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Wound care issues can quickly become one of the most stressful parts of patient care for a Medicare-certified home health agency. When…
- a wound isn’t improving,
- your nurses and the wound provider are giving different instructions,
- or CMS reviewers flag measurement inconsistencies
…it doesn’t just become a clinical problem. It also becomes a credibility problem.
- Patients lose confidence
- Surveyors develop concerns
- Your team ends up spending weeks trying to fix something that could have been prevented on day one
*This article was written in consultation with Mariam Treystman & Dr. Robert Goldberg.
At The Home Health Consultant, we work with home health and hospice agencies across the country on compliance systems and workflows that support better patient outcomes.
This guide is grounded in insights shared by Dr. Robert Goldberg, a cardiothoracic surgeon turned advanced wound care specialist. He now performs wound care in patients’ homes (something only a handful of physicians do in the Los Angeles area), with his practice Gold Bro MD.
His perspective offers a unique, practical look at what actually works, and what causes most wound care breakdowns in home health.
How Can Home Health Nurses Ensure Their Wound Measurements Match the Wound Care Specialist’s?
Measurement discrepancies are one of the biggest red flags during audits and ADRs. Even groups with minimal wound-specific training typically know how to measure wounds accurately:
- Length
- Width
- Depth
- Undermining
- Tunneling
- Proper tissue exposure
- Proper patient positioning
While wounds measured a few days after a specialist’s visit may be slightly different, chronic wounds rarely shift more than a few millimeters over short periods of time. When an agency’s measurements differ significantly from the wound professional’s, CMS reviewers don’t just question the numbers. They question the agency’s competency in wound management.
Dr. Goldberg explains one extreme example. In this case, an agency measured two wounds located on independent body areas as a single wound. This resulted in a wildly inflated measurement that did not match the physician’s notes.
According to Dr. Goldberg, the best way to avoid this is surprisingly simple:
“Compare measurements directly with the wound provider whenever there’s uncertainty.”
Coordinate to understand the discrepancy. Consistency protects both the patient and the agency.
When Should Home Health Staff Contact the Wound Provider Immediately?
Emergencies in wound care are rare, but uncertainty isn’t.
If a nurse notices something concerning, it’s better to reach out than wait. This could look like redness, unfamiliar drainage, or a change in appearance. Many times, what looks like “pus” is actually just drainage absorbed by a dressing, and what seems like redness is a normal part of healing.
A quick, HIPAA-compliant photo sent to the wound care specialist can often resolve concerns promptly. Most of the time, the provider reassures the agency that everything is stable.
But that reassurance only comes if the nurse asks.
Why Do Some Nurses Resist Following Updated Wound Orders?
Some nurses have been treating the same patient for months and feel confident in their routine, even if the wound hasn’t improved. Others may rely on outdated beliefs such as “keeping the wound dry,” which directly contradicts modern wound healing principles.
Dr. Goldberg explains this tension often comes down to:
- Habit
- Prior experiences
- Ego
- Misunderstanding of new instructions
If the nurse cleans a wound that should not be touched, or replaces a dressing incorrectly, weeks of potential healing can be lost. Worse, the patient receives conflicting information, and trust deteriorates.
Agencies can prevent this by reinforcing the importance of following current orders exactly as written, even when they differ from what has been done historically.
Why Does Patient Trust Suffer When Wound Care Instructions Aren’t Aligned?
The fastest way to lose a patient’s trust is to give them mixed messages. For example, a wound specialist may update a treatment plan. But the home health agency nurse may continue performing the older routine out of habit or because “that’s how it’s always been done.” When this happens, patients are left confused or distrustful of their treatment plan.
Dr. Goldberg explains that, in these situations, he’s had patients say things like “Well, my nurse said…” or “Why are you changing everything now?” When this happens, the entire wound plan becomes harder to execute. The wound care physician’s education loses its impact. Patients follow instructions less consistently or not at all. Progress slows.
This breakdown usually stems from a simple root cause: the agency and the wound care provider are no longer communicating the same plan.
Clear communication isn’t just a courtesy. It’s essential for timely healing.
How Can Agencies Improve Their Communication With Wound Care Professionals?
One of the most avoidable barriers to healing is poor communication. Dr. Goldberg explains agencies can strengthen collaboration by:
- reviewing orders closely and asking for clarification immediately
- sharing consistent patient education across all staff
- confirming measurements and dressing instructions directly
- updating the wound provider quickly when changes occur
- reinforcing to patients that everyone on the care team is communicating
When the agency and wound care specialist speak with one voice, patients feel secure, follow instructions more reliably, and heal more quickly. And it’s the path to compliance; proper, timely communication amongst clinicians is the cornerstone of home health services.
Q&A: What Are the Most Common Questions Agencies Have About Working With Wound Care Professionals?
Q: Should nurses ever deviate from the wound provider’s written orders?
A: No. Even small changes like cleaning a wound that should not be touched can derail the treatment plan and delay healing.
Q: Is it normal for wound measurements to differ from visit to visit?
A: Slight changes are expected, but large differences almost always mean the wound was measured incorrectly.
Q: Can wounds worsen simply because instructions were inconsistent?
A: Yes. Conflicting guidance leads to lost patient trust, incorrect wound management, and delayed healing.
Q: When should nurses send photos to the wound care provider?
A: Anytime they’re concerned. A quick photo can prevent unnecessary hospital trips and clarify whether the wound is progressing as expected.
What Should Agencies Do Next to Improve Wound Outcomes?
According to Dr. Goldberg, strong wound care partnerships rely on:
- Accuracy
- Aligned communication
- The discipline to follow orders as written
With clear expectations and consistent collaboration, agencies can significantly reduce measurement discrepancies, speed up healing time, and reinforce the trust patients need to stay engaged in care.
To learn more about Dr. Goldberg and his LA-based wound care practice, visit the Goldbro MD Website.
To dive deeper into how your administrative systems directly impact clinical outcomes, read our article:
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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