What It Means To Be A Dietitian On The Wound Care Team

When I think about being a dietitian in long-term care, a few key words come to mind: quarterly documentation, weight tracking and wounds. My very first job as a long-term care dietitian required me to report to work every Tuesday morning at 5:00 AM ready to round the facility as a member of the wound care team. Coming from an acute care setting, this job duty was new to me and admittedly, I was a little unsure of what my role should be. Not to mention, could I handle it? (Spoiler alert: I survived!) I ended up learning a lot about how nutrition relates to healing all types of skin impairments as well as preventing them from occurring in the first place.

Wound Team Members and Their Roles

Wound nurse – This is an RN who specializes in evaluating and treating all types of skin breakdown, especially pressure injuries. This nurse can debride, clean and treat wounds. They also play a key role in educating the patient and their caregivers on how to manage the wound after discharge.

Physical therapist – PTs are critical in helping patients manage and treat all types of wounds including necrotic wounds, pressure injuries, diabetic ulcers, chronic vascular wounds, and surgical wounds. PTs are experts when it comes to mobility and have in-depth knowledge of how the body is made and its response to healing. The PT will often be tasked with measuring or documenting the characteristics of the wound, deciding on the treatment used and educating the team and patient during the different stages of healing.

Occupational therapist – The OT plays a very important role in prevention of skin breakdown. Their experience in patient positioning and use of medical equipment like wheelchair cushions or bed cradles allows them to strategize on how to prevent skin breakdown from occurring. An OT can manage a wound when it develops and plays a key role in patient care once the wound beings to heal. Their interventions include educating the patient on wound management and teaching modalities to speed healing, such as increasing circulation and reducing swelling. Once the wound is healed, the OT will work with the patient on compensatory techniques, such as foot care and staging a safe home environment, to prevent the wound from reoccurring.

Registered dietitian – The RD is an essential member of the wound care team because of the role that nutrition plays in preventing wounds from occurring, healing skin once it becomes impaired and maintaining the integrity of the skin after the wound has closed. Without proper and adequate nutrition, wounds may become chronic and lead to other conditions that compromise the health of the patient. The calculation of nutrient needs for wound healing is crucial and individualized depending on the type of wound and the unique needs of the patient. A dietitian will evaluate the patient and assess their needs, then recommend nutritional interventions that will be supported by the team.

Nutrition for Treatment of Wounds

There are several nutrition interventions that can be used to treat wounds. Each one has an opportunity to promote healing, but truly, patient compliance and commitment will affect the final outcome. Following your evaluation of the patient, determine which intervention is most realistic and start with that. For example, if a patient refuses oral supplements, it doesn’t matter if you provide them three times a day, the intervention will not work. Often, we are forced to try one intervention and modify it several times before “getting it right.”

  • Add enhanced or fortified foods to the diet order, push fluids and monitor hydration status.
  • Trial different high calorie and/or high protein oral supplements with the patient to see which they prefer, then order for a minimum of 30 days.
  • Talk to the doctor about daily vitamin and mineral supplementation such as vitamin C and zinc.
  • Consider a supplement that contains the amino acid L-arginine that has been shown to enhance protein metabolism and collagen synthesis.

Documentation and Follow Up

As in the case of any patient interaction, documentation is imperative. A clear and concise progress note, perhaps labeled “wound note” will inform the healthcare team what nutrition interventions are recommended and your plan of care for the patient. A patient with a wound is considered high risk and should be followed weekly or monthly depending on your facility protocol. Detailed tracking of the wound and documentation of the effectiveness of your interventions are a valuable part of the healing process.

Sarah Hammaker, RDN

Sarah Hammaker, RDN is a clinical dietitian working primarily in long-term care and acute rehabilitation hospital settings in Pennsylvania. Outside of work, Sarah enjoys spending time with her husband and their four children. She loves running and being outdoors. Her hobbies include reading, planting and shopping.

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References

Wound Care Nurse. Registered Nursing.org website. Updated July 26, 2021. Accessed on January 26, 2022. https://registerednursing.org/specialty/wound-care-nurse/#wound-care-nurse

Wound Care. Cleveland Clinic website. Accessed January 26, 2022. https://my.clevelandclinic.org/departments/rehabilitation/services/wound-care

Occupational Therapy and Wound Care: A Match Made in Heaven. ARC website. Accessed January 26, 2022. https://arcseminars.net/occupational-therapy-wound-care/

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