This interview is brought to you by ReNew Wound Care. This interview took place during a live Q&A session with ReNew Wound Care CMO Dr. Rekha Bhandari at the SNN RETHINK event in Chicago held on September 1, 2021. The interview has been edited for clarity.
Skilled Nursing News: What trends are you seeing among the best SNF operators in wound care right now?
Dr. Rekha Bhandari: To understand the state of wound care today you have to trace the evolution of wound care over the last two decades. It is linked to better clinical outcomes in chronic disease management, hence, you’re seeing a different set of wound care outcomes as well. Some of the most technologically adaptive operators and clinical teams are in wound care, and it’s exciting as a clinician because I know health care and technology adaptation is slow in nature.
A lot of these technologies involving artificial intelligence, machine learning, IOT can validate clinical delivery with much more precision. Previous speakers have talked about the adoption of telehealth in response to COVID. Telemedicine really helps us evaluate and recommend all kind of wounds in skilled nursing facilities in real-time. The real-time assessments and care management, helps to achieve better outcomes in the future.
What are the most common types of wounds seen in skilled nursing facility residents right now?
Dr. Bhandari: Most of my nursing home partners here will agree there has been a lion’s share of focus on pressure injuries. However, there are equal number of wounds stemming from diabetes, peripheral vascular disease and hyperlipidemia. The main reason that the focus happens to be on pressure injuries are due to ramifications associated — the quality metrics, patient experience, patient outcomes, risk management, PDPM etc.
What does chronic wound care management look like in SNFs?
Dr. Bhandari: In SNFs, the chronic wound care management is set up differently in every facility. In the mainstream, chronic wound care management follows a consultative model. Wherein the wound care experts like RENEW provider weekly rounds and management recommendations which are evidence based
Are there a lot of skilled nursing operators that have that in-house wound care management, or is that rare?
Dr. Bhandari: When we look at outcomes and risk share, we need to have a whole team invested in the conversation. There are some facilities who have robust programs, and there are some facilities who are not there yet. I’m sure the intent from every operator is to ensure every facility has a strong wound care program.
What kind of metrics should operators be focused on?
Dr. Bhandari: From an operator’s perspective, the most important metric for skin health outcome is human resources — whether that is nursing staffing, CNA’s or a truly integrated, interdisciplinary team approach. We’ve so far heard there are huge gaps or need in staffing.The staffing matrix should be a high priority on the operator side, followed by utilization of the products and hospitalization. When I say hospitalization, I’m talking about all wound-related causes including sepsis. While we are focused on 30-day rehospitalization from STR, we should also focus on long-term wound outcomes and hospitalization from the community as well.
Clinically, we should be looking at all kind of wounds we have in the facility and currently most facilities are looking at healing rates, stagnant rates and worsening rates if there are any.
One area the continuum of care should be focusing on is called hospital-acquired condition, such as CLABSI for central line associated infections, or CAUTI for catheter related UTI, and there hospital acquired wounds. While CLABSI and CAUTI indicators have improved, hospital-acquired wound numbers don’t look great. That translates to the SNF numbers since we inherit these patients. These are some of the metrics most operators should be looking at.
Any general advice for wound prevention in vulnerable populations?
Dr. Bhandari: Health care organizations should almost always focus on wound prevention, with a proactive approach for the most vulnerable. There’s enough research on how to risk stratify these patients. Major focus is on cardiac and pulmonary health, but there should also be a focus on skin health. Skin health or skin disease is a manifestation of multiple, complex changes with aging. We have macromolecular damage, we have to anticipate blunted response to stress, we have to anticipate blunted response to immunity, etc. A truly holistic, comprehensive and patient-specific approach is extremely important.
Some of our programs are great at risk stratifying for pressure injury. At times, the evolution of life is such that we do accept transitions and palliative goals may need to be discussed. These discussions should be led strongly by clinical team. Prevention is the key with good nutrition, managing chronic illnesses for the vulnerable population and having a patient-specific, interdisciplinary approach.
We have an interesting question here from the audience related to CMS penalizing skilled nursing facilities if an admitted wound is not healed within 100 days. Do you consider this an ample time to heal on average?
Dr. Bhandari: It all depends. It’s extremely subjective in nature, and the ruling is such that it removes the objectivity. It has to be a patient-specific lookout seeing the majority of patients — if managed aggressively — on an average is a decent time expectation to heal.
From the technology perspective, is there anything about ReNew Wound Care or SNF wound care in general that people might not be aware of?
Dr. Bhandari: All stakeholders have to invest in new technology, which is available in a hospital clinical settings and not as common in SNFs. At the end of the day, I still think that if we bring best care practices into the home and look at the outcomes, we are in better financial shape than when we use an acute care set up.
Let’s take it to the care side since we spoke about the tech side.
Dr. Bhandari: The care side is very simple. As a geriatrician, I’ve done this for the last two decades, and if we have a team invested approach we will have more success. We need to make sure we have the best nutrition, best skin assessment and best modalities to prevent ulcers. I’m talking about main depression injuries and other illnesses that trigger vascular conditions. It all boils down to better outcomes.
We need a holistic, comprehensive approach instead of the current scenario where everything is siloed and fragmented. We need to integrate the services as best as we can.
This article is sponsored by ReNew Wound Care. ReNew partners with SNFs, ALFs, and LTACHs to provide the most advanced treatment protocols available in the post-acute setting. To learn more about how ReNew Wound Care can help your business, visit renewcares.com.
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