Create a designer wound care program for staff
Nurses keep up with the latest technology
Most home care agencies struggle with trying to provide the best care to wound care patients to enable them to heal quickly. But with the wound care field changing so rapidly with new techniques and treatments, it has become difficult for nurses to stay informed of the latest and best practices.
The Atlantic Home Care and Hospice in Mill burn, NJ, has a solution to this challenge. The hospital-based agency, which serves north central New Jersey, has an ongoing educational program for its wound care nursing specialists. The wound care specialists frequently update the rest of the staff about the latest techniques.
"We have a good number of wound care patients, and we have an interest in having the wounds heal as quickly as possible," says Nancy Brothers, RN, MA, staff educator for the agency, which is part of the Atlantic Health System in Morristown, NJ. "And we want to treat the patient holistically, so naturally we’re dealing with nutrition and mobility, and we need to make sure we’re using the best product to facilitate healing," she adds.
Typically, field nurses will call a wound care clinical specialist when they have a complex wound care patient. The specialist will visit the patient and then work with the physician in developing a treatment plan. "Everybody works together because we want to facilitate optimal healing and optimal recovery," Brothers explains.
But Atlantic Home Care has found that achieving optimal results requires more than simply hiring nurses who are specially trained and certified in wound care. These same nurses also need to be continually educated because the field is always changing.
The agency typically has between 12 and 22 nurses on its wound care team, which meets once a month for two hours to learn more about wound care, says Christine Starkey, RN, BSN, CWOCN, wound, ostomy, and continence clinician with Atlantic Home Care.
To be a team member, nurses must have been employed at the agency for at least six months, and they must study to receive six continuing education units in skin and wound care each year. Their responsibilities include serving as a resource person at team meetings, facilitating referrals to the wound care clinician as needed, monitoring select clients with wound or skin care issues, and serving as a role model to colleagues by using accepted wound assessment and documentation skills.
"We have extensive inservicing on wound management, ostomy management, going over case studies, slides, hands-on demonstrations of compression wraps of lower extremities, and troubleshooting of different ostomy cases," Starkey says.
Starkey conducts the inservice, which typically takes a few hours to prepare. "I do some research in magazines, copying recent articles and giving them copies of those as handouts, or I go back to my textbooks and prepare an inservice based on that information."
Wound care product sales representatives also speak to the team. Their talks may last 45 minutes to an hour, and then Starkey finishes the inservice with additional information. "Usually, if something new comes up or if there is a new product in the field that physicians have been ordering, I will call the reps to see when they can come out and speak," she adds.
Starkey and the product representatives provide hands-on demonstrations, usually asking members of the team to participate. Also, the wound care team follows a special protocol and assists other nurses in following it. The 13-page protocol includes descriptions of how to do a variety of procedures, including wound cleansing, wound culturing, periwound skin care, wound debridement, wet-to-dry dressings, silvadene dressings, transparent film dressings, hydrocolloid dressings, hydrogel dressings, and calcium alginate dressing. (See sample pages from the wound care protocol, inserted in this issue.)
In the next part of the inservice, team members educate the rest of the staff. "Basically, whenever a new referral comes in for a complicated wound or ostomy, the clinical coordinator tries to send those nurses on the wound care team out to those patients," Starkey says. "They make joint visits with the other nurses so, over time, everyone becomes educated on how to do wound care."
Also, at nursing staff meetings, nurses are asked to do return demonstrations. For example, a nurse might have to demonstrate a compression wrap, using a colleague’s leg. "The whole purpose of the team is to disseminate information," Brothers says.
Starkey says the dual wound care educational program has worked well so far. "I feel like education should be an ongoing process, and I think it’s most important to give nurses incentives for becoming better nurses. "I’d like to see our agency get to the point where every nurse has a certain area of expertise, whether it’s through cardiac inservices or having diabetic nurse specialists go to inservices with certified diabetic nurses."
Sources
• Nancy Brothers, RN, MA, Staff Educator, Christine Starkey, RN, BSN, CWOCN, Wound, Ostomy, and Continence Clinician, Atlantic Home Care and Hospice, 33 Bleeker St., Millburn, NJ 07041-1414. Phone: (973) 379-8400. Fax: (973) 379-8412.
• U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Executive Office Center, Suite 501, 2101 E. Jefferson St., Rockville, MD 20852. Phone: (800) 358-9295. Anyone may order up to 200 copies of the agency’s publications at no charge. Among the handouts available are "Preventing Pressure Ulcers" (#92-0048) and "Treating Pressure Sores" (#95-0654).
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