Chronic Wound Evaluation and Consultation

Delayed in one or more phases of healing, and for one reason or another, a chronic wound is any wound that fails to heal within three months. It takes years for some chronic wounds to heal, while others never completely heal. When not properly evaluated and treated, a chronic wound can interfere with a patient’s day-to-day activities and cause them significant physical, mental, emotional, and financial duress – not to mention the financial burden it places on the healthcare system.

A consultation is an essential first step for accessing suitable treatments. Since hospitalized or otherwise immobilized patients are more likely to develop chronic wounds, wound care consultations are now available through telehealth applications. As a less-costly alternative to an in-person consultation, a telehealth consultation connects the patient and healthcare provider through electronic forms of communication. It is a notably useful option for patients in long-term care settings because it allows nurses with specialized wound care training to assist nurses who are directly providing patient care, ultimately improving the likelihood for wound healing.

Proper wound assessment can have a dramatic impact on patient outcomes. When evaluating a wound, a full physical examination of the patient must be completed, including their height, weight, and skin characteristics. Any patient weight fluctuations must be noted, as proper nutrition is critical for wound healing. Skin color, temperature, texture, and turgor (elasticity) must also be assessed. Healthy skin should feel smooth and firm to the touch and have good turgor with an absence of redness (erythema).

After the wound has been cleaned and debrided, characteristics such as depth, circumference, location, and condition must be documented weekly. Wound depth should be classified as partial (no penetration of the dermis) or full (penetration of the sub-dermal tissue) thickness.

The surrounding skin and tissue must also be checked, as any compromised skin near a wound is at risk for breaking down – placing a greater emphasis on preventative care. The color, amount, and odor of wound drainage (exudate), along with the undermining (space between intact skin and wound bed) and tracts (channels extending from one area of the wound to another), must also be evaluated. The patient should be asked to score their pain level based on the healthcare facility’s pain scale.