Benefits of a Multidisciplinary Wound Care Team in an...

Purpose and Objectives• Toeducatewoundcarecliniciansonthebenefitsthatamultidisciplinary

approachprovidesincaringforpatientswithandatriskforwounds.• Listthemultidisciplinaryteaminvolvedinpatientwoundassessmentinan

inpatientrehabilitationsetting.• Identifythecontributionofmultipledisciplinesinpreventionofwoundsinan

inpatientrehabilitationsetting.• Describethebenefitsofmultipledisciplinesinthetreatmentofwoundsto

expeditehealing.

Benefits of a Multidisciplinary Wound Care Team in an Inpatient Rehabilitation SettingHealthSouthRehabilitationHospitalofMechanicsburg

SarahLohman,MSN,RN,NEA-BC,CNO•BarbaraElmore,BSN,RN,WOCN•KarenBurket,DPT,NCS,CWS

ReferencesMakingHealthCareSaferII:AnUpdatedCriticalAnalysisoftheEvidenceforPatient

SafetyPractices.SectionE.GeneralClinicalTopicsChapter21.PreventingIn-FacilityPressureUlcersNancySullivan,B.A.EvidenceReports/TechnologyAssessments,No.211

WhittingtonK,BrionesR.NationalPrevelanceandIncidenceStudy:6-YearSequentialAcuteCareData.AdvancesinSkin&WoundCare.2004;17:490-4.

Whittington,K.,PatrickM.&Roberts,J.L.(July2000).Anationalstudyofpressureulcerprevalenceandincidenceinacutecarehospitals.JWoundOstomyContinenceNurs.27(4):209-15.

Gadd,M.(2012).PreventingHospital-AcquiredPressureUlcers.JWOCN.292-294.

Wound,OstomyandContinence(1June2010).Guidelineforpreventionandmanagementofpressureulcers.WOCNclinicalpracticeguideline.2:96.

Patient Assessment• Physicians,nurses,occupationaltherapists,physicaltherapists,dietitians,and

attimes,speechtherapistscompleteadmissionassessmentsforallpatients.• Thefullteamapproachevaluatesthepatient’sstrengthsandweaknesses

fromtheviewpointofavarietyofexpertmindsets.

Wound PreventionTheBradenRiskAssessmentTooliswellestablishedinthewoundcarecommunityasavalidandreliabletoolforassessmentofpressureulcerrisk.Aninpatientrehabilitationcenterwithamultidisciplinaryapproachtopatientrecoveryinherentlyfocusesonmost,ifnotall,oftheBradensubsetcategories.

Sensory perception -Identifyandcommunicatetheneedto managepressure-relateddiscomfortMoisture -Skin’sexposuretomoistureActivity -OveralldailyactivitylevelofthepatientMobility -Abilitytocompletetransitionsandstabilize bodyoncenewpositionisachievedNutrition -Normaladultnutritionalintake,includingproteinand fluidintakeFriction and shear -Abletonegotiatebedandseatingsurfaceswithclearance betweenbodyandindicatedsurface -Fullcontrolofbodytostabilizepositionsthroughoutday

Activity• Nursingstaffreceivesadvancedtrainingin

mobilityofpatients,allowingforincreaseduseoftoiletsandbedsidecommodes..

• Interdepartmentalpatientcommunicationboardsareinplaceatthepatient’sbedside,allowingforstaffconsistencywithpatientassistanceneedsforbedsidetasks.

• Forbestcarryover,therapystaffdemonstratesspecifictechniqueswithdifficulttransferstonursingstaff.

• Minimumof15hoursoftherapyaweekforthedurationoftheaverage12.4daylengthofstay

Mobility• Four45-minutesessionsoftherapyare

spacedthroughoutthedaytoprovideformobilitythroughoutthecourseofthedayandneededrestperiodsbetweentherapy.

• Nursingandtherapystaffscommunicateduringtheentirelengthofstaytodeterminewhenapatientissafetoindependentlynegotiatewithinandoutsideoftheirroom.Familymembersaretrainedtoassistwithpatientneedsintheeventthatthepatientcontinuestorequireassistancewithsomeaspectsofcare.

