Introduction

Even before the onset of COVID-19 and certainly since, health care facilities have faced challenges related to resources, staffing, and infection control.1 However, telehealth resources can aid across the care continuum. These resources can facilitate patient data dissemination to the multidisciplinary team. For example, a telehealth encounter may help determine the need for an in-person appointment, thus minimizing the amount of travel required by staff and patients to uphold a certain level of care. Mobile technology can also involve patients in their care in new and innovative ways, potentially increasing adherence and optimizing wound care outcomes in the face of evolving obstacles.

The Stalled Patient Engagement Trajectory

It’s not just chronic wounds that stall during the healing trajectory. Patient engagement can stall, too, leading to wound care fatigue for the patient. The link between psychosocial factors and wound healing has long been recognized.2 These roadblocks on the patient engagement trajectory could potentially initiate a vicious cycle of nonadherence to wound care, poor healing outcomes, and impacts on mental health, as well. If a patient expresses disengagement, how can clinicians spark their interest? How can wound care professionals help lead patients from despair to hope? The use of mobile technology is one option that could facilitate this transition from passivity to partnership in wound care.

Mobile Technology in Overcoming Patient Engagement Barriers

Patient expectations: Chronic and hard-to-heal wounds require long and often complex courses of treatment. Patients may not be prepared for this reality and may misinterpret slow healing as failure to heal. They can lose trust in wound care professionals and the wound care process when they don’t quickly see results. Certain treatments, such as debridement or dressing changes, may be painful, and aging patients may have comorbidities or cognitive impairment that complicate wound healing and management. Patient education is key, and mobile technology can provide teaching tools for patients across outpatient settings to better understand their wound and track its healing progress.3The patient-provider relationship: A patient’s lack of trust may reflect a feeling of helplessness, and a patient who doesn’t trust the clinician may be less likely to adhere to the wound care plan. Empowering patients as an equal partner in their care is important because both the patient and provider are actively engaged in their wound care, and adherence to treatment will come more naturally. Mobile technology can reinforce this collaboration by giving the patient ways to document and monitor wound healing autonomously and to share that information with the multidisciplinary team. Wound care systems and dressings: Some wound care protocols and dressings, especially advanced wound care systems, are difficult for patients and their caregivers to manage and may require extra training. These supplies may not be affordable or readily accessible. It is likely wise to speak with the patient and/or caregivers to find appropriate wound care supplies and techniques that may be more comfortable or cost-effective. During telehealth visits, clinicians can offer real-time reassurance and guidance while a patient performs dressing changes and other wound care protocols.

Mobile Technology in Facilitating Patient Engagement

Mobile technology has advanced with the increase in chronic and nonhealing wounds,4 and has transformed wound care. Technological advances that enable providers and patients to identify and monitor the progress of wounds may also help patients feel hopeful about their healing process. In the clinic, the mobile devices used in initial and ongoing wound assessments may provide accurate measurements and detailed photographs of wound healing in action that can be shared with patients.5 At home, patients can follow subtle wound changes and may be encouraged by each small improvement.2 Mobile technology can also be used to prevent wounds. For example, a study in patients with diabetes found that diabetic foot ulcers were prevented, and patient engagement was increased through a protocol combining the use of a mobile app with patient education.6

Telehealth

Many patients unable to access in-person wound care services can benefit from telehealth.4,7 These patients may not have available or affordable transportation to in-person appointments. Some patients may not feel well enough to leave their homes, either because of the wound or because of comorbidities, including psychological, sensory, or cognitive issues. Another consideration is the prevention of exposure of older or otherwise immunocompromised patients to infectious pathogens, such as COVID-19. One major advantage of telehealth technology is the ability to remotely assess and track wound healing. Another advantage with a positive impact on patient engagement is the convenience of receiving professional wound care services at home, aided by digital photography and other advances.3-5,7-8 This technology removes geographic and accessibility-related barriers to wound care, including in remote areas with limited numbers of wound care providers,7 and thereby opens the door to wound care in underserved populations.9

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Barriers to the use of telehealth include the system’s technical requirements, such as reliable rural internet access, as well as any physical and cognitive impairments patients may have that would interfere with operating the telehealth system and devices. In addition, some older adults are unfamiliar or uncomfortable with medical technology and prefer in-person wound care.7 Telehealth requires a HIPAA-compliant video system for patient-provider communication and a camera that will allow accurate wound assessment and monitoring.4 It is also important to keep in mind any insurance or regulatory guidelines based on licensure, geographic location, or other factors that could impact a patient’s eligibility for telehealth services.

