11/5/2013

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ADVANCING WOUND CARE

Angela Graham, RN BSN CWOCN

DOCUMENTATION:ROADBLOCKS TO

RESULTS

CWOCN

Kaye Keel, BS CHA CHC

Alacare Home Health & Hospice

OBJECTIVES:Discuss challenges of wound care documentation.Describe implementation of point care technology to improve documentationExplain ICC – Integumentary Command Center and it’s impact on agency outcomes.

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24 Branch officesFamily owned since 1970Services ProvidedServices Provided• Home Health- 1972• Hospice- 1994ADC• 4500 Home Health• 600 Hospice• 600 HospiceAnnual Admissions• 17,550 Home Health• 2900 Hospice

OUR WORKFORCE…..1000 Employees

Birmingham Business Journal Best Places to Work Top 10for 9 years running.

Business Alabama, Best Companies to Work For inAlabama Top 10 for 3 years running.

Alacare nurse was awarded the Caring Magazine’s Top Home Care & Hospice Nurse in the Nation

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CHALLENGES OF WOUND DOCUMENTATION

1200-1400 patients daily1200 1400 patients daily average receiving wound care60+ NPWT patients dailyCWOCN on staffComplex woundsComplex wounds

OUR MUTUAL CHALLENGES

Assessment toolsCMSOASIS

Staff Education TerminologyCost of Care

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WHAT WE WERE FINDING…

Mysterious vanishing woundsMysterious body partsMysterious moving woundsOrders or lack of orders….AuditsState Survey issuesNurse compliance

SURVEY EXPERIENCE

• Top Survey issues resulting in citations• Migrating locations• Inconsistent measurements• Improper or absent orders• Response to change in condition of wound

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PI FINDINGSRoutine Performance Improvement Chart Audits• Wound care documentation #1 issue

• Orders• Notification of MD• Complete assessment• Measurements

WHAT OUR DATA TOLD US

90% HH HOS

30%

40%

50%

60%

70%

80%

0%

10%

20%

Orders match care Orders contain all info Full Assessment Completed

Wound measurement

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OUR SOLUTION

Approached by our pp yvendor – Homecare Homebase™Beta tester for new ICC programAgency decisionApproach to implement

INTEGUMENTARY COMMAND CENTERBates-Jensen Wound Assessment Tool

• - issue of Closed vs. Open WoundsValidated/tested toolStandardized documentationImproved reporting/tracking

Wound care intervention in a “template”Wound care intervention in a template and prepopulates each visitNo more narrative entries and increased risk of discrepancy in the record

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SCORES AND TRENDS

HOW DO WE IMPLEMENT?

Old habits die hard! Staff engagementStaff engagementDesign of education roll out

• 24 offices• 1 CWOCN• Need for clinical

education to accompany user information

• Follow up challenges

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PLAN OF ACTIONEducation Sessions 1 ½- 2 hours½ ou s

• Photos to correspond with questions

All staff presentPower-pointOne on one assistPost implementation audits

PLAN OF ACTIONStarted slow!! Initial branch inInitial branch in February 2013Slow progression till completion with all 23 offices in October 2013Follow up sessions as needed

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OPPORTUNITIES

1. Opportunity to include wound care/assessment education

2. Relate questions/assessment to real wound photos

3. Scenarios

EDGES OF WOUNDS

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HOW WOULD THIS IMPACT OUR CLINICAL CARE?

St d di d / lidStandardized /valid wound assessmentsScoring of wounds Improved clinical assessment skillsI d ti tImproved patient careStaff Satisfaction

IMPROVED ASSESSMENT1. We went from 9

general questions ge e a ques o sto 19 specific and validated questions

2. System names the wound ..not the nurse!nurse!

3. Over 600 locations

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ROADBLOCKS REMOVED1. No more disappearing wounds….locked and

present for each visit!present for each visit!2. No more name changing visit to visit!3. No more care provided without a VO!4. No more lack of care provided…5. Improved wound tracking6 I d t6. Improved case management7. Reduction in Documentation time!!8. Staff Job Satisfaction!!!

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IN FOLLOW-UP

90%

100%Home Health

80%

90%

Hospice

0%

10%

20%

30%

40%

50%

60%

70%

80%

10%

20%

30%

40%

50%

60%

70%

80%

0%

Pre-ICCPost-ICC

0%

Pre ICCPost-ICC

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STATE SURVEY EXPERIENCE

• Recent survey0 (Zero) survey• 0 (Zero) survey citations related to wound care

• Surveyors response

AREAS OF IMPROVEMENT• Staff ability to see the big picture

• Recognize changes more easily • Alerts of changes to workflow

• Reduced frustration

• HOWEVER…Nothing takes the place of the nurses clinical expertise/judgment

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CONTINUED IMPROVEMENT…Areas which are still a challenge:

Verbal order verbiage

Correct wound type identification and pressure ulcer staging

Correct “template” formation

Starting ICC at the right timeg g

. What is our staff saying? sta say g

They “love it”!“It’s faster”! It has made the

subsequent visits easier!It is so much easier to

manage the patient.The information is

easier to find re: patient/wound status.

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THANK YOU!Thank you!

Questions?