How to Optimize SNF Wound Care at Your Facility

Skilled nursing facilities (SNFs) typically provide short-term rehabilitation and medical care to patients who often need support from licensed nurses and therapists, often after being released from a hospital. How short? It’s debatable, but generally one to two weeks. Medicare, for example, only fully covers SNF care up to 20 days in each benefit period.

With short term being the primary care goal of these healthcare facilities, wounds can present a significant hurdle to quick healing. This is because patients of SNFs tend to be older adults with multiple health conditions that make wound care more challenging, and can lead to longer healing times.

Overcoming the SNF wound care challenge requires a multipronged approach that considers the patients, staff, and facility itself. Keep reading to learn more about ways you can address each of these perspectives at your facility.

SNF Wound Care: 3 Patient-Focused Action Items

1. Track Wound Prevalence Among Patients

Every SNF has a prevalence for certain wound types due to local and environmental factors, which can change the types of wounds seen in the SNF population as well as the general population. Here are a few common wound types you may encounter.

• Pressure injuries: These are the most prevalent wounds in SNFs. They develop due to prolonged pressure on the skin, often over bony prominences. Patients with limited mobility, poor nutrition, and incontinence are at increased risk. These injuries are often seen on the heels, sacrum, coccyx, hips, and elbows.
• Venous ulcers: These typically occur on the lower legs and ankles due to poor circulation in the veins. Patients with conditions like chronic venous insufficiency, varicose veins, or a history of deep vein thrombosis (DVT) are more susceptible.
• Diabetic ulcers: These wounds usually develop on the feet and toes of individuals with diabetes. Nerve damage (neuropathy) can lead to loss of sensation, making it difficult to detect injuries. Poor circulation and impaired immune response also contribute to delayed healing.
• Surgical wounds: Many patients are admitted to SNFs following surgery, and their surgical incisions require careful monitoring and care to prevent infection and promote healing. Factors such as age, underlying health conditions, and surgical technique can influence healing.
• Skin tears: These are common in older adults with fragile skin. Even minor trauma can cause the outer layer of skin to separate. These tears can be painful and prone to infection.

It’s vital to collect and analyze data on wound prevalence, types, locations, and outcomes within the facility. How does this help?

• You can identify areas for improvement in wound prevention and management.
• You can track the effectiveness of interventions.
• You can benchmark performance against other SNFs.
• You can justify resource requests for wound care supplies and staff training.

2. Identify Patient Risk Factors

Several risk factors contribute to wound development in an SNF patient population. Since patients often have multiple interacting health issues, it’s rarely just one factor at play, but following are common ones to keep in mind.

• Immobility: Residents who have difficulty moving or changing positions are at high risk for pressure injuries. This can be due to physical limitations (e.g., paralysis, weakness), neurological conditions (e.g., stroke, Parkinson’s disease), pain, and sedation, among others.
• Incontinence: Exposure to urine and stool can irritate and break down skin, increasing the risk of pressure injuries, skin tears, and infections.
• Sensory impairment: Residents with decreased sensation due to diabetes or neuropathy, for instance, may not feel pressure or pain, making them unaware of developing wounds.
• Poor nutrition: Adequate nutrition is essential for skin health and wound healing. Deficiencies in protein, vitamins (especially A and C), and minerals such as zinc can impair tissue repair and increase wound risk.
• Medical conditions: Certain conditions increase wound risk, such as diabetes (impaired circulation), vascular diseases (reduced blood flow to extremities), and obesity (increased pressure on tissues).
• Age: Older adults have thinner skin, reduced elasticity, and decreased subcutaneous fat, which makes them more vulnerable to wounds.
• History of wounds: Patients who have had wounds in the past are at higher risk of developing new ones.

Actively and regularly identifying these risk factors among your patients nets multiple benefits.

• It enables you to implement preventive measures—such as regular skin assessments, frequent repositioning schedules, and nutritional support—before wounds develop.
• Knowing a resident’s specific risk factors allows you to develop tailored care plans that address their unique needs.
• You can improve resident comfort and quality of life, reduce healthcare costs, and minimize hospital readmissions.
• You can consistently meet regulatory requirements and demonstrate quality of care.

