By the WoundSource Editors The current COVID-19 pandemic has changed various aspects of care across the health care continuum. Health care professionals have been forced to develop different strategies for engagement for those patients at higher risk for infection, those who are quarantined, and those who have tested positive for COVID-19. We know that telemedicine cannot replace an in-person visit to a provider, but during this time of crisis it serves as an advanced approach in wound care. Telemedicine was initially developed to help patients living in rural communities. It has been proven to be time saving and effective. Telemedicine has its pros and cons like anything else, but with proven protocols in place, outcomes are most efficient. Telemedicine technologies include using a smartphone, two-way video, and electronic medical records to exchange and store medical information. Patients with chronic conditions such as diabetes and vascular disease need a broader range of medical care and monitoring, including ongoing advanced education to patients, family, and caregivers for chronic condition management and wound care. There are various strategies in providing the most effective patient teaching. First evaluate whether your patient has mental, physical, or emotional impairments that may hinder learning. Develop a “bulletproof” patient teaching plan specific to the learner’s needs. You want your learner to be an “A” student.^1,2

Patient Teaching Strategies

Educating your patient and their caregiver can be a difficult task. Following are some strategies to encourage education.³

• Involve patients in their care. Ask your patient to explain the steps they would take to perform their dressing change. What does the patient already know about their chronic condition or non-healing wound? Ask questions.
• Educate patients, family members, and caregivers during every telemedicine encounter. Evaluate learning styles. Not everyone learns the same way.
• Provide education in lay terms. Establish a rapport. Do they want to know every detail, ask questions, use a checklist, or only want the facts?
• Provide patients with education about dressing product use and the treatment plan.
• Provide information about signs and symptoms of infection and what requires immediate attention.
• Utilize telemedicine technology to maximize the patient education experience. (e.g., literature, photos).

Patient Education

Make sure your patient knows what to check for and how to perform tasks as they care for their wound. Following are topics to review with your patient.

• Skin care – cleansing, moisturizing
• Infection control – hand washing, face mask, symptoms of COVID-19 and flu
• Signs and symptoms of infection – redness, increased exudate, fever, increased pain, edema, and odor
• Wound cleansing – technique, cleansing solution
• Dressing application, product information, ordering process
• Glucose control for diabetic patients – hemoglobin A1c, fasting blood glucose
• Compression (bandages, stockings)
• Edema management – compression, leg elevation, diuretics
• Nutrition – supplements, daily caloric intake, weight monitoring
• Pain control – is the pain constant, intermittent, or only during dressing changes?

There are many advantages of utilizing telemedicine. There is no sitting in a waiting room, where exposure to infection may be more likely. The convenience of providing care from the patient’s home allows for the development of an essential bond between the provider and patient, fewer emergency department visits, and streamlined treatment care plans. Telemedicine is also cost-effective by cutting out the transportation use of ambulance, caregiver escort, gas, etc.¹ Disadvantages of telemedicine include the obvious issue of the lack of “hands-on” wound assessment, patient learning curve with technology, diagnostic accuracy issues, and difficulty in managing more complex wounds that need debridement and surgery.

Conclusion

Both health care workers and patients are currently experiencing the strain and challenges during the pandemic of COVID-19. We continue to expand and explore various avenues for better providing and delivering care to our patients. Telemedicine technology is an excellent platform to help health care professionals monitor and treat patients; however, most effective outcomes are driven by consistent advanced patient education and utilizing various strategies to maximize patient engagement while streamlining care.

References 1. Carver C. The future of telemedicine in wound care. WoundSource. 2017. https://www.woundsource.com/blog/future-telemedicine-in-wound-care. Accessed May 18, 2020. 2. Advanced Tissue. Tele-wound care: the use of telemedicine in ongoing wound care. Advanced Tissue. 2015. http://www.advancedtissue.com/tele-wound-care-the-use-of-telemedicine-i…. Accessed May 18, 2020. 3. 5 strategies for providing effective patient education. Lippincott Solutions. 2017. http://lippincottsolutions.lww.com/blog.entry.html/2017/08/22/5_strateg…. Accessed May 18, 2020.