Wound care at home: what a nurse does, what families can do, and when to call

Wound care is the reason I fell in love with home health nursing. A wound you can see, measure, photograph, and watch close week by week is one of the most satisfying things in medicine. It is also one of the easiest things to get wrong at home, and I have seen a small pressure sore become a hospital admission because nobody knew what to look for.

Here is how we approach it, and how you can help.

The wounds we treat most

• Surgical incisions that need monitoring or have opened
• Pressure injuries on the tailbone, hips, and heels
• Diabetic foot ulcers
• Venous leg ulcers from poor circulation
• Skin tears and traumatic wounds in fragile skin

Each type heals differently and needs a different dressing plan, which is why "put some ointment on it" is rarely the right answer.

What a skilled nursing visit looks like

On the first visit the nurse measures the wound in three dimensions, photographs it for the record, checks the surrounding skin, and assesses the things that decide whether it will heal: circulation, blood sugar, nutrition, pressure, and moisture. Then we write a dressing plan with your physician and, when needed, a wound specialist.

At each visit after that we clean the wound, apply the ordered dressing, remeasure, and document. Progress is reported to your doctor. If a wound stalls or worsens, we do not wait for the next scheduled appointment to say so.

We also teach. If a family member can safely do a dressing change between visits, we show them exactly how, watch them do it, and leave written instructions.

Three things that speed healing more than any dressing

Protein. A healing wound is a construction site, and protein is the lumber. Older adults often eat far less than they need. We generally aim for a protein source at every meal: eggs, Greek yogurt, beans, fish, chicken, or a supplement shake if appetite is poor. Your physician or a dietitian can set an exact target.

Pressure relief. A pressure sore cannot close if the pressure that caused it continues. That means turning in bed at least every two hours, keeping heels off the mattress with a pillow under the calves, limiting time in the same chair position, and sometimes a special mattress or cushion, which Medicare may cover.

Blood sugar and circulation. Uncontrolled diabetes and poor blood flow starve a wound. Keeping glucose in range and, for leg ulcers, elevating the legs and using compression when ordered, does more than any product on the pharmacy shelf.

Signs of infection: call the same day

• Redness spreading outward from the wound, or a red streak running away from it
• New or increasing warmth, swelling, or pain
• Thick yellow, green, or gray drainage, or a foul odor
• Fever, chills, or confusion, which in older adults may be the only sign
• A wound that suddenly gets larger or deeper

Do not wait for the next visit. Call your nurse, and if you cannot reach anyone and the person looks ill, go to the emergency room.

What not to do

• Do not use hydrogen peroxide, rubbing alcohol, or iodine on an open wound unless specifically ordered. They damage healing tissue.
• Do not let a wound dry out and scab over if the plan calls for a moist dressing. Most chronic wounds heal faster covered and moist.
• Do not massage red areas over bony spots. That is early pressure damage and rubbing makes it worse.
• Do not skip dressing changes because it looks fine. Looks fine is how most wounds get to the emergency room.

How to get wound care at home

Skilled wound care is a covered Medicare home health service when a physician orders it and the patient is homebound. Ask your surgeon, primary care physician, or wound clinic to fax orders and a face sheet to 904-638-8752, or call us at 844-808-9096 and we will contact the office. Medicare pays 100% of covered visits for eligible patients.

This article is general information, not medical advice. Follow the wound care instructions given by your physician and nurse.