Digital Photography, Including “Wound Selfies”

In the clinic, digital devices used in initial and ongoing wound assessments can provide measurements of a wound’s dimensions and also photos of the wound’s healing progress that can be shared across the multidisciplinary team as well as patients.10 Some of these devices can be portable and noncontact devices, which may assist those patients with potential mobility issues. In the comfort of their home, patients can regularly take and upload “wound selfies” from a smartphone.11 These photographs show subtle, incremental changes in the wound as it heals and alert clinicians to signs of infection or nonhealing. For documentation purposes, these images are valuable additions to the patient’s electronic medical record. A study conducted by the American College of Surgeons found that patients and their caregivers were willing and able to monitor surgical wounds remotely by using digital “wound selfies,” These photographs aided in detecting and intervening in wound complications as well as keeping patients engaged in their care.12

Conclusion

The trajectory of patient engagement is essential to optimize wound care outcomes. Mobile technology can help patients become more active participants in their care and thus enhance adherence to wound care plans.

References

Grabowski DC, Mor V. Nursing Home Care in Crisis in the Wake of COVID-19. JAMA. 2020;324(1):23–24. doi:10.1001/jama.2020.8524
Alexander SJ. Time to get serious about assessing – and managing – psychosocial issues associated with chronic wounds. Curr Opin Support Palliat Care. 2013;7(1):95-100.
Patient engagement: encouraging healing by involving patients in wound care. Practice Accelerator blog. WoundSource 2022. Accessed January 5, 2023. https://www.woundsource.com/blog/patient-engagement-encouraging-healing…
Practice Accelerator blog. What’s new in wound care? WoundSource.com. Published May 31, 2022. Accessed December 29, 2022. https://www.woundsource.com/blog/what-s-new-in-wound-care
Shamloul N, Ghias MH, Khachemoune A. The utility of smartphone applications and technology in wound healing. Int J Low Extrem Wounds. 2019;18:228-235.
Kilic M, Karadağ A. Developing and evaluating a mobile foot care application for persons with diabetes mellitus: a randomized pilot study. Wound Manag Prev. 2020;66(10):29–40.
Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. J Nurse Pract. 2021;17(2):218-221.
Monshipouri M, Aliahmad B, Ogrin R, et al. Thermal imaging potential and limitations to predict healing of venous leg ulcers. Sci Rep. 2021;11(1):13239.
Ensuring equity of wound care through technology. Practice Accelerator blog. WoundSource.com. 2022. Accessed December 29, 2022. https://www.woundsource.com/blog/ensuring-equity-wound-care-through-tec…
Using wound photos to enhance your documentation. Practice Accelerator blog. WoundSource.com. Published January 31, 2021. Accessed January 5, 2023. https://www.woundsource.com/blog/using-wound-photos-enhance-your-docume…
Webb R. Remote monitoring-the rise of the wound selfie. J Wound Care. 2018;27(3):117.
Gunter RL, Fernandes-Taylor S, Rahman S, et al. Feasibility of an image-based mobile health protocol for postoperative wound monitoring. J Am Coll Surg. 2018;226(3):277-286.

Introduction

Health care delivered in the home or outpatient setting has continued to increase. According to the latest figures in 2018 and 2017, over 11,500 home care agencies treated 4.9 million individuals in the United States.1 As the aging population increases, the nuances of optimal wound care delivery in the home health setting should be examined.

