Optimizing Wound Care to Reduce High Readmission Rates

Optimizing Wound Care to Reduce High Readmission Rates

00:00:05.780 –> 00:00:15.500
Dennis Gill: Okay guys. So welcome to CareSmartz360 on Air, a home care Podcast. I’m Dennis, Gill, a senior sales consultant at Caresmartz.

00:00:16.180 –> 00:00:20.859
Dennis Gill: So in a value-based system. Reducing readmissions is key

00:00:20.970 –> 00:00:28.019
Dennis Gill: to optimize, wound care and tackle this issue. It’s vital to focus on the entire healing journey.

00:00:28.760 –> 00:00:42.810
Dennis Gill: wound care protocols across the care network must be standardized to ensure consistent treatment. Further, it’s important to invest in effective wound dressings that promote healing and reduce infection risk.

00:00:43.800 –> 00:00:56.159
Dennis Gill: Also, there should be clear communication between the caregivers and the care recipients who should be equipped with self-care skills and provided with the resources for post-discharge wound management.

00:00:56.820 –> 00:01:07.150
Dennis Gill: So this comprehensive approach improves, care, and outcomes it reduces unnecessary readmissions, and demonstrates better value for home care providers.

00:01:08.320 –> 00:01:44.580
Dennis Gill: So for that today we have on the panel. Jennifer Bierhup. So today welcome to the podcast again, Jennifer. So the 1st question that I have for you is, how can providers ensure seamless wound, care, and coordination in the home setting? What do you say on that?

00:01:45.520 –> 00:01:51.175
Jennifer Bierhup: Wow! So you you brought together 2 interesting pieces here, providers and home care.

00:01:51.580 –> 00:01:52.819
Dennis Gill: Why does the home cat? Yeah.

00:01:52.930 –> 00:02:10.739
Jennifer Bierhup: Providers and home care right cause. That’s the disconnect. I think a lot of times are the providers, and then the home care. So the docs and the nurse practitioners, those providers. Is that what you’re asking versus? And then the home care itself? How do they seamlessly communicate.

00:02:10.740 –> 00:02:11.669
Dennis Gill: Yeah, yeah, that. That.

00:02:11.670 –> 00:02:12.110
Jennifer Bierhup: Yeah, the thing.

00:02:12.110 –> 00:02:13.260
Dennis Gill: That’s the thing we are talking about. Yeah.

00:02:13.260 –> 00:02:25.040
Jennifer Bierhup: Yeah. Well, when it comes to providers. It is absolutely necessary to. It’s simple. It truly is simple. It’s over-communication

00:02:25.860 –> 00:02:54.139
Jennifer Bierhup: which one would think, Okay, that’s okay, Jen, what does that mean? And collaboration as well is so many times in home health when the when the provider either comes into the home to do wound care, or they go out of the home for wound care. The orders are sent, but there is no other updates. So the home health is really left in the dark about what is going on, what really needs to happen. And so many times, then multiple things get missed.

00:02:54.350 –> 00:03:06.189
Jennifer Bierhup: and we can talk a little bit later about how maybe having somebody in your office that’s dedicated to wounds will help bridge this gap. But the onus also falls on the provider to communicate

00:03:06.460 –> 00:03:18.409
Jennifer Bierhup: and to write very clear orders. So it’s it’s it’s simple and very difficult all at the same time. So the providers have to also understand the rules and regs inside of home health

00:03:18.800 –> 00:03:45.779
Jennifer Bierhup: every post acute space. They’re really in silos, right? They’re really kind of siloed, and they really don’t know what the other person, other provider post acute space, needs to have to be successful. So really, for providers and home health to live in synergy. They need to understand each other. So providers need to understand the rules and regs in home health. They need to understand a little bit how home health believe it or not gets paid.

00:03:45.800 –> 00:04:02.710
Jennifer Bierhup: So it’s a good idea for providers to stay within those Medicare guidelines. You talked about the dressings, using the appropriate dressings, the appropriate visit frequencies. An example is a daily dressing change that is very difficult for a home health to accommodate.

00:04:03.010 –> 00:04:09.669
Jennifer Bierhup: so can they work together, then can the provider and home health work together for a better dressing option

00:04:09.810 –> 00:04:17.910
Jennifer Bierhup: and for a different visit frequency? So that way the patient has good outcomes, but the agency and the provider are now collaborating and working together.

