Role of Wound EMR in Selecting Most Appropriate Wound Dressing

Choosing the most appropriate dressing for a wound is very important to reduce the healing time. Accurate wound documentation can help wound care nurses match the right dressing with the right wound at the right time with the right patient. Rather than a general EMR that supports generic information, a wound care EMR that specifically documents multiple wounds can provide with the most specific details of wounds at the right time to help in selecting the right wound dressing.

There are number of specialty dressings such as hydrocolloid, hydrogel, alginate, hydrofiber, antimicrobial, silver and so on. In addition to that, the dressings are categorized into primary (where materials are placed to interact with the actual surface of the wound), and secondary (for covering and securing the primary dressing in place). The nurses should understand the mode of action of the materials involved and realize that wound healing requires a frequent reassessment of the wound and that the dressing must be changed as required to meet the changing goals of wound management. Here are the major criteria to consider when selecting a dressing type.

  • The actual nature of the wound and the patient’s needs.
  • Location of the wound. Based on the location, nurses can determine whether a dressing will remain in place for the desired length of time and protect the periwound skin. It is easy to secure primary dressing if the wounds are on a lower extremity, while it is difficult to secure the same if the wounds are in other areas such as the trunk or close to a joint since it will depend upon how the patient moves.
  • The size of the wound determines the size of the dressing required to cover the wound surface adequately.
  • The amount and type of exudate will determine whether a dressing material can adequately handle the wound drainage and prevent the pooling of exudate on the wound surface and causing bacterial growth.
  • The predominant tissue type on the wound surface will determine the dressing type that can improve or maintain the overall tissue health. For example, if there is predominance of necrotic tissue and the goal is debridement, then a dressing that either creates or improves the moist environment needed for autolytic debridement would be required while a clean and granulating wound requires a dressing that maintains the current ambient moisture level. The topography of wound surface needs to be considered as well.
  • The condition of the surrounding skin should be considered while choosing a method of adherence for the dressing. If there is risk of soiling the dressing, secondary dressings are required. Silicone dressings are better for sensitive or fragile skin.
  • The chosen dressing type should be compatible with other phases of wound management such as the mode of action and the frequency of dressing change so that it will effectively work with the accompanying therapy.
  • The presence or potential threat of bacterial contamination at every dressing change.
  • Patient’s comfort during dressing changes. Use of dressing type that do not exacerbate pain and trauma during dressing changes are a better choice.

The Importance of a Specialty EMR

When it comes to general EMR, there will be all types of functionalities and general templates regardless of whether the user wants them or not. So it is often quite difficult for wound care nurses to extract specific wound information they require (for example, condition of the surrounding skin) to determine a dressing type from such a system. Since this process of extracting data from general EMR takes time, nurses may not be able to provide effective wound care to their patients. For example, if it takes a lot time to find information regarding the condition of the surrounding skin and determine the risk of soiled dressings, nurses will probably fail to place the secondary dressing on the wound at the proper time, which will adversely impact healing.

On the other hand, specialty EMR is loaded with templates specifically designed for wound care. This allows nurses to extract the patient’s history, wound assessment details and other information more quickly. Specialty EMRs are equipped with order sets for various wound conditions including diabetic foot or surgical wound along with the flowchart of wound therapy. Nurses can quickly make a choice of the primary dressing and secondary dressing, if necessary, with this information. They can easily choose the dressing type from a list and the physicians can immediately check it out through the physician interface and ensure successful wound management.