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Case Study
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Community wound care: a team approach Teresa Hurd, RN, CCRN, BScN, MScN, Judy Zabrikas, RN, ET, Barbara Baker, RN, ET, Trish Fowler, RN, ET Acute and chronic wounds represent one of the most widespread, yet least recognized problems in health care today. Chronic and debilitating wounds are common across all sectors of Canadian health care. The costs of wound care to both patients and across the health care sector are also very high, although these costs remain hidden and poorly understood. Further, wound care costs are growing rapidly and will continue to mount as the population ages. Recently, Ontario health care is evolving, resulting in new challenges that are specific to community care. The increasing aging population, complexity of care and new technology has accelerated the need for wound care educated nurses and evidenced- based protocols based on current best practice guidelines..As the APN in a community that serves a population of over 500,000 in Southern Ontario, the development of interdisciplinary protocols/clinical pathways, product formularies and the education of nurses from basic to advance was a tremendous challenge. Initially, the community lacked monitoring systems for the prevalence of wounds, inadequate assessment, careplanning and documentation concerning wounds, and a standard evidenced based approach or guidelines for treatment of wounds. In addition, costs tied to wounds were astronomical. An interdisciplinary team was developed that consisted of an APN, 3 ETs, chiropodists and Occupational therapist. Evidenced based wound care clinical pathways were developed and implemented. The author developed a curriculum that has educated over 100 nurses in the region to practice evidenced based advanced wound management. Product formularies were implemented to ensure consistent use of products and technology. The interdisciplinary teams have produced an improvement in service delivery with a particular patient population (patients with chronic wounds). Monitoring of outcomes has demonstrated: an improvement in healing times, consistent evidenced based wound management, prudent and appropriate use of resources with a significant and dramatic cost savings. The most important and dramatic outcome, overall, has been a significant and sustained improvement of the quality of life of patients with chronic wounds in the Niagara region. . . Davis DA, Vaisey AT. Translating guidelines into practice. Canadian Medical Association. 1997:408Ð416 Dolynchuk K, Keast D, Campbell K, et al. Best practices for the prevention and treatment of pressure ulcers. Ostomy Wound Manage. 2000;46(11):38Ð52 Foster C, Frisch SR, Denis N, Forler Y, Jago M. Prevalence of pressure ulcers in Canadian institutions. CAET. 2002;11(2):23Ð31 Gallagher SM. Outcomes in clinical practice: pressure ulcer prevalence and incidence studies. Ostomy Wound Manage. 1997;43(1):28Ð32, 34Ð35, 38 Keast DH, Orsted H. The basic principles of wound care. Ostomy Wound Manage. 1998;44(8):24Ð28, 30Ð31. |
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