Below are the Genesis HealthCare COVID-19 Emergency Wound Rounds Telehealth Guidelines, which were created to give the provider’s staff a framework for maintaining weekly wound rounds in every facility via telemedicine during the COVID-19 pandemic, in accordance with federal guidelines.

The goals are also to mitigate risk of resident exposure by reducing the number of staff entering facilities (especially specialists who deliver care to multiple centers) and to provide continuity of support for wound management during any outbreak.

Technology: Third Eye with iPAD (preferred device), laptops, mobile phones, Zoom (as back up), and PointClickCare Skin Wound App (SWIFT), along with a review of resident electronic health record.

Recommended Workflow Process Guide:

Each center will designate a primary Telehealth Coordinator on each shift.

Center Telehealth Coordinator will coordinate virtual wound rounds with their wound care provider, resident, and center team.

There will be a Skin Integrity Coordinator assigned to each unit.

Telehealth Coordinator and each unit’s designated Skin Integrity Coordinator will ensure that required equipment and Third Eye capability are in place prior to scheduled wound rounds.

Center team will inform patients/residents and families of telehealth process for wounds.

The Skin Integrity Coordinators on each unit will round with PointClickCare Skin Wound App, lead the Third Eye session, and ensure resident understands and permits telehealth.

Telehealth requires two-way, real-time communication, including both audio and video connection.
There will be a “Modified” wound care team in order to reduce the number of staff entering patients’ rooms and to minimize patient exposure: meaning, the nurse at the bedside and the team attending remotely.

Family communication will be maintained.

When a new wound develops and/or a wound declines, the patient’s PCP/APP (primary care physician or advanced practice provider) will facilitate the initial family contact, and the wound specialist will provide regular updates.

Include documentation regarding wound status and prognosis.

Document details of all communications with patient and/or family.

Infection control:

Maintain aseptic technique and wipe telemedicine equipment with approved disinfectant after each visit.

In-person consultant visits may be permitted based upon specific resident need in order to prevent use of outpatient wound clinics and/or hospitalization. For any requested in-person visit needs, review with the Medical Director and Director of Nursing for guidance to ensure infection control needs are met based on Center/Area/State requirements.

If debridement is required, determine if there is an internal provider (physician or advanced practice provider) or physical therapist that is qualified and available to provide this service in order to decrease risk of spread. If not, then schedule the on-site visit accordingly. Medical providers must follow all state/federal screening procedures prior to entering the building and follow all center infection control procedures to keep the resident, center, and provider protected.

For the telehealth visit, here are further guidelines outlined by Genesis for its teams:

Telemedicine Visit: Step-by-step Guidance and Tips for Wound Consultants and Providers.

Telehealth requires two-way, real-time communication, including both audio and video connection.

Review chart, including notes, labs, vitals, and medications—in PointClickCare Skin Wound App.

Complete an interview with patient and nurse in the same manner as an in-person visit.

Physical examination: Document objective data (for example, no audible wheeze, no cough noted). Request that the nurse provide “hands on” aspect of exam (that is, palpate tunnels with swab). Assess for signs of discomfort or pain. Use the camera to show the bed, food tray, body positioning, anatomy (that is, joints, feet, legs).

A great deal of information can be gained from direct observation.

Assess mobility (ability to move limbs).

Assess the patient’s overall response to exam, including signs of distress.

Assess the patient’s wound.

Document the wound assessment and family communication.

Source: Genesis HealthCare​