Wound Care: Home or Outpatient Setting

Number: 1054

Table Of Contents

Policy
Applicable CPT / HCPCS / ICD-10 Codes
Background
References

---

Policy

Scope of Policy

This Clinical Policy Bulletin (CPB) addresses chronic wound care in the home or outpatient setting. This CPB does not address wound care in an acute care hospital or inpatient setting, nor the management of acute wounds. For definitions, see Glossary of Terms. For other CPBs related to wound care, see Related Policies.

Note: To be eligible for wound care in the home setting, member must be confined to the home as defined in CPB 0201 - Skilled Home Health Care Nursing Services

1. Medical Necessity

   1. Criteria for Initial Approval

      Aetna considers initial care for a chronic wound in the home or outpatient setting medically necessary when this care is prescribed by a physician or other health professional qualified to prescribe wound care according to state scope of practice laws, and when all of the following criteria are met:

      1. The complexity of the wound care can only be safely and effectively performed by or under the guidance of a licensed medical professional; and
      2. An individualized wound care program appropriate to the type of wound being treated has been initiated and meets all of the following criteria:
         
         
         1. Medical record documentation includes evaluation, plan of care, wound care, wound characteristics, and wound measurements by a licensed medical professional (see Documentation Requirements); and
         2. Dressings are being applied according to manufacturer guidelines; and
         3. Necrotic tissue, if present, will be debrided; and
         4. Nutritional status has been evaluated and is being optimized; and
         5. Nicotine status has been evaluated; and if current usage, cessation counseling has been offered; and
         6. Underlying medical conditions (e.g., venous insufficiency, diabetes) are being managed appropriately.

   2. Continuation of Therapy

      Aetna considers continuation of chronic wound care in the home or outpatient setting medically necessary when this care is prescribed by a physician or other health professional qualified to prescribe wound care according to state scope of practice laws, and when all of the following criteria are met:

      1. The wound care provided in the home or outpatient setting meets all initial criteria in Section IA; and
      2. The plan of care, wound care, wound characteristics, and wound measurements are documented at least once a week by a licensed medical professional (see Documentation Requirements); and
      3. The prescribing physician or qualified health professional will review the plan of care at least once every 30 days to assess the continued need for wound care in the home or outpatient setting; and
      4. Progressive wound healing is demonstrated through measurable changes in wound characteristics and wound measurements taken no more than 30 days apart. Wound care on a continuing basis is contingent upon (i) photographic documentation (with ruler), and (ii) evidence in the member's medical record that the wound is improving in response to the wound care being provided. Evidence of improvement may include measurable changes in the following: (Note: wound care treatment plan should be modified if there is no progression of healing within 30 days)
         
         
         1. Drainage
         2. Granulation tissue
         3. Inflammation
         4. Necrotic tissue/slough
         5. Pain and/or tenderness
         6. Swelling
         7. Tunneling or undermining
         8. Wound dimensions (surface measurements, depth).

   3. Not Medically Necessary

      Aetna considers chronic wound care in the home or outpatient setting not medically necessary for any of the following: 

      1. The wound care provided in the home or outpatient setting does not meet all initial criteria in Section IA; or
      2. Criteria for continuing wound care in the home or outpatient setting per Section IB have not been met; or
      3. The goals have been achieved per the plan of care; or
      4. The wound care is considered custodial as defined in CPB 0201 - Skilled Home Health Care Nursing Services.

2. Documentation Requirements

   Wound care should be provided in accordance with an ongoing, written plan of care. The purpose of the written plan of care is to assist in determining medical necessity and should include the following: (see Appendix for pressure injury descriptions)

   1. Member and prescriber information;
   2. Date member was last seen by the health care professional and/or wound care specialist; 
   3. Start date of wound treatment; 
   4. Diagnostic information pertaining to the underlying diagnosis and condition, other medical diagnoses and conditions, and member's overall health status;
   5. Off-loading pressure and glucose control for member who has a diabetic ulcer;
   6. Adequate circulation present for a member who has an arterial ulcer;
   7. Member's current and prior functional activities and limitations;
   8. Nutritional deficits or optimization needs required;
   9. Nicotine status and, if applicable, offered cessation counseling;
   10. Dose and frequency of medications;
   11. Description of wound:
       
       
       1. Weekly photo of the wound with ruler for measurements, which include length, width, depth, tunneling and/or undermining; 
       2. Wound color, drainage (type and amount) and odor, if present;

   12. Wound treatment:

       1. Describe current prescribed wound care regimen, which includes frequency, duration and supplies needed;
       2. Describe all previous wound care therapy regimens, if appropriate;
       3. If an infection is present, describe the current treatment regimen;
       4. If wound debridement is prescribed, documentation must support the level and number of debridements. Documentation should indicate if the debridement involves muscle or bone;

   13. Provide evidence of maintaining a clean, moist bed of granulation tissue.

3. Policy Limitations and Exclusions

   Benefit plan documents may include a more specific definition of custodial care that would supersede the general definition of custodial care provided in this CPB. Please check benefit plan descriptions for details.

