Sutter VNA & Hospice has developed and implemented an advanced wound product formulary for better standardization of topical wound therapies. All Sutter VNA & Hospice wound care nurses are trained to do bedside Doppler assessment of patients with lower extremity ulcers. To improve wound assessment and outcomes, Sutter VNA & Hospice offers the following referral criteria for wound care patients:

• Characteristics of Appropriate Wound Care Referrals
• Patients Who May Not Meet Home Care Criteria:
• Special Considerations

Characteristics of Appropriate Wound Care Referrals

• Patient is able to be taught wound care or has a caregiver willing/able to assume care.
• Patient/identified caregiver is able/willing to comply with treatment plan as outlined by MD and home care staff.
• The referring MD is willing to collaborate with nursing staff and wound care specialty nurses to determin appropriate topical therapy based on patient's needs and advanced wound product formulary.

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Patients Who May Not Meet Home Care Criteria:

• A chronic non-healing wound and no one to assume the ongoing treatment.
• Requires BID dressing changes and no available caregiver.
• Will require ongoing daily dressing changes and no caregiver to assume care.
• Patient has a history of non-compliance with wound treatement plans.
• A Medicare patient who is receiving outpatient wound therapy and needs dressing changes on weekends and holidays.

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Special Considerations

• For a wound that is high risk for complication and/or requires close assessment, RNs may go into the home for daily assessment and treatment for a limited time period. If the wound cannot be stabilized, moving the patient to a higher level of care may be necessary.
• Wound care treatments that require ongoing, intermittent skilled nursing are acceptable when the wound is responding favorably to treatment.
• If a patient has a lower extremity wound with indications of compromised perfusion, vascular studies may be requested in order to accurately assess the patient’s ability to heal. Once the vascular study is completed/evaluated, the nurse will collaborate with the referring MD on a realistic treatment plan and appropriate goals.
• In the instance that a wound is determined to be non-healing, the patient and/or caregiver will be instructed in all aspects of wound care. Once the patient and/or caregiver are deemed competent and wound is stable, the patient may be discharged to the community with physician follow up.
• Board and Care and assisted living facilities (RCFEs) are often unable to provide wound care, depending on the severity of the wound and the complexity of the treatment. These cases will be reviewed by our Intake Department on a case-by-case basis. The criteria of having a willing and able caregiver applies to these facilities as well. These facilities may need to obtain a facility waiver to keep patients with pressure ulcers greater than Stage II.

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