What are the responsibilities and duties of a Wound Care Provider (WCP)?

Core Responsibilities of a Wound Care Provider

A wound care provider's primary duty is to systematically assess, debride, manage infection, optimize healing conditions, and coordinate multidisciplinary care to prevent amputation, sepsis, and death while maximizing functional outcomes. 1, 2

Essential Clinical Responsibilities

Initial Wound Assessment and Documentation

• Perform comprehensive wound evaluation including measurement of wound dimensions, depth assessment using sterile blunt metal probe to detect bone involvement, foreign bodies, or communication with deeper structures 3
• Document baseline characteristics including wound size, surrounding cellulitis extent, drainage quality/quantity (color, odor), and presence of necrotic tissue to enable tracking of healing progress 3
• Assess vascular perfusion immediately through ankle-brachial index (ABI), toe pressures, and transcutaneous oxygen pressure (TcPO₂) measurements, as inadequate blood supply must be identified before initiating definitive wound treatment 3, 2
• Evaluate for peripheral neuropathy using 10-g monofilament testing at multiple plantar foot sites to identify loss of protective sensation 3

Debridement and Wound Preparation

• Execute sharp debridement immediately to remove hyperkeratosis (callus), necrotic tissue, and slough from wound base using scalpel, scissors, or tissue nippers 3, 2
• Perform conservative, tissue-preserving debridement rather than aggressive excision, as overly aggressive approaches can expose bone/tendon and lead to chronic osteomyelitis or amputation 3, 1
• Repeat debridement based on clinical need—typically weekly or more frequently if significant necrotic tissue accumulates 2
• Debride before obtaining cultures if infection is suspected to ensure accurate microbiological sampling 3, 2

Infection Recognition and Management

• Identify clinical infection signs at each visit: increased exudate, odor, pain, surrounding erythema, warmth, or purulent drainage 3, 2
• Obtain appropriate culture specimens from debrided wound base via curettage or tissue biopsy—never swab undebrided ulcers as this yields inaccurate polymicrobial results 3, 2
• Initiate prompt antibiotic therapy for infected wounds with broad-spectrum coverage targeting aerobic gram-positive cocci, gram-negatives, and anaerobes 3, 4
• Recognize that not all wounds require antibiotics—do not prescribe antimicrobials for uninfected wounds as this does not promote healing and contributes to resistance 3, 2
• Mandate surgical debridement immediately for wounds with abscess, gas, or necrotizing fasciitis 3, 1

Wound Care Protocol Implementation

• Cleanse wounds with sterile normal saline only—iodine or antibiotic-containing solutions are unnecessary 1
• Apply simple moisture-retentive dressings that absorb exudate while maintaining moist wound environment 2
• Stop topical antibiotic ointments immediately—topical antimicrobials do not improve healing outcomes and are strongly discouraged 2
• Maintain dressings undisturbed for minimum 48 hours post-operatively unless leakage occurs 1
• Never close infected wounds—use approximation with Steri-Strips followed by delayed primary or secondary closure 1

Pressure Offloading and Edema Control

• Implement strict offloading immediately for plantar wounds—this is non-negotiable for healing 2
• Use total contact casting or irremovable walkers for non-infected plantar wounds 2
• Protect wounds from all pressure and trauma during daily activities 2
• Control edema through appropriate compression therapy when it doesn't compromise wound offloading 3, 2

Advanced Therapy Decision-Making

• Re-evaluate at 2 weeks after implementing optimal standard care 2
• Consider adjunctive therapies only if wound shows insufficient improvement (<50% reduction in area) after 2 weeks of proper debridement, offloading, and basic wound care 2
• Apply negative pressure wound therapy (NPWT) after revascularization and minor amputation when primary closure is not feasible 3, 1
• Delay wound closure with skin grafts until patients are stabilized in substance use treatment contexts 3

Multidisciplinary Coordination Duties

Team Leadership and Referral Management

• Lead nurse-coordinated multidisciplinary care as wound management is predominantly nurse-led but requires interprofessional collaboration 3
• Arrange urgent vascular surgery consultation if severe ischemia is present (ABI <0.5, ankle pressure <50 mmHg), as revascularization must precede aggressive wound therapy 2
• Coordinate podiatry consultation for ongoing debridement and specialized foot care 2
• Refer to qualified wound care provider (QWCP) if wound fails to heal or reduce by 40-50% within 4 weeks despite standard therapy 5

Patient Education and Engagement

• Educate patients on infection warning signs and ensure all patients return within 48 hours for wound check to optimize outcomes 6
• Empower patient participation in decision-making and self-care activities, as patient involvement improves safety, self-efficacy, and treatment adherence 3
• Provide discharge instructions that clearly alert patients to complications requiring immediate attention 6

Critical Pitfalls to Avoid

• Never perform overly aggressive debridement in complex wounds—this leads to tendon/bone exposure, chronic osteomyelitis, and amputation; conservative tissue-preserving approaches are superior 3, 1
• Never apply advanced therapies to actively infected wounds—infection must be controlled first or treatment will fail 1
• Never close wounds prematurely (within 8 hours) without meticulous irrigation and prophylactic antibiotics, as this increases infection risk 1
• Never initiate definitive wound treatment without ensuring adequate blood supply—failing to do so wastes resources and delays healing 1
• Never use topical antibiotics on chronic wounds—there is insufficient evidence they improve outcomes 4

Systematic Follow-Up Protocol

• Monitor hospitalized patients daily and outpatients every 2-5 days initially to ensure treatment efficacy 4
• Re-evaluate in 3-5 days (or sooner if worsening) for outpatient wounds to assess response to therapy 3
• Hospitalize patients with severe infection, systemic toxicity, metabolic instability, rapidly progressive infection, substantial necrosis, critical ischemia, or inability for self-care 3, 4
• Continue antibiotics until clinical resolution of infection (typically 2-4 weeks for severe soft tissue infections), not necessarily until complete wound healing 4