The Agency for Healthcare Research and Quality (AHRQ) estimates that a newly developed pressure ulcer costs a facility between $4000 and $40,000. The risk of pressure ulcer development in patients with extended stays in hospitals and nursing facilities is about 25 percent. An effective nursing wound care program can save your facility a considerable amount of time, effort and money. More importantly, it will prevent infection, promote healing of existing wounds and prevent the development of new pressure ulcers for your patients.
Instructions
1. Assemble an Interdisciplinary Team
Your wound care program-whether you work in a nursing facility or acute care hospital-should be a multi-disciplinary effort involving individuals from each department: nursing, dietary, physical therapy, infection control, risk management, and administration. If available, invite the medical director or a wound care physician to participate. Designate one individual to lead and coordinate the team's efforts, and give specific assignments to each member.
2. Schedule Routine Wound Care Meetings
Secure a conference room and schedule committee meetings no less frequently than once per week. Short daily meetings may work best while the program is first being developed.
3. Establish Guidelines and Definitions
Review the latest pressure ulcer guidelines and nationally recognized standards set forth by the AHRQ and the National Pressure Ulcer Advisory Panel. These will provide the basis for your wound care system, which will in turn ensure consistency among your team and with other facilities.
Create a glossary of terms and define wound stages. Everyone should use the same terminology and criteria to assess, stage, measure and document wounds.
4. Develop Wound Care Protocols
Because an effective wound care program focuses on prevention first, patients should be screened according to their risk level. The Braden Scale is one tool that predicts pressure ulcer risk and aids in decision-making. All patients should be screened on admission, transfer and for any change in condition.
Protocols should include treatments appropriate for the type of tissue involved (stage) as well as the health (presence of infection or dead tissue) of the wound bed. These protocols should be specific and evidence-based, but easy to understand and implement.
5. Select Wound Care Products
Consider cost, availability and ease of use when selecting which products to use. Each stage and condition of wound will call for a specific combination of wound cleansers, debriding agents, antimicrobials and/or dressings. Call local pharmacies, regional medical supply distributors and national vendors to compare prices, inventory and product selection.
If your facility has the resources, your wound care committee may also want to consider offering such adjunctive therapies as hydrotherapy or negative pressure wound therapy.
6. Continuous Quality Improvement
Periodically evaluate the effectiveness of prevention techniques and wound care treatments. Try different products and change strategies if no improvement is seen in a wound after 14 days.
Staff performance should be evaluated regularly to identify training needs; conduct timely and relevant inservices accordingly.
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