations or video resources should also be provided to patients since these methods have been shown to reduce the occurrence of surgical site infections and hospital re-admissions.2“Homework” may also be given to the patient or caregiver to practice going through the process of cleaning a wound and changing a dressing. This practice not only will help provide confidence and adequacy performing these tasks, but also offers a chance for the individual to come up with any questions that he or she can ask earlier on.2,3
Individualized Instruction
In addition to the general information regarding wound care that all patients should be educated on, each individual should receive information that pertains specifically to their own health needs. The surgical procedure, the patient’s comorbidities, and a number of other various factors may influence the type of wound dressing and specific care instructions that should be followed. For instance, diabetes is associated with slower movement of white blood cells in the wound site, along with less effective immune responses causing the inflammation stage to last longer in duration.4 Due to this, infection risk is higher. Some individuals with diabetes are also desensitized by neuropathy, which can prevent them from recognizing that their wound is infected making regular visual inspections essential.4
Educational Forms
Following verbal instruction and visual demonstration a form with the discharge plan for wound care should be provided. This form should include all of the pertinent and essential wound care information the patient or caregiver can refer back to if needed. Some of the information that is necessary to provide includes how often the wound should be cleaned and dressed, the wound care supplies that should be used, and specific instructions on how to properly clean and dress the wound.2The surgeon’s contact information should also be on the form so that he or she can be reached if any questions or concerns arise.
Identifying Signs of Infection
It is vital that patients are aware of the signs and symptoms associated with infection at the surgical site.2,5Information on how to identify the signs of infection should be included in the education provided prior to surgery, as well as prior to discharge home and in the informational forms provided.2The American College of Surgeons has published a resource for patients titled “10 Signs of Trouble” outlining the major signs that indicate infection could be present. This resource and other similar forms clearly outlining the signs of infection in patient-friendly terms can be accessed and used for patient education purposes.
Generally speaking, the major warning signs of infection are significant changes in the wound’s drainage, smell or color. Patients who have awareness and understanding of these signs of infection can detect infection sooner when it does occur, and this in turn allows for earlier treatment and improved outcomes.2
A number of studies have highlighted a greater need to educate patients regarding wound care prior to discharge. These studies indicate a lack self-efficacy for wound care at home and inaccessible communication with nurses about wound-care, which results in higher rates of wound infection.5Nurses can help to through improving communication on this topic prior to surgery, and allowing adequate time for practice and questions.
References:
- UCLA Department of Orthopedic Surgery. 2015 Quality and Outcomes Report. Published September 1, 2015. Accessed at: http://ortho.ucla.edu/workfiles/About_Us/Quality/Ortho%20QB%202015%20%20%282%29.pdf.
- A plan for wound care: 5 steps to ensure your patients can care for their wounds at home. Published March 2019. Accessed at: http://www.outpatientsurgery.net/surgical-facility-administration/patient-management/a-plan-for-wound-care–03-19.
- Bearden J. Education vital for successful wound management in the home. Woundcareadvisor.com. https://woundcareadvisor.com/education-vital-for-successful-wound-management-in-the-home-vol3-no4/. Published 2014. Accessed May 3, 2019.
4.WoundSource Editors. How diabetes impacts wound healing. Woundsource.com.