4. Related Policies

   • CPB 0069 - Lymphedema
   • CPB 0172 - Hyperbaric Oxygen Therapy (HBOT)
   • CPB 0175 - Pulsed Electromagnetic Stimulation
   • CPB 0210 - Phonophoresis
   • CPB 0244 - Skin and Soft Tissue Substitutes
   • CPB 0334 - Negative Pressure Wound Therapy
   • CPB 0363 - Cold Laser and High-Power Laser Therapies
   • CPB 0372 - Noncontact Normothermic/Nonthermal Wound Therapy and Noncontact Fluorescence Imaging of Wounds
   • CPB 0375 - Photodynamic Therapy
   • CPB 0430 - Pressure Reducing Support Surfaces
   • CPB 0475 - Coblation
   • CPB 0503 - Suction Pumps
   • CPB 0526 - Surgical Dressings (Wound Care Supplies)
   • CPB 0556 - Bio-Surgery: Medicinal Leech Therapy and Medical Maggots
   • CPB 0577 - Laser Treatment for Psoriasis and Other Selected Skin Conditions
   • CPB 0604 - Infrared Therapy
   • CPB 0649 - Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries
   • CPB 0680 - Electrical Stimulation for Chronic Ulcers
   • CPB 0746 - Ultrasound Therapy for Wound Healing
   • CPB 0784 - Blood and Adipose Product Injections for Selected Indications

---

Table:

CPT Codes / HCPCS Codes / ICD-10 Codes

Code	Code Description
Other CPT codes related to the CPB:
11000 - 11047	Excision - debridement of skin, subcutaneous tissue, muscle and/or fascia, bone
97597 - 97610	Active wound care management
HCPCS codes covered if selection criteria are met:
G0128	Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes
G0162	Skilled services by a registered nurse (RN) in the delivery of management & evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an RN to ensure that essential non-skilled care achieve its purpose in the home health or hospice setting)
G0299	Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes
G0300	Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes
S9097	Home visit for wound care
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)
S9124	by licensed practical nurse, per hour
T1000	Private duty/independent nursing service(s) - licensed, up to 15 minutes
T1001	Nursing assessment/evaluation
T1002	RN Services, up to 15 minutes
T1030	Nursing care, in the home, by registered nurse, per diem
T1031	Nursing care, in the home, by licensed practical nurse, per diem
Other HCPCS codes related to the CPB:
S9122	Home health aide or certified nurse assistant, providing care in the home; per hour
T1004	Services of a qualified nursing aide, up to 15 minutes
T1021	Home health aide or certified nurse assistant, per visit

---

Background

Wound care is a type of therapy that is focused on evaluating, treating, and managing wounds. This CPB addresses chronic wound care provided in the home or outpatient setting that is prescribed, and being managed, by a physician, or other qualified health professional.

A wound is a disruption of the integrity of the skin and soft tissue structure and function. The clinical assessment of a wound begins with a general determination of whether the wound is acute or chronic in nature. Acute wounds, such as from trauma or surgery, are considered recent or sudden injuries in which healing is anticipated to progress through the expected stages of wound healing (hemostasis, inflammation, proliferation, and maturation/remodeling), and generally heal within a short time without significant intervention and complications. A chronic wound has been defined as a wound that has failed to progress through a normal, orderly, and timely sequence of repair, or in which the repair process fails to restore anatomic and functional integrity (Bowers and Franco, 2020; Mustoe et al, 2006). Chronic wounds generally occur in persons with comorbid conditions, such as autoimmune conditions, diabetes, or vascular disease. Examples of chronic wounds include nonhealing or infected surgical or traumatic wounds; and neuropathic (e.g., diabetic foot ulcer), ischemic, venous, and pressure ulcers.