Wound Assessment and Monitoring

As in all wound care settings, care within the home setting begins with a thorough head-to-toe assessment of the patient and the wound. This assessment is followed by closely monitoring the wound during each home care visit. Handheld electronic wound measurement devices and digital photographs are useful tools for wound evaluation and monitoring in a home care setting because of their accuracy, portability, and ease of use.2

Infection Prevention: Across Home Health Settings

In addition to monitoring the wound, clinicians must strive to prevent any onset or spread of infection. In the home care setting, thoroughly washing one’s hands is the first step. The presence of certain devices, such as Foley catheters or IV lines, may put patients at a higher risk of infection.3 Various care items—such as a computer/tablet, bag, or other supplies—that wound care professionals carry with them may become infection vectors. To prevent contamination between homes, providers might place a barrier down before setting an item in the patient’s home. To further minimize risk, wound care professionals may also switch the order in which they visit patients. For example, a nurse may visit a patient with a weakened immune system before they visit a patient with a severe infection.3 It may also be wise to familiarize oneself with safe and effective disinfecting methods for such equipment to use between home visits. In the home health setting, patients or caregivers may have a larger role in the care plan than in inpatient settings. They may find themselves changing bandages, for example. For this reason, patients and caregivers should receive education on proper hygiene practices associated with wound care.3

Home Wound Care–Related Issues

The following issues, although not exclusive to wound care across settings, are particularly essential to successful wound care in the home care setting:

Patient education: When caring for the patient’s wound, clinicians should explain what they are doing and why and show the patient or caregiver how to care for the wound between home care visits. The teach-back technique, in which the patient demonstrates what the clinician has taught, can give the patient confidence in their ability to follow the wound care plan or, conversely, may reveal the need to modify the between-visit wound care protocol.4 For example, some patients and caregivers may find certain products, dressings, or advanced wound care systems too complex or difficult to use.
Financial concerns: Wound care professionals should be aware of the costs to the patient associated with home care. If the patient cannot afford the prescribed supplies, the clinician should advocate on the patient’s behalf for less expensive alternatives, if available.
Pain management: If the patient experiences pain from the wound itself, debridement, or other treatments, ensure that pain is managed appropriately and adequately.5 Unmanaged pain is a potential factor in patient nonadherence to wound care.
Environmental issues: If the wound care plan includes offloading, carefully inspect all offloading equipment, key home surfaces, and devices, and make adjustments and recommendations as needed. If turning and repositioning are part of the care plan, remind patients and caregivers to avoid friction and shear forces, and demonstrate the correct technique.

Benefits and Challenges of Home Wound Care

The home care setting has several clinical and logistical advantages and disadvantages. One advantage is that patients don’t have to travel to receive care. This setting minimizes environmental stressors, which is especially vital for patients with obstacles to mobility or transportation. Home care also gives wound care professionals a unique window into the patient’s world that may provide a deeper understanding of the patient’s preferences, lifestyle, and circumstances. One disadvantage of wound care in the home setting is that it may be challenging from a clinical standpoint. Some of these obstacles to clinical wound care may include the following:

Limited space for wound assessment and treatment
Variable lighting (it may be dim)
Sanitation level of the environment
Human and animal residents potentially interfering with care (despite the best of intentions)

Wound care professionals must be prepared if the above issues arise and resolve them as flexibly as possible. To list another disadvantage, clinicians must bring all supplies needed for each visit and supplies to be left when applicable with the patient for self-treatment between visits. The patient or caregivers may have difficulty with that intervisit care and may need additional monitoring, possibly through telehealth or a modified wound care plan.

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Looking Beyond the Wound

Wound care professionals should take a holistic approach, bearing in mind the adage, “treat the whole patient, not the hole in the patient.” A wound does not exist in isolation, so it is essential to ask open-ended questions, actively listen to the patient, and carefully consider their responses empathically. This process may take time because some patients may be unable, reluctant, or simply too exhausted to engage right away. The following information, which may already be included in the patient’s electronic health record, should be documented. It is vital for the provider to consider the unique applications of each of these topics to the patient’s home care plan, as they can impact coverage of services, available treatment options, available ancillary services, or the necessity of additional professionals on the team.

Care coverage: Does the patient have an additional home health provider? Family or caregivers? A care coordinator?
Comorbidities: Is the patient under medical care for comorbidities? How well are these conditions being managed?
Mobility: Is immobility an issue? If so, would the patient benefit from modifications to the living space, such as grab bars or ramps, if they are not already in place? Would the patient benefit from a consultation with an occupational therapist? Does the patient have a physical therapist?
Cognitive function and mental health: Is the patient’s cognitive function adequate? Can the patient understand the wound care plan? Does the patient have mental or behavioral issues that may complicate the patient’s care?
Access to care: Is the patient able to travel to medical appointments when necessary? If not, is the patient registered with a local agency, volunteer group, or social service that provides transportation?
Social services: Does the patient receive or have access to local services (meals, transportation, help with utilities, help with cleaning, etc)? If not, would the patient want these services if they were free or affordable?
Nutrition: Is the patient’s diet compatible with the needs of a healing wound? If not, is the patient unable to afford more nutritious food? Would the patient be willing to talk to a dietitian about possible options?
Cultural factors: Is the patient’s care culturally appropriate? If not, what changes would be beneficial?
Overall quality of life: What is the patient’s view on their health and quality of life? What improvements can be made? Remember that we all define quality of life differently.