00:04:18.579 –> 00:04:26.091
Dennis Gill: Okay, okay, yeah. Lots of details saying about that. I also got to know a few new things that I was not even aware about that.

00:04:26.499 –> 00:04:40.849
Dennis Gill: Thank you. Thank you for that update. And also just moving further with the next thing that any specific technologies or tools that can be used to monitor Boone. Progress. That you can talk about or facilitate communication between the team and the clients.

00:04:40.990 –> 00:05:05.479
Jennifer Bierhup: Right. Oh, my gosh, this is I I love it. Cause these questions are like, I could probably write a 30 page paper about each question, or spend the next hour discussing each question with with, when I got sent these questions I was like, Oh, boy, how do we condense this down again, you know, I mean, so we talk about home health Emrs, right? We talk about the electronic medical record system, or whatever system you’re using for charting

00:05:06.008 –> 00:05:26.830
Jennifer Bierhup: and I have had the great privilege of looking, reviewing charts, reviewing charts across the country in home health agencies for wounds, and so I will tell you that the Emrs. They vary greatly in the data that they collect for wounds, and I will. I will not

00:05:26.970 –> 00:05:33.939
Jennifer Bierhup: say any company names, but some are really pretty robust, and some are missing

00:05:34.050 –> 00:05:38.280
Jennifer Bierhup: quite a bit of information in order to risk mitigate.

00:05:39.650 –> 00:05:46.160
Jennifer Bierhup: yeah. So it’s very, very important to understand your Emr and understand what it can do.

00:05:46.460 –> 00:05:56.859
Jennifer Bierhup: Can it generate a report for wounds? Can it generate a dashboard? The crazy thing is, is a lot of times they can, and the home healths have no idea that they can.

00:05:57.598 –> 00:06:06.801
Jennifer Bierhup: They have no clue that they can generate a wound specific report that will help them understand what different

00:06:07.360 –> 00:06:26.890
Jennifer Bierhup: wounds they have on service, how many pressure injuries, how many Vlus where they’re at in the healing process most of the time this gets missed. So that’s the simple thing. Right? Let’s go to my Emr. What reports can I pull to be able to start to gather those those metrics. Another thing I wanna say, too, is that

00:06:27.480 –> 00:06:36.240
Jennifer Bierhup: There’s a really cool platform out there. I I’ve been kind of following them, and it’s been fun to watch, but it’s called care coordination, and it’s an app.

00:06:36.552 –> 00:06:58.110
Jennifer Bierhup: and Tj. Patel, who I’ve had a great I got to meet him one time. What a great guy! He’s a physical therapist with home health background. He did create a really great coordination platform between providers, the actual patients themselves, and the home health. And I really like where this is going. So it’ll be really interesting to see if he can really kind of

00:06:58.110 –> 00:07:06.940
Jennifer Bierhup: start to work. This it may be in, even in with wounds, because I like the communication with this particular software and this particular app

00:07:07.240 –> 00:07:12.780
Jennifer Bierhup: honestly, when it comes to technologies, use your Emr to the best advantage that you can.

00:07:12.780 –> 00:07:13.230
Dennis Gill: Okay.

00:07:13.518 –> 00:07:21.870
Jennifer Bierhup: Integration is the name of the game. We don’t want your home health nurses out there using 45 different pieces of technology, and they don’t talk to each other.

00:07:21.870 –> 00:07:22.240
Dennis Gill: Definitely.

00:07:22.240 –> 00:07:23.140
Jennifer Bierhup: Not gonna work.

00:07:23.140 –> 00:07:23.630
Dennis Gill: Yeah.

00:07:23.946 –> 00:07:30.269
Jennifer Bierhup: So again, it’s understanding what you have. What do you have? And can you leverage it the best way possible?

00:07:30.820 –> 00:07:36.399
Dennis Gill: Okay. Surely I would definitely like to go through that app. You told me that scare coordination. You said right.

00:07:36.400 –> 00:07:39.989
Jennifer Bierhup: Yeah, care coordinations. I think it’s care coordinations.com.

