Nurses and therapists often wonder if their license permits them to perform sharp wound debridement. Scope of practice varies significantly from state to state, so it’s imperative to check your state for specific guidance, but we can address some of the challenges clinicians face in deciding whether they can perform this valuable service for patients.
Sharp debridement vs. other forms
In general, clinicians can perform wound debridement using mechanical, enzymatic, chemical, biological, and autolytic means as long as their scope of practice includes wound care. These noninvasive forms of debridement aren’t highly technical, so they don’t require a specific skill set.
In contrast, sharp debridement is an invasive procedure and requires the ability to use scalpels, sharp curettes, and scissors safely and effectively. This type of debridement is divided into two types — surgical and conservative. Surgical sharp debridement refers to debriding “into” viable tissue, while conservative sharp debridement refers to “up to” viable tissue.
Scope of practice
In all states, surgical and conservative debridement fall under the scope of practice for physicians, nurse practitioners, and physician assistants. Physical therapists, physical therapy assistants, occupational therapists, certified occupational therapy assistants, and nurses (both registered nurses and licensed practical/vocational nurses) are allowed to perform conservative sharp debridement in some, but not all, states.
What if you are licensed in a state that doesn’t address if you can perform sharp debridement? In this situation, you should use a decision tree or algorithm to determine whether you can proceed. Some questions to ask are:
• Did my wound care training prepare me for debridement and am I competent to provide this service? Remember that in addition to the skill, you need to know how to manage the patient’s pain and bleeding.
• Will I be providing this service under the supervision of a prescribing clinician who has expertise in debridement?
• Does my facility allow me to perform this procedure? (See Sharp debridement policies and procedures.)
The answers will help you make the best decision for you and your patient.
Bill Richlen is the owner of Infinitus, LLC, in Santa Claus, Indiana. Denise Richlen is an area manager for Paragon Rehabilitation.
Note: This article is intended to provide general information. For specific legal questions, contact an attorney.