SEEING THE BIG PICTURE: Optimizing Wound Care Management · Objectives 1. Identify the needs of...
Transcript of SEEING THE BIG PICTURE: Optimizing Wound Care Management · Objectives 1. Identify the needs of...
SEEING THE BIG PICTURE:
Optimizing Wound Care
ManagementLaurajean Kudatzky, PT, DPT, ATP, CWS
Julianne Rece MSN, RN, CRRN, CWOCN
Objectives
1. Identify the needs of wound care patients transitioning
from acute rehabilitation to home.
2. Describe ways to expedite positive wound healing
outcomes through interdisciplinary collaboration.
Quick Background: Types of wounds
TraumaVascular
Incontinence/Moisture Associated
Surgical
Pressure Injury
Resources differ depending on wound type & patient
Our typical patient
Pain
Skin
Caregiver
support
Insurance Ventilator
Accessibility
Coping
Malnourished
Neurological
injury
Equipment
Bowel and Bladder
Discharge
Planning
Planning for the Transition
Transitioning home: Laying the Groundwork
Transitioning Home: Building a Support Network
Communication among
• Patient & Caregivers
• Nursing/CNAs/CWOCN
• Physicians
• PTs/OTs
• Case Management
• Dietitian
• Outpatient Staff
• VNs/CNAs
• Vendors: DME, software
Transitioning home: Preparing for Success
Transitioning Home: Surfaces
• Limited options from insurers/ vendors
• Group I: Preventative
• Group II: Treatment
• Group III: Air Fluidized
Buffers for home:
Air-filled positioning sling
Foam wedge
Offloading boots
Gel positioner
Disposable air-filled cushions
Transitioning Home: Wound Care
Realistic
Caregiver
abilities Insurance landscape
Out-of-pocket
abilities
Frequency
VN availability
Patient/Caregiver
teaching needs
Collaboration w/
VNSupplier collaboration
Prescriptive
coverage
Transitioning Home: Psychosocial Barriers
• Vulnerability
• Stress outlets
• Limited access
• Limited sitting
• Caregiver burnout &
availability
• Managing schedules &
transportation
Transitioning home: Structural Barriers
After discharge: Tailoring to patient needs
• Prioritizing needs/importance
• Must match the patient’s priorities to be successful
• Woundcare
• Nutrition
• Surfaces
• Vendors
• Variety of needs and concerns
After Discharge: Identifying Resources
• Seating clinic
• PT/CWS role in the wound care clinic
• Nutritional support and supplementation
• Access to CWOCN/CWS at every MD appt
• Case management
• Ongoing wound care supply orders
• Direct referrals
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After Discharge: Creativity Counts
• Insurance
• Meeting insurance requirements
• frequency/formulary coverage
• Collaborating w/outside vendors
• Surgeons
• Wound Care supplier
• Equipment vendors
• Collaborating with clinicians
• Social service resources
• Donation/limited free care options
• Physical Therapist/Certified Wound Specialisthttps://www.zastavki.com/pictures/1680x1050/2010/World_France_Garden_maze_022035_.jpg
After Discharge: Lifetime Follow Up Support
• Phone access for questions
• Daytime/ off shift w/ Residents
• Multiple disciplines able to be accessed
• Onsite appointments
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After Discharge: Lifetime Follow Up Support
continued
• Case Management services
• Wound care supply ordering
• Education
After discharge: Expedite wound healing
outcomes
• Efficiency
• Lifetime follow up
• Outpatient Resources
• Communication
• Education
• Biologics
• Modalities
Case Study #1
• 38yo female with longstanding paraplegia
• Chronic stage 4 coccyx pressure injury
• Active mother, works full time
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Case Study #1: Resources
• Wound care
• Nutrition
• Surgeon consult
• Physical Therapy
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Case Study #1: Outcome
• Adapting to patient goals and lifestyle
• Creativity
Case Study #2
• 34 yo man w/ paraplegia
• Extensive chest & abdominal wounding
• Coccyx stage 4 PI and bilateral buttocks wounding
Conclusion….
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References
• National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory
Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment
of Pressure ulcers: Clinical Practice Guideline. Emily Haesler(Ed.).
Cambridge Media: Osborne Park, Western Australia; 2014.
• Moore Z, Butcher G, Corbett LQ, McGuiness W, Snyder RJ, van Acker K.;
Exploring the concept of a team approach to wound care: Managing
wounds as a team; J Wound Care. 2014 May;23 Suppl 5b:S1-S38. doi:
10.12968/jowc.2014.23.Sup5b.S1.
• Zena EH Moore, Joan Webster, Ray Samuriwo; Wound-care teams for
preventing and treating pressure ulcers; ReviewIntervention; The
Cochrane Library; 16 September 2015
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