The 4 Ds of Wound Care: Determine, Defend, Debride, Develop A Cellular Response
Susan Dieter, MS, RN, CWS
September 27, 2021
I have been a certified wound specialist for more than 20 years. In that time, I have learned a number of best practices for wound prevention and treatment during delivery of compassionate patient care. The first is to not be quick to jump to a treatment. While easy to reach for something on the shelf, or the latest product that came through the door, it is not always the best match for the identified goal or outcome needing to be achieved. Here are my 4 Ds of Wound Care: Determine, Defend, Debride, Develop
1. Determine the cause of at-risk tissue or non-healing
Spending the time to review the patient’s history; medical, surgical, psycho-social and status of co-morbid conditions impacting their health is imperative. Identifying the systemic and extrinsic factors and other underlying causation for tissue at risk or delayed wound healing, allows for the development of a true plan of care. Diagnostic testing should be performed to support a wound diagnosis and evaluate the overall state of systemic health. Addressing the findings of that testing should take place and if not treatable, addressing the status to its most optimal state is required. Equally important is engaging the patient or family to determine their goals and outcome requirements. This discussion will lead to realistic goal setting and will result in their best opportunity for adherence to the plan of care.
2. Defend the tissue and treatment plan impact on the patient’s quality of life
This plan must incorporate techniques to defend the tissue from deleterious forces such as bioburden, pressure, friction, shear and moisture imbalance. As a patient advocate, it is equally important to defend the patients right to a sustainable quality of life. Investigate the impact of treatment on the patient’s lifestyle and make adjustments as needed in the plan of care.
3. Debride
Debridement of hyperkeratotic, necrotic, infected tissue and debris must be done in a timely fashion consistent with the goal of care, wound requirements and psycho-social tolerance of the patient.
4. Develop A Cellular Response
Once these aforementioned items are initiated, development of a cellular response is critical. This cellular response can be attained through the appropriate wound environment, chemotactic agents, cellular and tissue-based products, and other means consistent with the outlined plan of care.
‘Check your work’ are my words of wisdom on evaluation of the treatment plan. If the plan is not revealing the expected response in a timely fashion, go back to the first step. Switching the treatment without the re-evaluation of why outcomes were not achieved is not the answer.
Lastly, always continue to maintain compassionate care. While evidence-based healing is the goal, scientific evidence with inclusion criteria that looks like my patients is hard to find. Keep asking the questions. Maintain a demand for research. Just never give up on the individuals and families served by what you do. They matter. You matter. Positive outcomes matter. What I’ve learned as a wound care clinician is not that I love wounds. I love my patients, my partners in care across the continuum, my partners in research, development and industry and finally, a future of healing patients from pain and suffering.
