Providing a virtual care chronic wound management consultation can pose some challenges.
These challenges include using the technology effectively and how to assess clinical features of a wound when you aren't in physical contact with the consumer.
Clinicians experienced at providing virtual care chronic wound management consultations have developed these tips to minimise these challenges.
- Develop a referral or consultation request process that includes the information needed from the referring team, e.g. medical history, wound history, investigations. Follow up with the referring team if this information isn’t initially provided.
- Spend more time in pre-consultation documentation review to identify what is already known about the consumer's needs and what questions you need to follow up. This includes reviewing the consumer’s records for their medical history, treatment and investigations they have had to date, and any wound photography.
- District-wide documentation and wound photography standards will improve the quality of the information you have to review.
- Select the virtual care platforms that will be the most reliable and suitable for the type of consultation to be provided. Things to consider include:
- what modality to use, i.e. whether to use a videoconferencing platform, telephone, or other communication platform
- connectivity at both ends and the platforms that can be supported
- quality and features of camera devices, including the need to move around the wound or to zoom in with detail
- whether clinical assessment and treatment need to take place, and therefore whether a healthcare worker needs to be present, as this will inform the choice of location.
- Check who is in the room at the start of the appointment and ensure that there is adequate privacy for the consultation, e.g. checking that doors are closed and the consultation won’t be interrupted.
- Introduce yourself, identify who is in the other room and engage with the consumer before looking at their wounds.
- Check the lighting in the room and the functionality of the videoconferencing camera before starting with the wound assessment.
- Refer to Virtual Care in Practice for more tips on using virtual care.
- Have a healthcare worker in the room with the consumer, especially for initial consultations, to assess clinical features such as wound odour, skin temperature and texture, pedal pulses and oedema.
- Direct the healthcare worker present about what you need them to share with you, e.g. the type of photographs they need to take or how to share a live video that provides context about the wound and wound bed features, and how to perform assessment tasks.
- Ask potentially sensitive questions of the consumer or healthcare worker in a non-judgemental way and be conscious of the consumer’s feelings, e.g. about the wound odour or socioeconomic information.
- Ask more direct questions than for an in-person consultation, to get all the information you need to make an informed clinical judgement.
- Prepare a comprehensive checklist of questions ahead of time, including key points identified in the documentation review that you need to confirm.
- Use an educative approach for consultations to create an inclusive learning environment about chronic wound management for the benefit of consumers, carers, family members and healthcare workers present.
- Use the virtual care consultation to increase the consumer’s understanding of their wound and its management. For example, when supervising the commencement of compression therapy, as well as instructing the healthcare worker, it is a good opportunity to explain the cause of venous leg ulcers and why compression is essential for healing.
- Use the virtual care consultations to make appointments more accessible for carers and family members. Give them the opportunity to ask questions and to learn more about the consumer’s wound management needs and how they can support them.
- Show the healthcare worker present that you respect their knowledge and support them to contribute to the consultation. It will also enable you to teach them new wound management skills and build their own capability and confidence.