The precise timeline for complete epithelialization of a wound depends on numerous factors, such as anatomic location, comorbidities, increased body mass index (BMI), nutritional and smoking status, and medications. Although there is no specific time frame that clearly differentiates a wound as acute or chronic, acute wounds typically follow a trajectory of complete healing in 4 weeks (Berti-Hearn, 2022). For chronic state of a wound, some literature define it as failure to progress after 3 months (Bowers and Franco, 2020; Mustoe et al, 2006); whereas, some suggest it is the lack of approximately 15 percent reduction weekly or approximately 50 percent reduction of the surface area of the wound over a one-month period (Evans and Kim, 2022; Sheehan, 2006).

Wound healing will normally progress at a sustained, measurable rate (Evans and Kim, 2022). Yet, due to the complexities of wound types and underlying medical conditions, performing a thorough assessment of the individual is needed in order to develop a comprehensive wound care treatment plan. In addition, wound healing may be impaired by multiple factors, including smoking. Patients with wound healing complications typically have recurring visits (daily, weekly, and monthly) in a wound care clinic or home care setting. These regularly recurring visits provide an excellent opportunity for clinicians to deliver evidence-based nicotine dependence treatment interventions to patients who continue to smoke. Because cigarette smoking is a modifiable factor, WOC (wound, ostomy, and continence) nurses and other wound care clinicians should incorporate personalized, evidence-based smoking cessation strategies in their care plans in order to improve healing outcomes in this population (McDaniel et al, 2017). Thus, a detailed assessment generally includes, but is not limited to, medical conditions, wound measurements, wound characteristics, medications, nutritional status, and nicotine use.  

Once wound care therapy has been initiated, follow-up assessment should be performed at least weekly to determine the progress of wound healing (Berti-Hearn, 2022). If there has been less than 50 percent change in wound size in 4 weeks, or if the wound has stalled or not changed in a 2-week time frame, adjusting the wound care plan is recommended (Gupta et al, 2017). Furthermore, the Centers for Medicare & Medicaid (CMS) Local Coverage Determination (LCD) L37166, states that a wound that shows no improvement after 30 days may require a new approach, in which documentation may include physician reassessment of underlying infection, metabolic, nutritional, or vascular problems inhibiting wound healing, or a new treatment approach. Therefore, if the wound shows no measurable improvement within 30 days, the plan of care should be evaluated and amended.

See Appendix for additional information.

---

Glossary of Terms

Table: Glossary of Terms

Term	Definition
Acute care hospital	A hospital that provides inpatient medical care and other related services for surgery, acute medical conditions or injuries
Acute wound	A wound that demonstrates normal physiology and is anticipated to heal through the the expected stages of wound healing (e.g., lacerations, minor burns, postoperative surgical incisions).
Arterial ulcer	An ulcer that occurs from poor circulation due to blocked arteries (atherosclerosis). Also referred as ischemic ulcer.
Chronic wound	A chronic wound is one that fails to progress through a normal, orderly, and timely sequence of repair. It is considered a wound that is physiologically impaired due to a disruption of the wound healing cycle, such as from impaired angiogenesis, innervation, or cellular migration (e.g., nonhealing or infected surgical or traumatic wounds, arterial or ischemic ulcers, neuropathic ulcers [e.g., diabetic foot ulcer], pressure / decubitus ulcers, venous ulcers).
Complex wound	A wound that persists for more than three months secondary to one or more of the following: compromised vascularity or necrosis presence of infection associated comorbidities that impair healing potential.
Epithelialization	A process where epithelial cells migrate to repair the wounded area
Home setting	A place where a person resides, can include group home, assisted living, nursing homes (also called skilled nursing facilities [SNFs]), and long-term care facilities (LTAC)
Ischemic wound	A wound that is not getting enough blood supply resulting in cell death and damaged tissue
Initial wound care in the home setting	The first wound care service provided in the person’s place of residence.
Inpatient setting	Care provided in a hospital or other type of facility where patients are admitted and stay at least one night based on clinical criteria
Neuropathic ulcer	An ulcer resulting from the loss of sensation (pain, touch, stretch) as well as protective reflexes, due to loss of nerve supply to a body part (e.g., diabetic foot ulcer)
Offloading pressure	Minimizing or removing weight placed on the foot to help prevent and heal ulcers
Outpatient setting	e.g., outpatient wound center, wound clinic
Pressure ulcer (National Pressure Ulcer Advisory Panel, 2016)	A pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.
Qualified health professional	A person licensed to practice as a health professional and is permitted to prescribe and manage medical care as determined by statutes enacted by state legislatures and by rules adopted by the appropriate licensing entity
Venous ulcer	An ulcer that occurs from venous insufficiency and venous hypertension. Increased pressure and excess fluid in the affected area can cause an open ulcer to form. Also known as venous stasis ulcer.
Wound care	Care of wounds and ulcers that are refractory to healing or have complicated healing cycles either because of the nature of the wound itself or because of complicating metabolic and/or physiological factors.
Wound care center	An outpatient medical facility that treats wounds that are typically difficult to heal.

