Discover how home health RNs assess skin, wounds, and medications during the Start of Care (SOC) visit. Learn best practices for documentation, safety, and compliance.
Introduction: Why These Two Areas Matter Most
When you’re completing a Start of Care (SOC) visit, two of the heaviest hitters are skin/wound assessments and medication reconciliation. Both carry high risk, both require sharp RN skills, and both are front-and-center for Medicare auditors.
Handled well, they prove skilled need, prevent complications, and build patient trust. Let’s break down why skin/wounds and meds deserve extra attention during SOC.
Skin & Wound Assessment: More Than Meets the Eye
Skin is the body’s largest organ—and one of the most vulnerable in home health patients. During SOC, you’ll need to:
- Inspect head to toe: Don’t skip skin folds, heels, and bony prominences.
- Stage wounds accurately: Pressure injuries must be staged correctly.
- Document location, size, drainage, and appearance for each wound.
- Tie wounds to skilled need: Dressing changes, wound vacs, or caregiver teaching all justify skilled nursing.
👉 Want more on structured screening? Check out my post on Risk Screens: Falls, Depression, Nutrition, Pain & Skin.
📌 Watch-Out: Never chart “intact skin” without actually inspecting. Auditors notice vague documentation.
Medications: Where Errors Lurk
Medication reconciliation is one of the most error-prone parts of SOC. Patients may have:
- Duplicate prescriptions from multiple providers.
- Old pill bottles mixed with new fills.
- OTC meds and supplements they don’t think to mention.
Your role as RN:
- Gather every med—prescription, OTC, vitamins, herbals.
- Compare and clarify with referral orders.
- Confirm with provider or pharmacy when discrepancies arise.
- Educate patients and caregivers on safe routines (pill boxes, timing, interactions).
👉 For step-by-step strategies, see my post on Medication Reconciliation That Sticks.
📌 Watch-Out: Document teaching with teach-back so compliance is clear. See Teaching With Teach-Back & Goal Setting for tips.
Why Skin + Meds Go Hand in Hand
At first glance, skin and meds seem unrelated. But think again:
- Steroids → Thinner, fragile skin.
- Anticoagulants → Increased bruising and bleeding risk.
- Diuretics → Skin dryness, electrolyte shifts impacting healing.
- Nutrition meds/supplements → Directly affect wound healing.
This is why assessing both together gives you a complete safety picture.
Common Pitfalls to Avoid
- Rushing through the skin check because it “looks fine.”
- Assuming medication lists from hospitals are up to date.
- Forgetting to tie med/skin findings back into the plan of care (see Build the Plan of Care at the Bedside).
Final Thoughts: The Cornerstones of SOC
Skin/wound assessments and medication reconciliation aren’t just SOC tasks—they’re patient safety cornerstones. By taking time to assess thoroughly, document clearly, and teach effectively, you protect your patients, your license, and your agency.
✨ Want step-by-step guidance for SOC visits, including skin/wound assessment and medication reconciliation?
Check out my RN Home Health SOC Guidebook on Kindle. It’s packed with real-world examples, documentation tips, and compliance strategies to make SOC visits smoother, faster, and more effective.
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