Encouraging Patient Adherence to the Wound Care Plan

Patient engagement promotes a positive wound care experience, and this is where a solid patient-provider relationship is invaluable.6 Clinicians should use all the tools at their disposal to help patients understand their wound. Different strategies, like using various devices and/or photographs mentioned earlier, are beneficial for this purpose, and telehealth can be a great resource between in-person visits. Wound care professionals should explain all aspects of the care plan at each phase of the healing trajectory and empower patients to be informed participants in their wound care decisions.6

Conclusion

In home wound care, providers and patients are partners. Wound care professionals can work together toward healing by respecting the patient’s autonomy, using clinical expertise, and exhibiting agility in a unique setting.

References

Centers for Disease Control and Prevention. Home Health Care. National Center for Health Statistics. Updated December 14, 2022. Accessed January 4, 2023. https://www.cdc.gov/nchs/fastats/home-health-care.htm
Lucas Y, Niri R, Treuillet S, Douzi H, Castaneda B. Wound size imaging: ready for smart assessment and monitoring. Adv Wound Care (New Rochelle). 2021;10(11):641-661.
Dowding D, Russell D, Trifilio M, McDonald MV, Shang J. Home care nurses’ identification of patients at risk of infection and their risk mitigation strategies: A qualitative interview study. Int J Nurs Stud. 2020;107:103617. doi:10.1016/j.ijnurstu.2020.103617.
Yen PH, Leasure AR. Use and effectiveness of the teach-back method in patient education and health outcomes. Fed Pract. 2019;36(6):284-289.
Coulling S. Fundamentals of pain management in wound care. Br J Nurs. 2007;16(11):S4-S6, S8, S10 passim.
WoundSource Practice Accelerator. Patient engagement: encouraging healing by involving patients in wound care. WoundSource.com. Published March 31, 2022. Accessed December 21, 2022. https://www.woundsource.com/blog/patient-engagement-encouraging-healing…

Introduction

Wounds, including chronic and complex wounds, represent a tremendous challenge to the US health care system.1 In the United States alone, chronic wounds impact approximately 6.5 million patients, and the treatment of these wounds is estimated to cost $25 billion per year.2 Trauma, burns, skin cancers, infections, or underlying conditions, such as diabetes, can all contribute to a wound’s development and course. If one looks at the structure of wound terminology, they could ascertain that wound care is usually considered comorbid, defined by terms like diabetic foot ulcer, venous leg ulcer, and pressure injury.3

Why Documentation is Key

Proper wound management starts with thorough assessment and documentation, which can improve communication regarding care delivery across the multidisciplinary team. Inaccurate or incomplete documentation may affect the creation of the patient’s care plan and the healing process.2 Unfortunately, evidence-based wound care and assessment is, at times, left out in documentation. One study from 2015 found that 12% of wounds had no recorded diagnosis, and 56% of wounds documented as leg ulcers lacked a differential diagnosis.4 A failure to have proper wound documentation can jeopardize the healing trajectory. In fact, without the differential diagnosis for a leg ulcer, a multidisciplinary team member may unintentionally prescribe or apply a potentially detrimental treatment, like compression therapy, to treat an arterial ulcer.

