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Wound Care
Wound care is an overarching term that includes care of wounds caused by, for example, venous and arterial insufficiency, neuropathy, lymphedema, and burns.
The AAWC Conceptual Framework of Quality Systems for Wound Care
When the Association for Advanced Wound Care Quality of Care Task Force members determined there was no unanimously accepted definition of quality as it relates to wound care, they: 1) identified relevant components of quality wound care, and 2) created a framework of quality wound care indicators to enable the creation or assessment of wound care delivery systems. The framework is an innovative conceptual model that serves as a basis for the Association strategies to facilitate high quality wound care for patients/clients across the continuum of care and recognizes the role of the supporting systems necessary to provide wound care services. It uses the Institute of Medicine?s Crossing the Quality Chasm: A New Health System for the 21st Century to define quality systems for wound care and includes safety and effectiveness coupled with the delivery of timely, efficient, equitable, collaborative, patient-centered care. This framework can be utilized during clinical, managerial, or regulatory review of wound care service delivery.
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Successful Outcomes with the h.e.a.l. Program
The successful treatment of acute and chronic wounds can be daunting. In an effort to improve client outcomes and manage spiraling nursing and dressing supply costs, the Community Care Access Centre of Wellington-Dufferin (Canada) implemented the Healing Excellence with Advanced Learning (h.e.a.l.) program in March 2003 as a standardized, evidence-based means of providing wound care to home care clients. While implementation challenges remain and education is ongoing, indepth wound management education and standardization of care have reduced the percentage of patients receiving nonevidence-based wound care and resultant frequent dressing changes. This has enabled the Centre to reallocate $1.5 million from dressing change costs to new nursing initiatives beyond wound care. The initial goals of the program were met. Continuing documentation of its outcomes will help underscore the importance of evidence-based protocols and provider education to the wound healing process. KEYWORDS: evidence-based practice, moist wound healing, outcome measurement
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Managing Wound Care Outcomes?Part 2
Part 2 - Results Client demographics, wound prevalence, and pre-NSP wound care practices. Wound healing outcomes. Discussion Home care agencies implementing the NSP improved the quality and consistency of wound care outcomes and clients?
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Managing Wound Care Outcomes?Part 1
Chronic wounds increase home care costs, stressing an already overburdened system. To improve costs and wound outcomes of home care in Nova Scotia, dedicated home care professionals collaborated with the Nova Scotia Department of Health Clinical Issues Committee in a four-phase endeavor. In Phase I, a descriptive, retrospective chart review (1995-1999) was conducted using an Outcomes Management Model research framework to assess existing wound prevalence, costs, and outcomes of care in the Nova Scotia Home Care setting. In Phase II, using literature-based best available evidence, the Nova Scotia Standardized Prevention and Treatment Protocol was developed. In Phase III, the Protocol was disseminated to 20 Nova Scotia healthcare agencies educated on its use. Wound care outcomes and costs were measured in Phase IV using a prospective, quasi-experimental, descriptive study design. The study found that before 1999, Nova Scotia Home Care wound care practices were costly and outdated, yielding sporadically recorded, often inferior, outcomes ? eg, 30% of patients had pressure ulcers, 42% received daily home care visits, and of the 115 (24.6%) clients with venous leg ulcers only 16 received compression therapy. The Protocol increased awareness of the principles of moist wound healing and reduced the prevalence of chronic wounds, dressing change frequency, healing time, and costs of care. Phase IV study results (n = 50) showed an average decline in labor and materials costs of $946.64 per client per month after Protocol implementation. The Nova Scotia Protocol enables home care professionals to provide quality wound care and has since been issued as policy for Home Care in Nova Scotia. KEYWORDS: home care, policies, costs of care, moist wound healing, outcomes
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A Survey of Current Physical Therapy Practices in Wound Care
Few standardized treatment protocols are available to guide physical therapists through the rapidly changing area of wound care. To assess current physical therapy practices and to determine relationships between specific demographic data and evaluation/intervention techniques utilized in wound care, a questionnaire was developed that used a Likert scale (1 to 5) for responses, offering choices from "always" to "never." The questionnaire was sent to physical therapists at 170 clinical sites used by the University of Mary Program in Physical Therapy in Bismarck, ND. The final return rate was 48.1%. The most commonly used evaluation and intervention techniques were determined. Use of the rubor of dependency test, sharp debridement, enzymatic debridement, compression dressings, and autolytic debridement was found to have a significant (P < .05) relationship to the reported percentage of compromised wound care patients in a clinician's practice; whereas, years of clinician experience has a significant (P < .05) relationship to the use of monofilament testing and the use of electrical stimulation. Reasons for the differences observed, including the role of guidelines, need to be explored.
