Chronic wounds at home: what the nurse does, week by week
Written by Thomas Berthier, State-registered nurse · · 2 min read
Reviewed on · Reviewed by Léa Marchand
A wound that has not healed after six weeks becomes a chronic wound. Here is what home care actually involves: assessment, protocol, monitoring, warning signs and the exact role of everyone involved.
Key points
- A wound is called chronic beyond six weeks without healing: follow-up then becomes methodical and dated.
- The dressing is not the care: the care is assessing the wound, offloading pressure and treating the cause.
- A dated photograph, with the patient's consent, is the only reliable way to evidence progress to the prescriber.
- Deterioration is judged on three objective signs — odour, exudate, surrounding skin — not on today's impression.
What makes a wound chronic rather than ordinary
An acute wound follows a timetable: it closes. A chronic wound stalls, because a cause keeps acting: sustained pressure, poor circulation, unbalanced diabetes, undernutrition.
Treating the wound without treating the cause is emptying a bath without closing the tap. That is why the first visit is never only a dressing: it looks at the bed, the chair, the shoes, the meals and the current medicines.
This initial assessment is what makes everything after it credible: without a documented starting point, no progress can be demonstrated.
The course of care, week by week
The real rhythm of a course of care, barring complications. Exact frequencies are set by the prescription and adapted to the wound, never the other way round.
| Period | What the nurse does | What is decided |
|---|---|---|
| Week 1 | Full assessment: size, depth, edges, exudate, pain, likely cause. Dated photograph if agreed. | Choice of dressing protocol and visit frequency. |
| Weeks 2 to 4 | Dressing changes per protocol, weekly measurement, pressure offloading, pain and nutrition monitoring. | Keep or adjust the dressing; alert the doctor if progress stalls. |
| Week 6 | Measured review: has the surface reduced? Photographic comparison. | Continue, change dressing class, or request specialist advice. |
| Beyond | Visits gradually spaced out, patient and family education, relapse prevention. | Discharge from protocol once healing is achieved and the cause controlled. |
What is checked at every visit
Five observations take two minutes and catch almost every early complication.
- The wound bed: granulating, sloughy, necrotic
- Exudate: amount, colour, odour — a new smell is reported the same day
- Surrounding skin: spreading redness, heat, swelling, maceration
- Pain: its intensity, but above all any change in its nature
- General condition: fever, unusual fatigue, loss of appetite
What patients and relatives can do
Three simple actions matter more than any technical dressing.
01
Remove the pressure
Change position every two to three hours when the wound is a pressure ulcer, and report any mattress or cushion that seems inadequate.
02
Feed the healing
A wound consumes protein. Insufficient intake slows closure, however good the local care.
03
Protect the dressing without opening it
The dressing stays in place until the planned visit. If it lifts or leaks, call us — do not redo it yourself.
When we call the doctor, and when you should call us
We contact the prescriber as soon as any of these appear: spreading redness, a distinct smell, fever, sharply increased pain, or a wound enlarging despite a followed protocol.
On your side, call without waiting for the next visit if the dressing is torn off, if the wound bleeds, or if the person becomes confused or feverish.
A wound that changes smell or colour within 24 hours does not wait for the next appointment: call the practice.
Supplies, waste and traceability
Dressings are prescribed and dispensed by the pharmacy: we pass on the exact list to avoid mid-week shortages, which force improvised protocols.
Sharps and soiled waste go into an approved container, collected through the DASTRI channel via the pharmacy. Nothing goes in the household bin.
Every visit is recorded: date, appearance, product used, decision. That record — not memory — lets a locum or a doctor pick up the case with nothing lost.
Frequently asked questions on this page
- How long before a wound is considered chronic?
- Beyond roughly six weeks without healing despite suitable treatment. That threshold triggers a review of the cause, not merely a change of dressing.
- Can I redo the dressing myself between visits?
- No, unless written instructions say so. The protocol depends on contact time and regular observation: opening it outside a visit undermines both.
- Are wound photographs compulsory?
- No. They are offered, taken only with your consent, stored in a secure health tool and used solely to document progress for the prescriber.
- Who pays for the dressings used at home?
- They are prescribed and dispensed by the pharmacy and covered under the usual health insurance rules; cover is enhanced for long-term conditions.
Terms explained
- Pressure sore
- Damage to skin and tissue caused by prolonged pressure on a support area (sacrum, heels, hips), common with immobility.
- Prescription
- A doctor's written order stating the procedure, frequency and duration. Without it, nursing care cannot be delivered or reimbursed, apart from procedures allowed in direct access.
- Care protocol
- A written, dated description of how a specific patient's care must be delivered: products, supplies, frequency, alert criteria.
- Handover notes
- The written record of a visit: what was done, what was observed, what must be watched. The shared memory of the care episode.
- Sharps waste (DASRI)
- Infectious healthcare waste — needles, syringes, lancets — collected in an approved yellow container, never in household waste.
- Long-term condition (ALD)
- A chronic condition recognised by French health insurance, granting 100 % cover for care related to that condition.
Official sources
What we write is based on public references you can check for yourself.
- Prevention and treatment of chronic wounds: guidelinesHaute Autorité de santé
- National nursing agreement: procedures, fees and amendmentsAssurance Maladie (ameli.fr)
- Disposal of sharps and soiled care wasteDASTRI
This page is informational and replaces neither a medical consultation nor a prescription.