1. Section Editor(s): Hess, Cathy Thomas BSN, RN, CWOCN

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Wound Infections Lead HCFA List

If you work at or consult for a home health agency, take note: emergent care for wound infections, deteriorating wound status has topped the list of 13 adverse events identified by the Health Care Financing Administration (HCFA) in its OASIS reporting for home health agencies.


Each of the 13 adverse events is reported as a percentage of total patient episodes. HCFA gave this hypothetical example: Suppose an agency has 572 valid cases (ie, the number of patients determined to be at risk) for the adverse event emergent care for wound infections. This adverse event occurred among 15 cases of the 572 cases, for an agency incidence of 15/572, or 2.6%.


According to HCFA, emergent care for wound infection occurred in 1.66% of patient episodes nationwide between October 1, 1999, and September 30, 2000. The hypothetical agency's 2.6% is well above the reported nationwide average and slightly above HCFA's cutoff of 2%. The agency could face a condition- or standard-level deficiency as a result.


Preventing Adverse Events

An agency that exceeds the cutoff level would want to investigate how and why patients developed wound infections. But before it gets to that point, agencies can take steps to reduce wound-related adverse events.


According to Sharon Baranoski, MSN, RN, CWOCN, who is responsible for the home health department at Silver Cross Hospital and Medical Centers, Joliet, IL, agencies need to have a comprehensive wound assessment program in place. A certified wound nurse should be involved in educating the agency's nurses on assessment, staging, treatment modalities, signs and symptoms of infection, dressing options, and appropriate wound documentation. An agency in Pennsylvania did just that, according to a report in the newsletter ...home health line, and its nurses' assessment accuracy went from 75% to 100%, with emergent care for wound infection reduced by half.


Baranoski also advises agencies not to underestimate the value of educating the patient, family, or caregiver. For example, they need to thoroughly understand how to cleanse the wound and how to apply a new dressing. They also need to know what to expect when they remove the dressing, such as what the wound should look like if it is healing normally and what they should report to the patient's health care provider for follow-up care.


If the education process is done right, it will help to reduce trips to the emergency department and adverse events for agencies, Baranoski says.


The report in ...home health line recommends another simple solution: Look at the wound care products (including topical ointments) on the agency's formulary and eliminate those that could be causing reactions. This can be done by going through the charts of patients who have developed wound infections and looking for patterns that can be attributed to specific products.


More Adverse Events

Besides emergent care for wound infection, skin and wound care practitioners should be aware of 2 other wound-related adverse events on the HCFA list:


* increase in the number of pressure ulcers-the patient had more pressure ulcers at discharge than at the start or resumption of care


* discharge to the community needing wound care assistance- the patient was discharged without paid or resident assistance, while confused or nonresponsive, and with a Stage III or IV pressure ulcer or nonhealing surgical wound.


HCFA has indicated that it plans to use the adverse events reports in its survey and certification procedures for home health agencies.