Skilled Nursing Facilities

Contents

Completing Wound Assessments in the Skin & Wound Mobile App

You can complete Wound Assessments from the PointClickCare Skin & Wound mobile app. The Skin & Wound app, powered by Swift, calculates the wound images using digital planimetry. This provides accurate and consistent measurements and accounts for irregular margins and islands of healing in the wound. The mobile app measures the wound area after you refine the image.

After creating a wound assessment, the assessment tile appears on the resident's home screen in the mobile app in the Assmnts and Skin & Wound tabs of the resident's chart in the web application.

Note

When reassessing an existing wound, it is important to create assessments from an existing wound assessment. This allows tracking of progress and prevents duplicate assessments. The assessment tile shows the number of assessments.

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When completing the PCC Skin & Wound - Total Body Skin Assessment in the mobile app, if new wounds are indicated, a placeholder icon shows on the resident's home screen. You must click the placeholder icon to create the wound assessment. 

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    • To assess an existing wound - Click the wound image of an existing wound assessment. Click + to add an assessment. The camera screen appears.

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      Note

      Apply the HealX each time you capture the wound image. When capturing a new image of an existing wound, the previous image appears for you to ensure correct positioning of the camera. Clicking on the image shows an overlay (ghost image) to assist with positioning.

    • To assess a new wound - Click + to add an assessment, then select New Wound. The camera screen appears.

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  5. Capture the wound image. For more information, see Capturing Wound Images.

  7. Complete options as required.

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  8. Click the padlock/X icon scn_padlockXicon.png and select Sign & Lock or Sign to complete the assessment. 

  • Measure

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    • Area - Define the wound by clicking Trace, then trace around the wound margins with your finger. Click Refine to automatically adjust the green overlay to identify the wound margin.

      Note

      You can further refine wound margins using Fine or Coarse settings.

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    • Length - After clicking the Length icon, a blue arrow appears and shows the maximum length of the wound. The maximum length determines the longest point in all directions. 

      Note

      You can measure head to toe measurement by clicking Head to Toe. When measuring head to toe, use your finger to rotate the arrow until it is pointing in the direction of the patient's head, relative to the wound. If using Head to Toe on the initial assessment, the direction of head must be the same for all subsequent assessments. 

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    • Depth - Click the wound image to document depth and enter measurement. After saving, the area of depth appears as a red dot on the image. Multiple areas of depth can be documented. 

    • Undermining - Use your finger to trace the portion of the wound image border to indicate undermining. After saving, the area of undermining appears in blue. 

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    • Tunneling - Use your finger to mark the border of the wound image to indicate tunneling, A yellow line appears to indicate tunneling on the wound image. Enter the tunneling depth. Multiple areas of tunneling can be documented. 

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  • Assess 

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    • Wound Bed - Select responses to describe the wound bed. Multiple responses can be selected. 

    • Exudate - Select responses to document amount, type, and odor of exudate.

    • Periwound - Select responses to document wound edge appearance, surrounding skin appearance, induration, edema, and temperature.

    • Pain - Select pain level and frequency using the Numerical Pain Scale or PAINAD Scale. 

  • Treatment - Allows you to document wound treatments. Options include dressing appearance, cleansing solution, debridement, primary dressing, secondary dressing, modalities, and additional care. If applicable, multiple responses can be selected.

  • Progress - Allows you to document progress, infection, education, any notes that may be necessary, and information regarding notifications. 

Adding Wound Description - You can add the wound type, location, acquired in-house or externally, and wound age by clicking Tap to edit description.

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Adding Goal of Care - You can document the goal of care for a wound by clicking the Orders icon.

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  • Wound measurements can only be documented from the mobile app and are view-only from the web application.

  • To document a healed or closed wound, click the closed icon after capturing the image of the healed area. The closed icon only appears when reassessing an existing wound. 

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    Note

    After documenting a wound is resolved, it is recommended to click Progress and document Resolved.

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