Nutrition• Thedietaryplanisestablishedbasedona

patient’smedicalconditionsandspecificnutritionalneeds.

• Additionalproteinandfluidintakeprovidedforpatientswithwounds

• Supplementsofferedwhenconsumptionofmealsisbelow50%andmonitoredbynursingstaff.

• Therapeuticdiningisprovidedwithnursing,speechtherapyandoccupationaltherapytoincreasethepatient’sabilitytosafelyingestadequatenutrition.

Friction and Shear• Nursingstaffreceivesadvancededucation

inmobilitytechniquesthatallowforgreatestpatientparticipation.

• Significantamountoftimeintherapysessionsfocusesonmobilitytechniques

• Therapysessionsalsoincludepatienteducationandpracticesessionstoenhancecarryover.

• Seatingandpositioningtoolsincreasesuccessfulpositioningandminimizeshearingeffectsatrest.

WoundPreventionSensoryPerception

Comprehension

Expression

SocialInteraction

ProblemSolving

Memory

Rehabilitation Approach to Treating Patients with Wounds• ContinuedfocusonBradensubsetcategoriestominimizeriskof

additionalskindamage• 24-hourfocusonincreasingpatient’slevelofindependence• Educatingpatientsandfamiliesonwoundandimpactofmanaging

healthconditionsisahospital-widefocus• Physiatristsandinternistsmanagethepatients’healthconditions,pain

anddirecttheoverallcare• Nursingstaffassistswithpaincontrol,completeswoundtreatments,

supportspatients’advancingindependence,managespositioning,preventionmeasuresandbedsurfaces

• Registereddietitiansassistwithmealselectiontoaddressnutritionaldemandsandprovidesupplementsasneeded

• Therapystaffdevelopscustomizededucationprograms,selectsseatingsurfaces,assistswithpositioningandmayprovideadjunctmodalities

• Casemanagementoverseesschedulingformaleducationwithfamilymembersandmanagesthetransitionofcareforthepatientafterdischarge

Multidisciplinary Skin and Wound Care Team• PrimaryMembersareNurse:WOCNandPhysicalTherapist:CWS• Complimentaryclinicalview-pointsofthesetwodisciplinesresultsina

comprehensive,wholepatientapproachtohealing• Membersareresourcestothehospitalstaff• Teamcompletesweeklyroundsonpatientswithoratriskfor

developingpressureulcers• Consultsmaybetriggeredbyaconcernofanyclinicalstaffmember• Woundnursecoordinateswithphysicianspost-assessmenttomanage

bestwoundtreatments,bedsurfacesandpaincontrol• Physicaltherapistprovidesadjuncttreatmentsandmanages

seatingsurfaces

Incidence and Prevalence• Itisthecombinedeffortsoftheteamthatallowsfora0.47wound

incidencerate(WIR),despiteanaverageadmissionBradenscorebelow19.

• Forcomparison,thisisa0.002%woundincidenceforstageIIorgreater,duringanaveragelengthofstayof12.4days.

• Pressureulcerpreventionstudiesfrom1999-2011indicatewoundincidencepostimplementationofmulti-componentinitiativesfrom0.448%to12%inbothacutecareandlong-termcaresettings.Moisture

• Focusonthepatient’sabilitytoindependentlymanagebowelandbladdertasks,toileting,andtransfers

• Utilizationofbowelandbladderretraining

• Nursingstaffmonitorsthoroughnessofurinevoidwithnon-invasivebladderscanners.

Patientinconti-nentofbladderduringfirst48

hoursofadmission

No:notrainingneccessary

Yes:Startbladdertraingprogram

Obtaintimer,determinetime

frame(twohours),informcharge

nurse

Nursingshift-toshiftreports,

communicatewiththerapies

Educate:patienttousetimeifable

Documentation:planofcare,IDD,

therapybillingsheet,education

record

PatientLevelofIndependence

FIM®scoresfromJanuary1toAugust14,2014