3. Educate Patients and Their Families

Educating patients and their families about wound prevention and care is essential for optimal outcomes. Considering the specific needs of SNF patients, try educational approaches like:

• Short, frequent sessions. Shorter, more frequent teaching sessions are often better for patients with limited attention spans or cognitive impairment.
• Real-life examples. Use real-life examples and case studies to illustrate key points and make the information more relevant.
• Focus on practical skills. Emphasize practical skills that patients and families can use to prevent and manage wounds.
• Adapt to cognitive level. Adjust your teaching methods to the patient’s cognitive level. For patients with dementia, you may need to rely more on demonstration and visual cues.
• Technology (where appropriate). For tech-savvy patients and families, consider using videos or online resources to supplement education.

What benefits does this education provide?

• Educated patients and families are more likely to follow care instructions, leading to better wound healing and reduced complications.
• Education empowers patients and families to take an active role in their care.
• When patients understand the rationale behind care practices, they are more likely to adhere to them.
• By preventing wounds or managing them effectively, you can improve patients’ comfort, mobility, and overall quality of life.
• Preventing wounds and complications can reduce healthcare costs.

SNF Wound Care: 3 Staff-Focused Action Items

1. Provide Your Staff with Wound Care Training

Your staff are your most valuable asset in providing optimal wound care. Here’s a look at the essential training and resources they need.

• Foundational wound care principles: All staff involved in wound care, regardless of their role in patient treatment, need a solid understanding of wound healing phases, wound assessment (including documentation), infection prevention, pain management related to wounds, and basic dressing techniques.
• Specific wound types: Training should cover the characteristics and management of the wound types you identify in your patient population (as described above).
• Documentation: Accurate and detailed documentation is crucial. Staff need training on wound assessment documentation, treatment plans, progress notes, and the use of electronic health records (EHRs) for wound care.
• Prevention strategies: All staff play a role in wound prevention. Training should include repositioning techniques, skin care protocols, nutrition and hydration, and pressure relief approaches.
• Wound care products: Ensure an adequate supply of appropriate wound care products, including dressings, bandages, cleansers, and other supplies.
• Technology: Utilize technology where appropriate, such as with EHRs for wound documentation and tracking, telehealth for remote wound assessments, and AI-powered wound imaging platforms.

Ensuring staff is properly trained and have adequate resources available has several advantages, like:

• Staff can provide more effective wound care, leading to faster wound healing, reduced complications, improved patient comfort, and increased quality of life.
• Training empowers staff to provide competent care, increasing their confidence and job satisfaction.
• Staff are more likely to adhere to established protocols and guidelines, improving regulatory compliance.
• Providing high-quality wound care can enhance the facility’s reputation and attract more patients.

2. Focus On Providing Consistent Care

Ensuring consistency in wound care practices is important for patient safety and optimal outcomes. Here are a few strategies to follow to this end.

• Standardized protocols and guidelines: Develop and implement evidence-based wound care protocols and guidelines that are readily accessible to all staff, both in print and electronically. Ensure the protocols are regularly reviewed and updated.
• Regular education and updates: Provide ongoing education and updates on wound care best practices, new products, and changes in protocols. This can be done through in-service training, online modules, or journal clubs.
• Clear documentation: Implement a standardized system for wound documentation. This includes using consistent terminology, documenting wound characteristics thoroughly (size, location, appearance, drainage), and using standardized forms or EHR templates.
• Interdisciplinary collaboration: Foster a culture of interdisciplinary collaboration. Encourage communication and teamwork between nurses, physicians, therapists, dietitians, and other members of the care team. Regular care conferences can facilitate this.

Consistent care across shifts and different staff members has multiple upsides, including:

• Consistency minimizes variations in care practices, ensuring that all patients receive the same high standard of care.
• Consistent wound care reduces the risk of errors and adverse patient events.
• Following standardized protocols helps ensure compliance with regulatory requirements.

3. Avoid Staff Burnout

Staff burnout, especially related to demanding tasks like SNF wound care, is a serious concern. It impacts both staff well-being and patient care. Consider these strategies to prevent burnout.

• Fair work distribution: Ensure wound care responsibilities are distributed fairly among staff members and avoid overloading certain individuals.
• Streamlined processes: Review wound care processes to identify any inefficiencies or unnecessary steps. Streamline processes to reduce workload.
• Adequate staffing: Maintain adequate staffing levels to meet the demands of wound care by advocating for appropriate staffing ratios.
• Regular check-ins: Conduct regular check-ins with staff to assess their workload, address concerns, and provide support.
• Counseling services: Provide access to counseling services or employee assistance programs (EAPs) for staff who are struggling with stress or burnout.

