Policy Manual sample

MDT Home Health Care Agency, Inc. 148 WOUND DEBRIDEMENT PURPOSE: Non-physician health care providers may perform the removal of devitalized/necrotic tissue after successfully completing required professional and educational programs. A physician’s order and a patient consent is required prior to the procedure. Debridement is perform to achieve several objectives: a) reduce the growth of bacteria and remove necrotic tissue and foreign matter to reduce the volume of pathogenic microbes in the wound; b) control and prevent wound infection in deteriorating; c) facilitate the visualization of viable tissue for assessment purposes; d) interrupt the cycle of the chronic wound so that protease and cytokine levels more closely approximate those of the acute wound. Use of standard infection control procedures are followed. SPECIAL CONSIDERATIONS: Debridement is contraindicated for non-infected ischemic (insufficient tissue oxygenation) ulcer covered with dry eschar such as arterial ulcers, diabetic ulcers or dry gangrene. Conservative sharp debridement may be contraindicated for patients with impaired clotting mechanism or an increased risk for bleeding. A non-physician health care provider cannot perform conservative sharp debridement when there is the presence of densely adherent necrotic tissue with unidentifiable interface between viable and nonviable tissue. RESPONSIBLE PERSONNEL: RN, LPN PROCEDURE: 1) Explain procedure to patient and/or caregivers and obtain patient/caregiver consent. 2) Wash hands and don gloves. 3) Assess wound to determine if debridement is indicated. 4) Obtain physician’s order if not already obtained prior to visit. FOR CONSERVATIVE SHARP: A) Prep the wound with cleanser or antiseptic. B) Set up sterile instruments. C) Grasp avascular tissue so that the line of dissection is clearly visualized. D) Cut away avascular tissue with scissors or scalpel. E) Avoid all vascular structures or any structures not clearly identified as avascular. F) Control minor bleeding with pressure and/or Silver nitrate sticks. G) Cleanse or flush the wound and redress the wound per physician’s order. FOR CROSS HATCHING: A) Prep the wound with cleanser or antiseptic. B) Set up sterile instruments. C) Using scalpel cut superficial horizontal and vertical lines in the eschar in a tic-tac-toe fashion. D) Avoid using pressure with the scalpel to cut deeply. E) Cleanse or flush the wound and redress the wound per physician orders.