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When working to improve your practice, you want to learn the best way to treat your patients.The place to start is your practice act. Certain procedures are limited to specific disciplines, and the scope of practice, even within a discipline, may vary from state to state, or between countries. The standard of care is the treatment which an average, prudent clinician would do. This is the minimum level of care legally allowed. However, advancing your practice means exceeding this basic care. Standards have been established for many aspects of wound assessment and treatment.
Regulations are established by governmental bodies (local, state, and federal) that mandate or restrict activities. State practice acts are interpreted in the form of regulations. Medicare and Medicaid have many regulations that influence practice. You should be familiar with the expectations laid out by these regulations.
• Medicare Manuals http://www.cms.hhs.gov/home/regsguidance.asp
• The Joint Commission www.jcaho.com
Joint Commission: Healthcare Organization Survey Activity Guide 2009
Guidelines for the assessment and treatment of wounds have been produced by many organizations. These groups often examine the available literature and compile the findings into a set of guidelines. These documents are not designed to be set protocols, though they are sometimes interpreted as standards, particularly in lawsuits. Each patient must be comprehensively assessed, and the treatment plan must be individualized. Below are several guidelines you may wish to review. More guidelines may be found at the National Guidelines Clearinghouse, http://www.guidelines.gov • AAWC Conceptual Framework of Quality Systems for Wound Care
• AAWC Content-Validated Venous Ulcer Guideline
• The Association for the Advancement of Wound Care: Summary algorithm
for venous ulcer care with annotations of available evidence.
• The Wound Ostomy and Continence Nurses Association: Guideline for management of wounds in patients with lower-extremity venous disease.
• Paralyzed Veterans of America: Pressure ulcer prevention and treatment following spinal cord injury
• Best Practice Statement: Care for the Older Person's Skin
• Best Practice Statement: Minimising Trauma and Pain in Wound Managment
• Best Practice Statement: Compression Hosiery
• Wound Healing Society Prevention Guideline
i. Guidelines for the prevention of venous ulcers
ii. Guidelines for the prevention of pressure ulcers
iii. Guidelines for the prevention of diabetic ulcers
iv. Guidelines for the prevention of lower extremity arterial ulcers
• Wound Healing Society Clinical Treatment Guidelines
i. Guidelines for the treatment of venous ulcers
ii. Guildelines for treatment of pressure ulcers
iii. Guildelines for the treatment of diabetic ulcers
iv. Guidelines for the treatment of arterial insufficiency ulcers
• Registered Nurses of Ontario : Risk Assessment and Prevention of Pressure Ulcers
i. En Francais
• Pressure Ulcer Prevention: National Guideline Clearninghouse (NGC) Guideline Synthesis
• Nursing Standard of Practice Protocol: Pressure Ulcer Prevention & Skin Tear Prevention
• Skin Safety Protocol: Risk Assessment and Prevention of Pressure Ulcers
• Guideline for Seating and Pressure Ulcers
• National Voluntary Concensus Standards for Developing a Framework for Measuring Quality for Prevention and Management of Pressure Ulcers
• Guidelines for the Managment of Contact Dermatitis: an Update
• NPUAP-EPUAP Guidelines for Pressure Ulcer Prevention and Treatment
i. Quick Reference Guide
1. Pressure Ulcers Treatment Quick Reference Guide
2. Pressure Ulcers Prevention Quick Reference Guide
II. Full Guidelines Consensus statements and position papers are written by groups and aim to state an opinion on an issue.
• Advancing Your Practice : Understanding Wound Infection and the Role of Biofilms
• EWMA: Hard-to-heal wounds: a holistic approach (available in multiple languages)
• EWMA: Topical negative pressure in wound management
• EWMA: Management of Wound Infection
• EWMA: Identifying Criteria for Wound Infection
• EWMA: Wound Bed Preparation in practice
• Minimising pain at wound dressing-related procedures
• Skin Changes At Life's End (SCALE): Preliminary Consensus Statement
• The Role of Nutrition in Pressure Ulcer Prevention and Treatment: National Pressure Ulcer Advisory Panel White Paper
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Guidelines