00:07:40.436 –> 00:07:51.180
Jennifer Bierhup: Really, really cool people. I really love what they’re doing. I’m excited to see where they go. I just really love their passion for that case. Management, care, coordination.

00:07:51.570 –> 00:07:56.266
Dennis Gill: Perfect perfect. No, I would definitely like to go through it. And I’ll also tell our audience to please check that.

00:07:57.170 –> 00:08:10.360
Dennis Gill: Okay, and then just maybe. With the next thing that we have overhead. That’s what data driven metrics must be used to measure the effectiveness of what you suggest on that multidisciplinary wound care program and the home health setting.

00:08:10.800 –> 00:08:23.769
Jennifer Bierhup: Right. So when we talk about multidisciplinary, let me clarify with that, because physical therapist, occupational therapists, dieticians, the nurse practitioners themselves, the wound care nurses, the nurse aides. They all play

00:08:23.840 –> 00:08:35.999
Jennifer Bierhup: a vitally important part of the team to heal this wound. Everybody does so. I love that you mentioned multi disciplinary. The problem with multidisciplinary is that they don’t like to talk to each other.

00:08:37.206 –> 00:08:37.843
Jennifer Bierhup: Okay.

00:08:38.480 –> 00:08:39.520
Dennis Gill: Okay. Okay.

00:08:39.814 –> 00:09:02.520
Jennifer Bierhup: So I I it’s like, Oh, my gosh! You know we really. 1st and foremost, let’s let’s come together. And what are the metrics? Then what’s the primary core metrics that each of those groups could look at? Maybe not, the nurse aids, but each of those groups could look at. And it’s simple. Are you ready? Super simple, super simple. It is wound healing velocity. How much has the wound healed in 4 weeks?

00:09:03.650 –> 00:09:05.080
Dennis Gill: Yeah, simple, thing. Yeah.

00:09:05.080 –> 00:09:11.120
Jennifer Bierhup: It’s super simple. Has this wound made any progress? The other thing is wound drainage. Seriously.

00:09:11.340 –> 00:09:19.810
Jennifer Bierhup: you need to monitor your wound drainage every week, because that is an indication of inflammation, and if that drainage pops up you might have an infection.

00:09:20.130 –> 00:09:21.550
Jennifer Bierhup: Oh, not hard.

00:09:22.020 –> 00:09:31.839
Jennifer Bierhup: not hard to monitor wound wound bed percentages. These are the top. 3 things wound healing, velocity, wound drainage and wound bed.

00:09:31.910 –> 00:09:33.860
Jennifer Bierhup: What does that wound bed look like?

00:09:34.190 –> 00:09:42.999
Jennifer Bierhup: If it looked like it was 100 granulation last week, and then they came out this week. And it’s 50% sluff. Well, where’s the problem?

00:09:43.000 –> 00:09:44.960
Dennis Gill: Yeah, there’s a problem for that.

00:09:45.210 –> 00:09:58.320
Jennifer Bierhup: And every single emr charts this a little bit differently. But you can pull the metrics as simple. I’m telling you as simple as this, because really there’s a there’s a nerds and stones mnemonic out there

00:09:58.330 –> 00:10:01.210
Jennifer Bierhup: which stands for nerds is non healing.

00:10:01.370 –> 00:10:04.649
Jennifer Bierhup: Ne is exudate. R is redness.

00:10:04.680 –> 00:10:09.319
Jennifer Bierhup: D is debris or extra stuck in the wound bed, and S is smell.

00:10:09.500 –> 00:10:19.749
Jennifer Bierhup: If you follow nerds and stones, so nerds means the smaller infection possibilities. If you simply follow those you will catch and risk mitigate

00:10:20.120 –> 00:10:25.610
Jennifer Bierhup: at least 80 to 85% of your wounds before they go back to the hospital.

00:10:26.250 –> 00:10:27.810
Jennifer Bierhup: It’s that simple.

00:10:28.810 –> 00:10:33.620
Jennifer Bierhup: It is that simple because we don’t want them to go onto stones, which means a bigger infection.

00:10:33.620 –> 00:10:34.150
Dennis Gill: Yeah.

00:10:34.680 –> 00:10:36.290
Jennifer Bierhup: Cause, then they probably will go back.

