Running the track

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Running the track
Running the track
Wound care tracking has grown more complex for today's long-term care provider, requiring that clinicians and support staff constantly keep apprised of new techniques, products and protocols. Without this knowledge base, caregivers are at a disadvantage in tending to the most common and problematic conditions residents face, wound care specialists say.

“Wound care tracking is imperative for the prevention, management and treatment of wound care,” says Rosalyn Jordan, executive vice president of clinical services for RecoverCare. “Tracking of the wound healing, such as improvement in the reduction of the depth and size of the wound, along with a decrease in drainage, guide the course of therapy provided for wound care. Decisions are also critical for treatment changes if the wound is not healing or there is a decline in wound status.”

The tracking of wound progress is required by most payment sources. In all cases, documentation of the care rendered is a legal and professional requirement, she adds.

Jordan recommends practitioners keep their knowledge and skills updated by reading current journal articles related to wound care practices and new technology. Attending workshops and conference sessions also are useful tools to advance knowledge and skills related to wound care, she notes.

“Many sources provide wound education webinars on the Internet. These are valuable educational resources,” Jordan says.

The top wound care organizations all have an online presence and offer educational materials. For instance, the National Pressure Ulcer Advisory Panel has posted its “Pressure Ulcer Prevention and Treatment: Clinical Practice Guideline” for interventions and treatment. A pair of other member organizations with evidence-based wound care guidelines are the Wound, Ostomy, and Continence Nursing Society, and the American Association of Wound Care.

“Manufacturers of wound care products also provide excellent sources of wound care education,” Jordan says. “The wound care nurse could simply ask the manufacturer's sales representative about the kind of educational support the company provides. These vendors will also typically provide on-site product or equipment demonstrations.”

Talking technology
The new quality standards providers must meet should serve as an impetus to upgrade their information technology systems, believes Louis Lenzmeier, director of marketing for MDI Achieve.

“Given that quality is one of the premier measures each long-term care organization is now judged by, technology plays a key role in clinical decision-making and process changes,” he says. “Providers should seek technology that gives them the decision support tools, like observations and assessments, to allow efficient recording and tracking in wound care. This leads to higher quality scores and is a big plus in the survey process.”

With the advent of electronic medical records, computerized wound treatment records are the most advantageous method of wound tracking, Jordan says.

“Wound tracking can assist clinicians in documenting and tracking patient outcomes, designing outcome specific programs, and possibly increase the time for patient care,” she explains. Computerized documentation provides a concise method for reporting, she says, as it provides the ability for “comparing and contrasting both the changes in the wound and treatment interventions.”

“These programs provide customized reports that can be specific for patients and facilities,” Jordan says. “Also, it serves as a guide for complete wound documentation and helps in collecting data without missing areas of required documentation.”

Ulcer ‘avoidability'
The key to staying on top of the latest wound care techniques and approaches is to be vigilant with training and to be aware of new concepts, Lenzmeier says.

“Obviously, continuing with periodic education of wound care is important, as direct care of the resident is the first priority,” he says. “Evidence-based education is important. However, providers should also consider prevention education. For example, there are several educational opportunities for staff to reduce the incidence of pressure ulcers and incontinence-related skin breakdown. Many are taking advantage of this.”

A leading source on the issue of prevention and “avoidability” is the National Pressure Ulcer Advisory Panel, which in 2010 determined that patients who choose not to participate in their own pressure ulcer prevention could develop unavoidable pressure ulcers. NPUAP experts also agree that there are clinical situations in which the development of pressure ulcers can be unavoidable. It established a new definition of “unavoidable” to mean that “a pressure ulcer developed even though the provider had evaluated the individual's clinical condition and pressure ulcer risk factors.”

Often precipitating “unavoidable” pressure ulcers is a condition called hemodynamic instability, which can occur prior to turning or repositioning a critical care patient. Moreover, the NPUAP has determined that patients who refuse to be repositioned also might develop pressure ulcers.

