I have a confession to make. My name is Emily…. and I’m obsessed with wound care.
I never imagined my occupational therapy career would lead me down the path it did- working heavily with people with chronic edema, skin conditions I had never heard of, and hand-in-hand with this- wound care.
Whether this is a role for an OT or not is a question that comes up again and again. One of the things I love about OT is the wide range of areas we practice and are effective in. I always felt- if I’m going to be working in a field for 40+ years, I want to have options of different fun things to grab my interest every few years!
This held really true when 5 years after graduation, I fell down the edema rabbit hole. This massively misunderstood and under-treated area captured my attention, and the payoff of seeing people becoming more mobile, engage with their communities again, and improve their QOL was (and is) fantastic!
However, as any clinician who encounters chronic swelling of any kind knows, skin breakdown and infection is never far behind. And that is where my newest pet obsession- wound care- comes into its own!
Is wound care within the scope of practice of an OT?
Wound care is squarely within an OT’s scope of practice, and intersects with many of our other, occupation-based, interests. Check out the AOTA’s position paper on Occupational Therapy and wound care for details on what occupational therapists may complete as part of their wound care practice.
Skin integrity is central to a person’s ability to function at the best capacity. A wound- whether it is a pressure ulcer, a burn, an ostomy, an abrasion, or any other skin condition- will stymie or completely alter a person’s ability to pursue meaningful occupation. This runs contrary to what OT’s hold centrally- that engagement in activities and tasks is integral to a meaningful life. Engaging in these activities, and the associated mobility, helps some types of wounds, like pressure ulcers, from occurring (or worsening!).
Why would occupational therapy get involved with wound care? Isn’t it more of a nursing role?
Firstly- wound care is a concern for everybody on the team. If a client has a wound, this will be the #1 thing that will complicate their stay, impede upon their outcomes, and is the most likely factor to send them to a long-term facility instead of going home.
Wound care is a huge deal! But yet, many, many clinicians don’t feel comfortable or equipped to manage these issues.
Within the multidisciplinary team, OTs have a really distinctive role they can play. As I mentioned before, prevention of wounds is an area that we can be instrumental in. Positioning, use of equipment and cushions, pressure-relief: these are strategies that OTs are uniquely positioned to address, with our ability to analyze activity and engagement.
- Before the wound: Wound prevention in our vulnerable population is also an extremely important role that OT’s can play. Through activity analysis, positioning, appropriate equipment usage, environmental modifications, and lifestyle/risk reduction- we can help keep skin intact. Returning to previously held activities and roles- but ensuring it in a safe and skin-protecting manner is an area that many OTs can identify with.
- As a wound occurs: Managing wounds as they occur is a vital skill for a clinician working with vulnerable clients- as many occupational therapists are. We work with people in very close and intimate way, and are able to monitor and observe their skin. Therefore, we’re in a unique position to notice if a wound/pressure area is developing, or worsening (such as dehiscence/surgical). If an OT notices a wound is happening, we should be able to know how to accurately assess this, know the correct terminology to use, and know how to go forward with intervention- both to the area itself with medications and dressings, and also in support (positioning, swelling management, etc.). When working with someone who is at risk to develop a wound (such as- someone with Spinal Cord Injury, or Diabetes, or chronic swelling, and so on), we can also be looking out for high risk areas and teach a person how to monitor and assess their own skin.
- During wound healing: Lifestyle modification to maximize safety while living with a wound may be a less considered area for OT’s- but equally valid! Many of our clients will have wounds when they come to us, which may take some time to heal. Think of someone with a new ostomy bag, for example. This issue is a perfect intersection between functional engagement and skin/wound care, where OT’s can be instrumental in success. Similarly, living with trachs/PEGs/pressure wounds/post-surgical wounds are all open areas that a person may be dealing with for some time. Teaching a client how to manage these wounds, yet engage safely with daily tasks is vital for an occupational therapist. OT’s can also teach clients best practice to ensure that the wound heals as best and as fast as possible. We may also use modalities to speed up wound healing by stimulating circulation, granulation, and so on.