00:10:36.390 –> 00:10:36.990
Jennifer Bierhup: so.

00:10:36.990 –> 00:10:37.540
Dennis Gill: Come!

00:10:38.110 –> 00:10:38.690
Jennifer Bierhup: Yeah.

00:10:38.690 –> 00:10:40.860
Dennis Gill: No, no, no, please, please, Karen, please, Karen.

00:10:41.132 –> 00:11:02.399
Jennifer Bierhup: So it’s very. It’s it’s it’s not earth shattering. But I’m here to tell you that so much of this documentation is missing so much of it’s not there. There’s nobody following it. There’s nobody in home health following it. But the scary part about it is is that 30 to 50% of a skilled home. Health population is wounds, and it’s the number 2 reason why they go back to the hospital. Those wounds.

00:11:03.580 –> 00:11:22.862
Dennis Gill: Gotcha point gotcha point. Obviously, sometimes it’s saying, it’s that easy sometimes. So most simple things we people, we make it very difficult, and we just understand those aspects step by step, whatever you saying, our audience maybe it’s very helpful for you. Please. Listen to this very carefully.

00:11:23.220 –> 00:11:31.299
Jennifer Bierhup: Yeah, it’s as simple as really is the wound healing. What’s the drainage? And what is the wound that look like? And you can risk, mitigate off those 3 things

00:11:31.540 –> 00:11:32.680
Jennifer Bierhup: absolutely.

00:11:32.680 –> 00:11:34.659
Dennis Gill: And you said Ned’s and stones. Yeah.

00:11:34.660 –> 00:11:35.539
Jennifer Bierhup: And nerds instead.

00:11:35.540 –> 00:11:36.349
Dennis Gill: Body, yeah.

00:11:36.540 –> 00:11:43.479
Jennifer Bierhup: Yup nerds and stones. I won’t even get into stones because stones means bigger infection. And if you got those chances are you’re gonna you’re gonna

00:11:43.650 –> 00:11:47.650
Jennifer Bierhup: go back to the hospital. We want to catch it when it’s nerds. The little guys.

00:11:48.620 –> 00:11:51.560
Jennifer Bierhup: And use that mnemonic to help you risk, mitigate.

00:11:52.630 –> 00:12:07.200
Dennis Gill: Got the point. Got the point. I hope everybody is clear about that thing when they go through this session. So the next thing just a simple thing that is there that are there any social determinants of health that may impact boon healing for clients at home?

00:12:07.590 –> 00:12:17.209
Jennifer Bierhup: That is an understatement that is the biggest understatement of the year. So chronic wounds are a clinical manifestation of a disease process.

00:12:17.510 –> 00:12:17.840
Dennis Gill: Okay.

00:12:17.840 –> 00:12:40.939
Jennifer Bierhup: So those wounds aren’t just there because there’s oh, you got a hole in your leg. Okay, it’s there because you have an underlying disease processes. That’s not allowing something to heal or it caused it. In the 1st place, a lot of these disease processes are things like diabetes, Venus leg ulcers. Also, you know, smoking, a lot of these have to do with lifestyle and lifestyle choices.

00:12:41.130 –> 00:12:41.920
Dennis Gill: Okay.

00:12:42.070 –> 00:12:51.130
Jennifer Bierhup: And so, and as you can understand, there’s a lot of social determinants of health that don’t allow people to be able to take care of themselves has

00:12:51.540 –> 00:12:53.410
Jennifer Bierhup: as best as they can

00:12:53.888 –> 00:13:03.410
Jennifer Bierhup: as a matter of fact, healthy people, 2030, if anybody’s really interested, look it up. It’s really interesting. They identified 5 different areas of social determinants of health.

00:13:03.510 –> 00:13:05.710
Jennifer Bierhup: And those 5 areas are economic

00:13:05.770 –> 00:13:27.499
Jennifer Bierhup: education and access healthcare access neighborhoods. So who’s there for them and social and community. So those are 5 things that we have identified that are the big hot button overall topics for social determinants of health. So inside of that. If our wound patients don’t have the nutrition that they need.