Vendor resources
Medline Industries has made a major push into the wound care education arena, offering practitioners various resources, including Medline University, a free online clinical education program for nurses, technicians and administrators. The company says more than 200,000 users are currently registered for the online education site, taking an average 23,000 courses every month.

The company's thrust toward wound care education is in response to a major industry need, says Jonathan Primer, president of Medline's Dermal Management System division.

“Access to information and expertise has long been a major concern in this business and keeping current is always a challenge,” he says. “We've spent a lot of time asking what we can do to provide information for our customers in a way they can better understand and more easily deliver wound care at the patient's bedside. We know the products are good, but if things aren't done properly, that doesn't matter. So we are committed to using every vehicle we can imagine to provide educational support.”

The educational focus includes live seminars, DVDs, webinars and a telephone hotline. Even the product packaging has been designed to provide a “two-minute course in wound care,” says Margaret Falconio-West, RN, Medline's senior vice president of clinical education.

The new packaging was created to improve delivery and communication in order for healthcare professionals to better understand and more easily deliver wound care at the patient's bedside, she explains.

“Whereas the old packaging used to just say ‘alginate,' we now put a picture of the product on the package so the user can see exactly what the product is,” she said. “It reduces confusion with clear, step-by-step information, eliminating the clutter and highlighting critical information.”

Formulating a plan
To ensure its staff members keep current on wound care tracking methods, each facility should review its own policies and procedures for relevance and compliance with the latest standards, Jordan says.

“Practitioners must first understand and follow the policies and procedures in place,” she stresses. “If revisions are needed, they should volunteer to work with a committee to revise them. Practitioners also should have an understanding of the regulatory requirements for wound care, especially if they refer to pressure ulcers. Evidence-based clinical best practice guidelines are an excellent source of information for wound care interventions.”

Certification in wound care is needed for comprehensive wound care training, Jordan says. There are currently three routes to certification: a WCC certification provided by the National Alliance of Wound Care; CWCN certification from the Wound, Ostomy and Continence Nursing Society; and the CWS certification for wound care nurses from the American Board of Wound Management.

“After certification as a wound care clinician,” she says, “the wound care nurse will have opportunities through professional organization membership to be abreast of the latest evidence-based care improvement in not only practice but advanced techniques and technologies.”

Document updates ‘clean' vs. ‘sterile'
The Wound, Ostomy and Continence Nurses Society's Wound Committee and the Association for Professionals in Infection Control and Epidemiology have updated a 2001 joint position statement to review the evidence about clean vs. sterile technique and present approaches for chronic wound care management. Then, as now, controversy exists due to a lack of agreement on the definitions of “clean” and “sterile” technique, lack of consensus as to when each is indicated in the management of chronic wounds, and lack of research to serve as a guide. The groups forged the following definitions:

Sterile technique: Sterile is generally defined as meaning “free from microorganisms.” Sterile technique involves strategies used in patient care to reduce exposure to microorganisms and maintain objects and areas as free from microorganisms as possible. Sterile technique involves meticulous hand washing, use of a sterile field, use of sterile gloves for application of a sterile dressing, and use of sterile instruments. Sterile technique is considered most appropriate in acute care hospital settings, for patients at high risk for infection, and for certain procedures (e.g., sharp instrumental wound debridement).

Clean technique: Clean means “free of dirt, marks or stains.” Clean technique involves strategies used in patient care to reduce the overall number of microorganisms or to prevent or reduce the risk of transmission of microorganisms from one person or one place to another. Clean technique involves meticulous hand washing, maintaining a clean environment by preparing a clean field, using clean gloves and sterile instruments, and preventing direct contamination of materials and supplies.

Using wound care tracking
Administrators also can use a wound tracking system in order to:

--Monitor and evaluate any consistent patterns in the population of
the facility
--Monitor and evaluate the effectiveness and cost of wound therapy
--Understand length of stay for wound care patients
--Enhance use of customized reports

The MDS nurse can use the wound tracking documentation tool for discussions at MDS review meetings and for completion of MDS documentation.

Source: RecoverCare, 2011