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Informational/Educational Report
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Re-engineering the infrastructure for wound management in acute care Virginia Capasso, PhD, APRN, BC, T. Cantanno-Evans, J. Collins, V. Donahue, J. Empoliti, E. Cox, S. Gavaghan, C. Griffith, S. Haldeman, M. Jeffries, K. Fitzgerald, S. Kilroy, C. LaSala, A. Martin, M. O'Donnell, J. Pedro, M. Phipps, S. Stengrevics The fastest growing segment of the population is over the age of 65 years - a group which accounts for the highest number of hospital admissions and highest percentage of wounds. In 2000, Medicare's implementation of capitated payment systems for home care fostered more efficient and cost-effective treatment of wounds in the home. Proposed policy changes by the Center for Medicare and Medicaid Systems (CMS), which may reduce reimbursement to acute care facilities when patients develop a new pressure ulcer or worsening of an existing pressure ulcer during hospitalization, prompted a systematic program to re-engineer the infrastructure for the delivery of contemporary, evidenced-based wound care in our 900-bed teaching hospital. This presentation describes the key components of an innovative wound care program, which integrates education, practice, and research. The program was designed by a task force of 20 Clinical Nurse Specialists (CNS) over a 14-month period. The first major practice change involves empowerment and designation of the 47 Master's-prepared, unit-based Clinical Nurse Specialists as the first line consultants for wound care on their respective in-patient units. The second practice change involves recruitment of staff nurses as wound care champions to increase 24 / 7 availability of basic wound care knowledge and skills on all units. In addition, 13 parameters for wound assessment were integrated into a new 24-hour patient flowsheet for general care units. The flowsheet permits assessment of up to seven wounds and tube sites. To date, two of four projected components of the Wound Care Education Program have been developed and implemented: Phase I Ñ Wound Cleansing, Assessment, and Documentation (programmed instruction), and Phase II Ñ Wound Care Education Program (14.5 contact hours of didactic and cognitive and psychomotor skills laboratories). Evaluation includes knowledge acquisition, change in attitudes and values, as well as nursing practice. |
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