---

Appendix

The following information on chronic wound evaluation, treatment options, dressing selection, and monitoring, are found in various literature sources and chronic wound management care guides. Thus, the information may be useful for care teams; however, it is not intended to direct care.

Assessment / Evaluation

1. Wound history:

   1. Onset
   2. Prior diagnostic work-up and treatments
   3. Prior pain
   4. Barriers to wound healing;

2. Comprehensive skin assessment;

3. Wound assessment:

   1. History and physical exam

      • Location and etiology

        • Anatomical location
        • Laterality
        • Causation and wound type (e.g., pressure injuries, venous ulcers, arterial/mixed ulcers, diabetic foot ulcers, non-healing surgical wounds)

      • Wound / surrounding tissue characteristics and measurements

        • Length, width, depth
        • Undermining location and depth (if present)
        • Wound edge
        • Wound base color
        • Wound base tissue type
        • Surrounding tissue color
        • Surrounding tissue characteristics (e.g., blistered, bloggy, callus, dry, ecchymosis, edematous, excoriated, friable, hyper- or hypothermic, indurated, moist, macerated, painful, pruritus)

      • Exudate and dressing characteristics

        • Exudate type, amount, and odor
        • Dressing assessment and dressing type

   2. Diagnostic tests / procedures: based on specific wound type;

4. Pressure ulcer risk assessment (e.g., comorbidities, mobility, incontinence, nutrition/hydration, smoking, support surfaces).

Pressure Ulcer Stages

A pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue. The table below includes pressure ulcer stages and other types of pressure injuries.

Table: Pressure Injury Stages

Pressure Injuries	Description
Stage 1 pressure injury	Non-blanchable erythema of intact skin Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.
Stage 2 pressure injury	Partial-thickness skin loss with exposed dermis Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel. This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).
Stage 3 pressure injury	Full-thickness skin loss Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.
Stage 4 pressure injury	Full-thickness skin and tissue loss Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.
Unstageable pressure injury	Obscured full-thickness skin and tissue loss Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e., dry, adherent, intact without erythema or fluctuance) on an ischemic limb or the heel(s) should not be removed.
Deep tissue pressure injury (DTPI)	Persistent non-blanchable deep red, maroon or purple discoloration. Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Stage 3 or Stage 4). Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic conditions.
Medical device-related pressure injury	This describes an etiology. Medical device related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure injury generally conforms to the pattern or shape of the device. The injury should be staged using the staging system.
Mucosal membrane pressure injury:	Mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury. Due to the anatomy of the tissue these injuries cannot be staged.

Treatment Considerations

• Based on wound type (etiology) 
• Management considerations include:
  
  
  • Offloading
  • Compression
  • Cleansing of wound base
  • Exudate control
  • Dead space (undermining, tunneling)
  • Proper wound dressing
  • Securement strategies for challenging wound locations
  • Dry intact eschar
  • Suspected infection
  • Debridement
  • Negative pressure wound therapy (NPWT) (also called vacuum-assisted wound closure)
  • Hyperbaric oxygen therapy (HBOT) / topical oxygen therapy
  • Surgical referral
    
    
    • Relatively small chronic wounds may be completely excised and closed primarily (sutures/staples) provided there is no to minimal skin tension
    • Larger or more complicated wounds may require graft or flap coverage.