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In addition to circumventing avoidable errors, documentation should note institutional, clinical practice, and regulatory guidelines. Multiple lists are available that address comprehensive wound documentation, and the list below outlines key components of an initial evaluation to be documented in the medical record.1These items include the following1-2:

1. General Health Information

Risk factors for delayed healing (for instance, the wound’s blood supply, infection risk, medications, skin integrity)
Allergies
Skin sensitivities
Impact on quality of life (physical, social, emotional, etc)

2. Wound Baseline Information

Wound number
Wound location, described in proper anatomical terms
Wound etiology, type, and classification
Wound duration
Treatment goals
Planned reassessment date(s)

3. Wound Assessment Parameters

Wound size (measurement of area and depth)
Presence of undermining or tunneling
The category (ie, if the wound is a pressure injury)
Wound bed tissue type and amount
Characteristics of the wound margins/edges
Color and condition of the surrounding area
Any signs of healing present

4. Wound Symptoms

Wound pain (presence, severity, and frequency)
Exudate amount consistency (scant – large), type (serous, sanguineous, serosanguineous, or purulent), and color
Odor presence (strong, foul, pungent)
Signs of systemic or local infection
Whether or not a clinician has performed a wound swab or other method of culture

5. Specialists

Investigation for lower limb vascular assessment if needed
Referrals made for wound treatment and continued care

With so many factors contributing to wound healing, knowing which items to document can be difficult. However, it can be helpful to also consider some other factors that can be included in documentation. For instance, a patient’s responsiveness to a particular treatment, changes in the treatment (or reasons for not changing it), referrals, refusal of care, or even resident or caregiver information can be documented, too.6 This list provides a starting point to ensure wound documentation is sufficient to support ongoing care and transitions in care.

Conclusion

Proper documentation can ensure continuity in care and that all regulatory requirements are met. Most importantly, analogous documentation can improve patient care and outcomes by making available key patient information to members across the multidisciplinary team.

References

Docherty J. Understanding the elements of a holistic wound assessment. Nurs Stand. 2020;35(10):69-76. doi:10.7748/ns.2020.e1154
Coleman S, Nelson EA, Vowden P, et al. Development of a generic wound care assessment minimum data set. J Tissue Viability. 2017;26(4):226-240. doi:10.1016/j.jtv.2017.09.007
Barakat-Johnson M, Jones A, Burger M, et al. Reshaping wound care: Evaluation of an artificial intelligence app to improve wound assessment and management amid the COVID-19 pandemic. Int Wound J. 2022;19(6):1561-1577. doi:10.1111/iwj.13755
Guest JF, Ayoub N, McIlwraith T, et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015;5:e009283. doi: 10.1136/bmjopen-2015-009283
WoundSource Practice Accelerator. Documentation in wound care. WoundSource. Published May 31, 2022. Accessed January 3, 2023. https://www.woundsource.com/blog/documentation-in-wound-care
Hess CT. Focusing on wound care documentation and audits. Adv Skin Wound Care. 2019;32(9):431-432.

Introduction

The National Quality Forum (NQF) introduced the term never event in the early 2000s, and it refers to a preventable error that may represent fundamental issues with the quality or safety of care within a medical setting.1 This wording was initially selected because these events are situations that should never happen to any patient, such as surgery to the wrong leg or leaving a sponge in a patient after surgery.2 In recent years, the NQF has adopted the term serious reportable events (SREs), but in many instances, the term never event is still used.2

Never Events in Wound Care

In wound care, the concept of a never event is complicated. In 2008, the Centers for Medicare and Medicaid Services (CMS) released a list of facility never events that are not covered under Medicare. Under that list were hospital-acquired stage 3 and 4 pressure injuries, along with unstageable pressure injuries.3 Several other hospital-acquired conditions are listed, including burns and certain surgical site infections.4

For those working in understaffed facilities or with patient populations at a higher risk of such injury, the inclusion of these conditions as never events may have serious consequences. In certain cases, wound care professionals who provide the standard of care or even care that exceeds expectations may receive repercussions when a patient develops a pressure injury. In addition to Medicare not providing coverage for these injuries, clinicians could face legal action from the patient or their family. Not all pressure injuries are avoidable. According to a literature review from 2019, certain injuries discovered at a patient’s end of life may have unmodifiable intrinsic and extrinsic factors. For instance, Kennedy terminal ulcers (KTU), also referred to as Kennedy terminal lesions,5 and discussion around the skin failure concept resulted in an update by CMS in 2017.6