- After wound healing: Occupational therapists are one of the clinicians best positioned to discuss risk factors, required environmental changes, and ongoing skin management (both self-administered or directing a caregiver). OTs can work with clients to make sure that their life supports them not getting a wound again. Whether it is compensatory techniques for checking shower temperature for someone with neuropathy, or how to make sure maceration is not occurring, by teaching how to keep skin fastidiously dry with a person who has lymphorreah- OTs have the necessary skills to analyze activities for risk and help ameliorate those issues. (We can’t help it that we rock!)
Is it worth it for my administration to get an OT involved with wound management?
Look, we all want what is best for our patients, every day! But as clinicians- we are able to be able to think like that. Our bosses and administrators have to deal with the bottom line- insurance companies, productivity, and more. So when you’re trying to advocate for upskilling in the area of wound-care- you must be able to justify it. Luckily…. its totally justifiable.
Including the whole rehab team in the approach and treatment of wounds has a big impact on the overall outcomes of the patient. Larger increases in independence scores, better patient satisfaction, more discharges to home as opposed to long term care (or re-hospitalization), and a shorter and more efficient use of interventions are some of the effects that you will notice if you work in a hospital or subacute setting. In addition, there are billing opportunities for therapists, both in terms of prevention and intervention. If you are an OT that works in an outpatient or home care setting, these factors still hold true, and also include a decrease in unnecessary emergency room and hospital visits.
These are all amongst the financial and QOL reasons that Occupational Therapy, and other therapy clinicians, are important members of the wound care team.
What kind of wound care procedures are Occupational Therapy allowed to do?
According to the American Occupational Therapy Associations 2018 position paper, an OT can provide the following interventions. These interventions, of course, must be in accordance with a plan of care established by an OT, and varies depending on each practitioner’s level of competence and scope of practice. Interventions include:
- Application of clean dressings with both exudating and non-exudating wounds
- Application of wound closure strips
- Removal of sutures
- Application of appropriate topical agents to facilitate healing and debridement
- Application of enzymatic agents for debridement
- Mechanical debridement using forceps/cotton-tipped applicators/wet-to-dry dressings/pulsed lavage
- Application of negative pressure wound therapy
- Sharp debridements using scalpel or scissors
- Application of silver nitrate for reduction of hypertrophic granulation tissue
- Application of physical agent modalities such as whirlpool/electrical stim/ultrasound
- Education of clients and caregivers in techniques for donning and doffing pressure garments
- Use of specialized techniques for the management of lymphedema
This list does not include other, more typical OT interventions, such as: education to the client and caregiver about skin care, risk reduction, and self-management; modification and environmental accommodation; and use of adaptive equipment.
Does an OT have to be certified as a WCC to provide these services?
No! These services are within the scope of practice of an OT/OTA, in accordance with the AOTA’s position paper. It falls on the clinician to make sure they have the skills and competence to provide these services, however.
Becoming a WCC (Wound Care, Certified) is a great option if you know that you want to open your own clinic; or really dedicate yourself to wound care. To become certified, you must be a clinician (Nurse, PT/A, OT/A, Doctor); have about 120 hours of wound care experience (or 2 years working in a center treating wounds); and have completed a wound care certification prep course (which cost over $2500- ouch!). As an investment in your Wound Care Career, however, this is the gold standard of what you should aim for!
If you are interested in building your skill and becoming more confident in assessment and hands-on management of all kinds of wounds, you should have a look at our one-day course, A Comprehensive Guide to Wound Care: Tools for the everyday clinician. This course provides the participant a specific overview of different wounds; teaches both through hands-on application (yes, you get to use real debriding ointments to build your confidence!). Some examples of the ‘wounds’ that you get hands-on practice with during this course: Pressure ulcers, dehiscence wounds, tunneling/undermining wounds, ostomies, tracheostomy/PEG sites… and many others!
So as you can see- Occupational Therapy and wound care go hand-in-hand! I hope by now that you are as obsessed as I am 🙂 If you are interested in learning more wound care management techniques, check out these videos of Michelle teaching various wound care techniques that you can apply immediately, no matter what setting you work in.
If you are interested in upskilling your practice, check out ‘A Comprehensive Guide to Wound Care: Tools for the Everyday Clinician‘! This engaging and super-practical seminar will give you the hands-on skills and the confidence you need to be able to assess and manage all types of wounds.
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