00:13:27.790 –> 00:13:33.279
Jennifer Bierhup: they can’t get to food. Maybe they live in a food desert or they can’t afford it. They can’t heal

00:13:34.110 –> 00:13:38.430
Jennifer Bierhup: if they don’t understand their disease process right? If they don’t understand it.

00:13:38.660 –> 00:13:39.180
Dennis Gill: Definite.

00:13:39.180 –> 00:13:45.129
Jennifer Bierhup: If their medical knowledge is lower, that’s a struggle. Maybe their environment is tough.

00:13:45.140 –> 00:13:52.779
Jennifer Bierhup: Maybe where they’re at is tough. Maybe it’s not clean. Maybe they struggle with that resource. Maybe nobody is there to help them

00:13:53.260 –> 00:14:15.050
Jennifer Bierhup: with that wound. So one of the key things that we as home health, and we as nurse pro nurse providers, providers across the board have to understand that social determinants of health is the key, and if you can start to identify some of those we can start to manage. And I’m not talking about saving the world here. People

00:14:15.570 –> 00:14:21.949
Jennifer Bierhup: just identify them. Understand? They are roadblocks to these patients. They’re not non-compliant.

00:14:22.510 –> 00:14:29.430
Jennifer Bierhup: These are the roadblocks. And how can we all work together to kind of move some of the roadblocks out of the way?

00:14:30.690 –> 00:14:31.260
Jennifer Bierhup: Yep.

00:14:31.260 –> 00:14:35.710
Dennis Gill: Working all everybody working together on that part. Yup that could be beneficial.

00:14:36.370 –> 00:14:37.120
Jennifer Bierhup: Absolutely.

00:14:37.120 –> 00:14:49.219
Dennis Gill: Okay, okay, okay? And lastly, just one last thing that the biggest challenges faced in delivering multi disciplinary. We won’t care in the home setting, and just how you would like to address them.

00:14:49.680 –> 00:14:51.714
Jennifer Bierhup: Well, it’s like everything we just talked about right?

00:14:51.940 –> 00:15:08.630
Dennis Gill: Everything, everything in a nutshell. Yeah. So that’s mostly because the thing is mostly the sessions that I do. The last query I have for the person that is there with whom I’m doing the podcast the last query is always that whatever we discuss and compete, so that’s a sum of that thing that we have covered anything.

00:15:08.800 –> 00:15:09.139
Jennifer Bierhup: People. Yeah.

00:15:09.140 –> 00:15:09.840
Dennis Gill: Than that.

00:15:10.010 –> 00:15:19.129
Jennifer Bierhup: Absolutely. Yeah. Let me let me add some quick things here. One of the key pieces here is that I would love to see home healthcare agencies educating

00:15:19.210 –> 00:15:21.160
Jennifer Bierhup: They their nurses.

00:15:21.705 –> 00:15:33.120
Jennifer Bierhup: You come into home health and wound. Care is not taught in neither medical school nor nursing school. Okay? So and if 30 to 50% of your population is wounds.

00:15:33.200 –> 00:15:55.719
Jennifer Bierhup: I really would love to see some investment from home healthcare agencies educating the pay, educating that nurse going out to the home, because that’s the only way they’re going to answer their oasis questions correctly regarding wounds. It’s the only way they’re going to be able to document correctly and understand. And remember, I said, some of those basic metrics they have to be able to document correctly. They need to understand it.

00:15:55.720 –> 00:15:56.360
Dennis Gill: Document.

00:15:56.360 –> 00:15:59.390
Jennifer Bierhup: 1st and foremost, educate, educate

00:15:59.550 –> 00:16:06.830
Jennifer Bierhup: care, coordinate work with that multidisciplinary team who in your agency is looking at these wounds every day?

00:16:06.870 –> 00:16:08.350
Jennifer Bierhup: Who is there who’s doing it?

00:16:09.460 –> 00:16:20.360
Jennifer Bierhup: Who’s watching those wounds that show signs of nerds that have increased drainage? Who’s keeping track of that? Who’s saying we need to do, and we need to act on this right now

00:16:20.640 –> 00:16:23.689
Jennifer Bierhup: and then, keeping those patients out of the hospital.

00:16:24.250 –> 00:16:24.750
Dennis Gill: Okay.

