A commitment to healing wounds

[cougarnurse]

Good article from the MidWest Nursing Spectrum: Nurse.com - A Commitment to Healing Wounds
They might start out small, but nonhealing wounds exact a big price in this country. Sixty thousand deaths a year are attributed to pressure ulcers, and one in four Americans over age 65 experiences a lower-extremity ulcer, says Mary Arnold Long, RN, MSN, APRN-BC, CRRN, CWOCN, clinical nurse specialist for the Advanced Wound Care Program at the Drake Center in Cincinnati, Ohio.

"As a regional referral center for nonhealing wounds, we see very challenging wounds, including [those of] patients who have had extended hospitalizations because of multiple trauma or multiple surgical procedures and [patients] with extensive pressure ulcers," says Long. "The most challenging patient we see is one with a nonhealing surgical wound with a fistula — an abnormal connection from one organ system to another — often from the intestines to the skin."

This type of wound requires a lengthy healing process and meticulous attention to treatment, including extensive debridements and assessments and frequent, lengthy dressing-change procedures.

"No floor nurse has the time to dedicate to that type of care," says Long, who is also president of the Mideast Region of the Wound, Ostomy and Continence Nursing Society.

Specialized care setting

To address this issue, the Drake Center developed the comprehensive, evidence-based Advanced Wound Care Program, which encompasses the facility's long-term acute-care inpatient and outpatient settings. The cornerstone of the program is the wound care team.

"What makes us so special is that we have a whole team of nurses who are dedicated exclusively to wound care," says Lu Ann Reed, RN, MSN, CRRN, RN-C, WCC, program director of wound care.

Outcomes of the program are dramatic and include —

• 90 percent of those receiving inpatient care experience wound volume reduction rates of 50 percent or better in four weeks (50 percent reduction in 12 weeks is a good indicator of potential healing, according to the Advanced Wound Care Program at the Drake Center)

• 55 percent of patients with complex surgical/trauma wounds experience wound closure

Specialized nurses

Team nurses are either certified or completing requirements to be wound care certified (WCC). In 2007, Reed was named as winner of the Outstanding WCC of the Year and Outstanding Research in Wound Care awards by the National Alliance of Wound Care, which administers WCC certification.

WCC nurses have completed extra education, have experience in providing direct wound care, and are knowledgeable as educators and resource nurses. They provide overall skin care and promote an optimal wound-healing environment, including prevention, therapeutic interventions, and rehabilitative interventions.

The role includes the identification, assessment, management, prevention, and continuing evaluation of patients with alterations in skin/tissue integrity. In collaboration with the physician, wound care team nurses individualize treatment strategies using the most cutting-edge products and therapies. (See "Advanced Wound Care.")

Stressing continuity

This dedicated wound care team concept maximizes continuity by integrating outpatient and inpatient care, Long says.

On the outpatient side, wound care team nurses assess outpatients and make treatment recommendations, complete initial dressing changes, and teach patients how to care for their wounds at home. Team nurses also teach patients how healthy lifestyle changes, such as adherence to medication regimes and smoking cessation, can maximize healing.

"Every time patients have to start over with a new group of healthcare providers, something might get missed," Long says. "When outpatients are admitted to the inpatient side, we already know about them. The same is true when inpatients are discharged and return for follow-up care in the outpatient clinic."