In the long-term care setting, CMS currently allows that certain injuries, including pressure injuries, which occur at end of life (6 weeks to 2 days before death) and receive appropriate treatment in line with the patient’s end of life goals can be recorded as KTUs, terminal ulcers, or terminal lesions. Although different from the Minimum Data Set, The State Operations Manual Guidance to Surveyors for Long Term Care Facilities states that the facility is responsible for classifying and assessing an ulcer as a KTU, or another type of pressure injury, and the facility must also show that measures were taken to prevent non-KTU ulcers.7

Despite being a step in the right direction, this update does not apply to the acute care setting, rehabilitation facilities, home health setting, or long-term acute care hospitals.6 Even with the efforts of influential wound care professionals, there isn’t enough research regarding which specific intrinsic and extrinsic patient factors are unmodifiable.8 In addition, injuries documented as terminal are difficult to diagnose before a patient’s death because the time of injury development in relation to death cannot possibly be determined. Therefore, wound care professionals can best protect themselves from these scenarios by implementing best practices and thorough, constant documentation of any assessment and management. Moreover, current technology may help further prevention efforts. Technologies like databases and safety tools may not only help prevent hospital-acquired stage 3 and 4 injuries but may also aid in preventing several other never events and SREs that pose a risk to staff and patients.

How Are Never Events Categorized?

In 2008, CMS identified specific never events and conditions that can result in penalties for medical facilities. Since then, the list has grown to over 30 events.9 Never events, or SREs, fall into 7 categories, including the following10:

Surgical or invasive procedure events: A never event in this category may include performing surgery on the wrong site or patient, performing the wrong surgery, leaving a foreign object in the patient after surgery, and postoperative death in an ASA Class 1 patient.
Product or device events: This category includes patient death or injury associated with contaminated drugs, devices, or biologics. It is also associated with the use or function of a device in patient care when the device is used other than its intended purpose. Patient death due to intravascular air embolisms is also in this category.
Patient protection events: In this category, the patient’s safety has been compromised. These events include the discharge of a patient who is not able to make decisions in any way other than to an authorized caregiver and the disappearance of a patient. These events also include attempted suicide or self-harm in a health care setting.
Care management events: A few examples of care management never events include patient death or injury due to medication error(s), falls, the unsafe administration of blood products, artificial insemination using the wrong donor sperm or egg, and maternal or infant death during labor and delivery with a low-risk pregnancy. Patient death or serious injury resulting from the irretrievable loss of irreplaceable biological specimens or those resulting from a failure to follow up or communicate laboratory, pathology, or radiology test results are also in this category. Some hospital-acquired conditions are also included in this category, which encompasses Stage 3, Stage 4, and unstageable pressure injuries acquired while in the health care facility.
Environmental events: This category includes patient or staff death, or serious injury, associated with electric shock during treatment, those in which oxygen or other gas delivery systems fail or are contaminated, those associated with a burn incurred while in the health care setting, and those associated with physical restraints or bedrails.
Radiologic events: This category is for the death or serious injury of a patient or staff related to the presence of a metallic object in the MRI area.
Potential criminal events: This category includes any instance of impersonation of a physician, nurse, or another health care provider, the abduction of a patient of any age, sexual abuse of a patient or staff member, and the death or serious injury of a patient or staff member within the health care setting.

While it may be tempting to think that only some of these SREs listed above may occur when administering wound care, like in the care management category, the reality is that depending on the patient, the wound, and the care team, there may always be a risk that an SRE from any category could occur.

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Strategies for Never Event Prevention

Regardless, never events can profoundly impact the clinician. Wound care professionals often experience profound psychological effects, such as anger, guilt, inadequacy, depression, and risk for suicide or self-harm due to real or perceived errors, and the threat of legal ramifications can compound these feelings.11 Therefore, reducing the risk of never events or SREs should be a top priority. In many instances, medical technologies can be used to reduce human error. For instance, one method for reducing medication errors involves physician computerized order entry. This procedure has not only helped reduce errors for materials such as prescriptions for patients, but it has also made information easily available and accessible, thus helping to reduce potential errors.13 Tools for streamlining information are all vital components in creating a culture of safety to ensure that errors are caught before any harm is done. And, often, reducing the risk of a never event includes the following elements12:

Review operations and make changes that reduce errors: This review of systems includes enhancements to the identification, documentation, and coding of conditions present upon admission and changes in medical practice, such as ordering additional tests at admission to adequately gauge each patient’s condition. Systems should ensure that wound care professionals assess and document the patient extensively upon admission. If the patient presents with a pressure injury and it is not documented appropriately, that could result in complications for the provider and the facility. Enhancements here can include incorporating safeguards that increase accuracy, facilitate better communication, and reduce the risk of medical errors.
Create a culture of safety: Most medical errors are systems-related rather than due to individual negligence or misconduct. System improvements should acknowledge the adage that “to err is to be human” and, as a result, create fail-safe mechanisms that can catch errors before harm occurs or have procedures in place to mitigate the level of harm to the patient or health care professional.
Implement safety tools, such as checklists, communication tools, handoff check sheets, and briefing guides: Checklists can be a huge asset that may reduce never events and SREs. The use of a 5-step checklist with reminders for clinicians to wash their hands and put on sterile gloves before performing an associated procedure, for example, may decrease the level of infection correlated with a particular treatment.

Conclusion

Never events and SREs represent a huge risk to patients, clinicians, and health care facilities. These events cost facilities thousands of dollars and, most importantly, often put both providers and patients in harmful situations. For wound care professionals, thorough documentation, and adherence to their facility’s standard of care are the first line of defense against financial and legal repercussions for unavoidable injury. For the myriad of other never events and SREs, clinicians can review operations, integrate fail-safe and mitigation procedures for anticipated events, and use various tools and technology to streamline documentation and procedures. These actions can significantly reduce the risk of never events and SREs, which benefits patients and clinicians alike.

References

Chokshi DA, Beckman AL. A New Category of “Never Events”—Ending Harmful Hospital Policies. JAMA Health Forum. 2022;3(10):e224703. doi:10.1001/jamahealthforum.2022.4703
Leving JM. Does the term ‘never event’ apply to pressure injuries? WoundSource. Published October 7, 2016. Accessed January 5, 2023. https://www.woundsource.com/blog/does-term-never-event-apply-pressure-i…
Medicare and medicaid move aggressively to encourage greater patient safety in hospital and reduce never events. CMS. Published July 31, 2008. Accessed January 9, 2023. https://www.cms.gov/newsroom/press-releases/medicare-and-medicaid-move-…
Hospital-Acquired Conditions. Centers for Medicare and Medicaid Services. Updated August 12, 2022. Accessed January 9, 2023. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalA…
Kennedy-Evans KL, Ritter L. Science Catches Up with the Kennedy Terminal Ulcer. Oral Presentation at: WOCNext. June 2022; Fort Worth, TX. https://www.wocnext.org/WOCN2022/Custom/Handout/Speaker0_Session976_1.p…
Centers for Medicare & Medicaid Services. Appendix PP—Guidance to Surveyors for Long Term Care Facilities. CMS. Published 2017. Accessed January 10, 2023. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107a….
State Operations Manual: Appendix PP – Guidance to Surveyors for Long Term Care Facilities. CMS. 2007;117. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads…. Updated October 21, 2022. Accessed September 23, 2022.
Ayello EA, Levine JM, Langemo D, Kennedy-Evans KL, Brennan MR, Gary SR. Reexamining the Literature on Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries. Adv Wound Care. 2019;32(3):109-121. Doi: 10.1097/01.ASW.0000553112.55505.5f
Torrey T. There’s More ‘Never Events’ Than Patient Safety. Verywellhealth. Published June 24, 2022. Accessed January 5, 2023. https://www.verywellhealth.com/what-is-medicares-never-events-policy-26…
List of SREs: List of Serious Reportable Events (aka SRE or ‘never events’). National Quality Forum. Accessed January 5, 2023. https://www.qualityforum.org/Topics/SREs/List_of_SREs.aspx#sre1.
Rodziewicz TL, Houseman B, Hipskind JE. Medical error reduction and prevention. StatPearls. Updated December 4, 2022. Accessed January 5, 2023. https://www.ncbi.nlm.nih.gov/books/NBK499956/
Bates DW. Using information technology to reduce rates of medication errors in hospitals. BMJ. 2000;320(7237):788-791. doi:10.1136/bmj.320.7237.788
Harden S. Six things you must know about never events. Lifewings. Published March 2012. Accessed January 5, 2023. https://qprinstitute.com/pdfs/SixThingsYouNeed.pdf