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Alliance Successful in Educating the MCAC on Usual Care of Chronic Wounds
John Macdonald MD, FACS, President-elect of the AAWC, focused his remarks on the interdisciplinary approach to wound care, stating: ? Other association presentations reinforced the following issues: ? Rendering national coverage decisions regarding wound care procedures, modalities, and devices is another potential course of action for CMS.
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Physician Adoption of Hyperbaric Oxygen Therapy in the Treatment of Chronic Wounds
Hyperbaric oxygen therapy, a treatment alternative for chronic wounds, has been used for several decades yet little is known about factors that influence physicians to incorporate this therapy into practice. To assess wound care physician knowledge of, attitudes toward, and adoption of hyperbaric oxygen therapy and to identify factors associated with physician adoption of this therapy, a 23-item questionnaire, based on Rogers? diffusion of innovation model, was developed by the authors and distributed to 653 American Academy of Wound Management Board-certified physicians. Of the 246 (43%) physicians in the study population who responded to the study survey, 167 (68%) reported they had used or referred patients for hyperbaric oxygen therapy during the past 12 months. More than half of the respondents reported a relatively high level of familiarity with and a positive attitude toward the effects of hyperbaric oxygen therapy on wound healing. Physician adoption of hyperbaric oxygen therapy was significantly associated with a community of >100,000 residents (adjusted odds ratio = 2.29, 95% confidence interval = 1.05 to 5.04); patient request for hyperbaric oxygen therapy (adjusted odds ratio = 5.38, 95% confidence interval = 2.50 to 11.56); positive attitude toward (adjusted odds ratio = 3.38, 95% confidence interval = 1.49 to 7.66) and high level of familiarity with hyperbaric oxygen therapy (adjusted odds ratio = 5.33, 95% confidence interval = 1.72 to 6.49); and practice location in either Florida or Texas (adjusted odds ratio = 3.44, 95% confidence interval = 1.24 to 9.54). Although the majority of the respondents reported adoption of hyperbaric oxygen therapy, most adopters are concentrated only in a few geographic areas. Despite the limitations of this study, especially the potential effects of sampling and response bias, the results help explain factors that have facilitated and hindered the adoption of this technology into practice. KEYWORDS: hyperbaric oxygen, diffusion of innovation, diabetic ulcers,
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SAWC Exhibitor Preview: The 20th Annual Symposium on Advanced Wound Care and the Wound Healing Society Meeting April 28 ? May 1, 2007 Tampa Convention Center Tampa, Florida
The Exhibitor Previews present a foretaste of the companies, products, and services participating in the upcoming Symposium on Advanced Wound Care. Much more than a place to shop, the Exhibit Hall serves as a valuable educational resource ? group demonstrations and one-on-one discussion provide practical take-home information. Plan to feast on the offerings available during the dedicated Exhibit Hall hours.
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Confessions of a New Kid on the Block
Sharon Aronovitch PhD, RN, ET, initially Robbie? Robbie's Pearls Robbie admits she was apprehensive. ? Sharon continued to mentor, support, and keep Robbie centered. ?
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Does Sterile or Nonsterile Technique Make a Difference in Wounds Healing by Secondary Intention?
After observing inconsistencies in care of acute surgical wounds healing by secondary intention and reviewing the potential cost savings of implementing clean dressing change technique policies, surgical nurses at a university-based medical center monitored supply usage and infection rates of these wounds using a nonexperimental, longitudinal study design. Staff from two acute care surgical units provided data for 3 months before and 3 months after standardization of wound care to a clean wound care technique. All adult patients requiring dressing changes three times per day with normal saline moistened gauze of their open surgical wound(s) participated in the study. Before changing the wound care procedures, nine (9) of 1,070 (0.84%) admissions to the two surgical units had a surgical site infection. During the 3 months following implementation of clean wound care protocols, eight (8) surgical site infections were documented in 963 admissions (rate .83%). Dressing supply costs were $380 less. In this study, using nonsterile wound care procedures for wounds healing by secondary intention did not negatively impact infection rates and saved supply costs.
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