00:16:24.750 –> 00:16:31.330
Jennifer Bierhup: And last, but not least, again, it’s going back to those social determinants of health. How can we start to learn

00:16:31.710 –> 00:16:37.130
Jennifer Bierhup: how to meet our patients where they’re at and how to help them move. Some of those barriers

00:16:37.170 –> 00:16:40.150
Jennifer Bierhup: wound care while super complex

00:16:40.250 –> 00:16:42.000
Jennifer Bierhup: is actually

00:16:42.090 –> 00:16:43.699
Jennifer Bierhup: simple as well.

00:16:45.030 –> 00:16:46.540
Dennis Gill: Complex but simple.

00:16:46.730 –> 00:16:48.039
Dennis Gill: Just to sum this up.

00:16:48.780 –> 00:16:49.160
Jennifer Bierhup: Yeah.

00:16:49.160 –> 00:17:08.170
Dennis Gill: Okay, okay, okay. And just out of my curiosity. Just wanted to check one thing that in the past few years, have you seen any major changes? That the home care, industry, or the home health industry has seen that they are they educating more their nurses? Or it’s the same as it was 3 to 4 years back.

00:17:08.170 –> 00:17:24.955
Jennifer Bierhup: It’s the same as it was 3 to 4 years ago, and I’m really super sad. To say that. But you know, home health agencies have been under the gun with Pdgm. Changes right? So we got that hit in 2020. And then we you know, we had a covid thing. You know, that that covid thing that we all had and.

00:17:25.210 –> 00:17:27.241
Dennis Gill: Forget. Nobody can forget that. Yeah.

00:17:27.589 –> 00:17:56.469
Jennifer Bierhup: And then, you know, now they headed right into their value, based initiatives purchasing initiatives. So you know, they’ve just been hit with a lot of things. So some of those core ideas of a wound care, how do you mitigate? How do you do these things? I just unfortunately, I haven’t seen it. There are some proactive agencies out there that has jumped, and they have worked very hard. But there’s a lot of agencies that their mindset is that we gotta get that nurse. We gotta get them out there. We can’t train them, we can’t.

00:17:57.189 –> 00:17:59.549
Jennifer Bierhup: And it’s

00:18:00.079 –> 00:18:08.869
Jennifer Bierhup: there we have a lot of work to do in the skilled home health area to get them where they need to be, to take care of the majority of their population, which is wounds.

00:18:09.520 –> 00:18:16.900
Dennis Gill: And they’re not taking it as a primary thing to just educate their staff that they have. Yeah. So.

00:18:17.425 –> 00:18:18.670
Jennifer Bierhup: Should be, and you know it should be

00:18:18.800 –> 00:18:26.409
Jennifer Bierhup: that should be primary. And when those nurses get educated, you know, what I have found is that those nurses feel that the agency supports them.

00:18:26.410 –> 00:18:27.589
Dennis Gill: Supports them. Yeah.

00:18:27.590 –> 00:18:29.719
Jennifer Bierhup: And feels like they’re included.

00:18:30.060 –> 00:18:41.330
Jennifer Bierhup: And then the agencies that have been educated. They have a lower turnover rate, because those nurses know now what they’re doing. Nobody likes walking into a house by themselves and saying, I have no clue. What I’m doing.

00:18:41.330 –> 00:18:44.639
Dennis Gill: Oh, for yeah, we’re rightly sad, rightly sad. Yeah.

00:18:45.310 –> 00:18:54.860
Jennifer Bierhup: So if that agency says, I want to train you, or even get you certified, or what have you that nurse stays because they feel supported. They feel like they now can do their job.

00:18:55.240 –> 00:19:04.070
Dennis Gill: Yeah, they feel that the agency has invested in them. And even if that’s the time that the agency has given all the training that they have provided. Yeah, it definitely does help.

00:19:04.588 –> 00:19:10.270
Dennis Gill: I hope this thing changes and it changes for good and for the nurses.

00:19:10.950 –> 00:19:33.760
Dennis Gill: Okay, so thank you. Thank you, Jennifer, for sharing these great insights today, and I’m sure the audience got in depth knowledge about the significance of optimizing wound care in a value based world to manage high readmission rates right? And to you, my wonderful audience, thank you for tuning in until the next episode. This is Dennis Gail, signing off. Thank you.