Dressing Selection

The below table includes dressings that have direct contact with the wound and have the ability to change the wound (e.g., moisture donation/retention, debridement and decreasing bacterial load)

Table: Primary Dressing Selection

Dressing Type	Examples	Indication	Duration
Alginate	Algisite™ Kaltostat™ Sorbsan	Moisture management for moderate to high exudate Absorbs fluid to form a gel (can be mistaken for slough) To fill irregular shaped wounds (e.g., cavities) Ideal for bleeding wounds due to hemostatic properties	Changed every 1-7 days depending on exudate. To be discontinued once wound bed is dry
Dry dressing	Gauze OpSite™ Primapore™	Protective dressing for low to moderate exudate Can adhere to the wound bed and cause trauma on removal (consider the use of an atraumatic dressing/ impregnated gauze)	To be discontinued when exudate is too high or the wound has healed
Film dressing	OpSite™ Tegaderm™	Protective dressing for no to low exudate Non-adsorbent Water resistant Allows for inspection through dressings
Foam	Allevyn™ Tielle™	For low to high exudate Used for granulating and epithelializing wounds as it provides protection Can be used in conjunction with other dressings to increase absorption and prevent maceration Not to be used with hydrogel	Changed every 1-7 days depending on exudate
Hydro fiber	Aquacel™	Moisture management for moderate to high exudate To fill irregular shaped wounds (e.g., cavities). Needs to be bigger than the wound as it will shrink in size Prevents peri-wound maceration	Used until there is low to no exudate
Hydrocolloid	Comfeel™ Duoderm™ Hydrocoll™	Moisture donation for low to moderate exudate Self-adhesive and water repellent Forms a gel when exudate present (white bubbles) Not for use in infected wounds Can be used as a primary or secondary dressing	Changed every 3-7 days
Hydrogel	Burnaid™ Instrasite Gel™ Intrasite Conformable™ SoloSite™	Moisture donation for low to moderate exudate Used on dry/ necrotic wounds as it hydrates the wound bed and promotes autolytic debridement	Changed every 3-7 days depending on exudate
Hypertonic saline	Mesalt™	For moderate to high exudate or hypergranulation tissue Used for moist necrotic wounds and draining infected wounds	For best results, dressing is changed frequently (more than once daily). To be discontinued when wound is granulating or epithelizing
Impregnated gauze	Bactigras™ Jelonet™ Mepitel™ Xeroform™	Protects the wound base and prevents trauma to the wound on removal Does not absorb exudate	Can be left on for up to 14 days (for orthopedic wounds)
Iodine dressing		Iodine is only be used in acute superficial wounds as it can damage granulating tissue so should be used with caution Has antifungal and antibacterial properties
Medical honey	Manuka Honey™ Medihoney™	For infected, contaminated or malodorous wounds as it promotes autolytic debridement
Silicone foam	Allevyn Gentle™ Mepilex Lite ™ Mepilex™	Protective dressing for low to heavy exudate Absorbs moisture and distributes pressure (good for pressure injuries) Atraumatic to the wound and surrounding skin Can be used on infected wounds	Changed every 1-7 days depending on exudate
Silicone foam adhesive	Allevyn Gentle Border™ Mepilex Border™	Same as silicone foam but includes adhesive film
Silver dressing	Acticoat 7™ Aquacel Ag™ Mepilex Ag™ PolyMem Silver™	Broad spectrum antimicrobial agent to reduce/ treat infected wounds If the silver needs to be activated, it is done with water (normal saline deactivates the silver)	Can be left on for 7 days (Acticoat3™ is changed every 3 days). Used for 2-3 weeks

Table adapted from The Royal Children's Hospital Melbourne 

The table below includes dressings that cover / compliment the primary dressings ( see above Table: Primary Dressing Selection) and support the surrounding skin.

Table: Secondary Dressing Selection

Dressing Type	Example	Indication
Absorbent/ Protective pad	Melolin™	Provides protection for moderate exudate Can adhere to the wound bed and cause trauma on removal (consider the use of an atraumatic dressing)
Bandage	Crepe bandage Elastic conforming gauze bandage (handiband)	Provides extra padding, protection and securement of dressings
Fabric tape	Fixomull™ Hypafix™ Mefix	Permeable dressing but can be washed and dried Conforms to the body and controls edema Can be used as a primary dressing or secondary dressing as well
Tape	Micropore™	Provides wound support Non allergenic
Tubular bandage	Tubifast™ Tubular Form™ (Tubigrip)	Provides protection and compression

Table adapted from The Royal Children's Hospital Melbourne 

Outpatient Monitoring (not an all-inclusive list)

• Mobility
• Incontinence
• Nutrition optimization
• Glucose (hemoglobin A1C) in diabetes mellitus
• Other conditions increasing risk for skin ulcer (e.g., vascular disease, nicotine exposure, support surfaces)
• Dressing changes as indicated by wound and dressing type
• Monitoring guidelines specific to each wound type
• Patient access to care
• Patient and caregiver education.

---

References