Preventing burnout helps staff and patients in several ways, such as:

• Reducing staff error and ensuring that patients receive the safest, best possible care.
• Raising staff morale and fostering a positive work environment.
• Reducing staff absenteeism and turnover, along with the associated costs and care disruption.

SNF Wound Care: 3 Facility-Focused Action Items

1. Make the Right Wound Care Products Available

Choosing the right wound care products and technologies is a balancing act between effectiveness and cost-efficiency. Consider stocking:

• Dressings. The type of dressing depends on the wound. It’s crucial to have a variety on hand, including gauze, foam dressings, hydrogels, hydrocolloids, alginates, films, antimicrobial dressings, and composite dressings.
• Cleansers. Saline is the gold standard for wound cleansing, as it’s cost-effective and gentle. There are also commercial wound cleansers that may be useful for certain wounds, but consider the cost and potential for irritation.
• Adhesive removers. Helpful for removing dressings without causing trauma to the skin and can reduce pain and prevent skin tears.
• Negative pressure wound therapy (NPWT). Uses a vacuum to remove exudate and promote healing. Effective for complex wounds, but can be expensive. Carefully assess cost-effectiveness.
• Wound imaging devices. Can help track wound progress and document healing. Some devices can also measure wound area and volume. Consider the cost of the device and the potential benefits.

The facility, staff, and patients all benefit from having carefully considered wound care products available.

• Properly stocked supplies can reduce the overall cost of care by minimizing the need for expensive treatments and preventing complications.
• Supplies that are readily available and organized can improve staff efficiency and reduce time spent on wound care.
• The right supplies can promote faster healing, reduce complications, and improve patient comfort and safety.

2. Ensure Compliance with Wound Care Guidelines

Compliance with wound care regulations and guidelines isn’t just about avoiding penalties—it’s about providing the best possible care for your patients. Here’s how you can accomplish that goal.

• Know the regulations: Stay up-to-date on all applicable regulations and guidelines. This includes federal regulations (e.g., those from the Centers for Medicare & Medicaid Services), state regulations, and professional guidelines (e.g., from wound care organizations).
• Quality audits: Conduct regular quality audits of wound care practices. Review documentation, observe staff performance, and identify any areas where compliance may be lacking. Use audit data to provide feedback and implement corrective actions.
• Seek expert advice: Don’t hesitate to seek advice from wound care specialists, legal experts, or regulatory consultants if you have questions or concerns about compliance.

Focusing on maintaining compliance is key to facility longevity because:

• It helps minimize the risk of legal action related to wound care practices.
• It ensures you maintain licensure and certification.
• It aids in avoiding financial penalties and sanctions.
• It protects patients’ rights and ensures they receive appropriate care.

3. Optimize Resource Allocation

An essential facility concern is the financial impact of SNF wound care. There are direct costs like supplies, equipment, and staff time, and indirect costs such as increased length of patient stay, hospital readmissions, and litigation.

All of these financial aspects make optimizing resource allocation a critical effort. Consider these optimization strategies.

• Product formulary: Create a formulary of preferred wound care products. This can help standardize product use, reduce waste, and potentially lead to volume discounts from suppliers.
• Inventory management: Implement efficient inventory management to prevent overstocking, expiration of products, and unnecessary waste.
• Data analysis: Track wound care outcomes, including healing rates, complication rates, and costs. This data can help identify areas for improvement and optimize resource allocation.
• Explore alternative therapies: Consider the cost-effectiveness of different wound care therapies. Some newer technologies may be more expensive upfront but could lead to faster healing and reduced overall costs in the long run.

Optimizing resource allocation ensures your facility is financially viable for the long term by:

• Leading to significant cost savings in SNF wound care.
• Improving staff efficiency and free up time for other important tasks.
• Improving the facility’s financial performance.
• Helping build contingency funds for unexpected events.

Effective SNF Wound Care Requires a Comprehensive Approach

Wound care may be only one challenge at your SNF, but does impact patient well-being, staff productivity, and facility finances. Thus, it’s essential to take a comprehensive approach that, at a minimum, considers the points above to improve this key care area.

Ultimately, your commitment to best practices in wound care will enhance patient quality of life, ensure staff members are motivated, reduce costs, and strengthen the facility’s reputation.