Practice Innovations
A large 9 hospital system lacked evidence based standardization in practices to prevent and treat wounds. Furthermore, a management company contract for outpatient wound care clinic and Hyperbaric Oxygen Therapy was due to expire. A growing number of wound care patients were being seen throughout the system, receiving fragmented care. In order to provide high quality care and optimal patient outcomes the hospital system needed someone to focus on the management and growth of a system-wide wound care program.
Methods:
A Clinical Nurse Specialist student submitted an SBAR to hospital leadership outlining how a CNS focused on wound care could help improve quality metrics, continue to provide outpatient wound care without the oversight of a contracted company, grow the wound care program across the continuum of care, and save money.
Results:
The CNS-wound care position was created and many gains have been made over the past 2 years. Two of three outpatient wound and HBOT centers are now hospital managed. The EMR has been adapted to optimize workflows and reporting potential while closing the communication gaps between outpatient, inpatient and home health care. Over 200 inpatient, outpatient, and home health care nurses have received wound care specific training. Hospital Acquired Pressure Injuries (HAPIs) have reduced and participation in NDNQI skin audits have increased. A community hospital virtual wound care nurse consult process was created. For outpatient wound care, quality dashboards have been created and median days to heal have reduced while patient visits have increased. A successful CMS TPE audit was completed. Evidence based practices for wound hygiene and proper culture technique have been implemented. Policies and standards of care have been created to meet compliance requirements.
Discussion:
A clinical nurse specialist (CNS) focused on wound care is a value to an organization. The CNS practices in 3 spheres, patient, nurse, and organization. Wound care patients have special needs and require an interdisciplinary team from many faucets of the organization. Having the knowledge and training to assess situations and formulate a solution through the three spheres of CNS practices improve patient outcomes, nurse satisfaction and autonomy, and organizational goals.