Skin and Wound Care Excellence: Integrating Best Practice Evidence

A new article on implementing safety solutions: "Skin and Wound Care Excellence: Integrating Best-Practice Evidence", authors Karyn Popovich, Paula Tohm and Theresa Hurd.

Abstract

North York General Hospital (NYGH), in collaboration with Nursing Practice Solutions, Smith & Nephew and the Central Community Care Access Centre, implemented a program in skin and wound care that has made best-practice, evidenced-based wound care management possible, affordable and sustainable. Focused action using advanced wound care products and proven clinical approaches has dramatically improved the identification, protection and support of skin integrity.

Wound prevention and management are among the most direct and cost-effective measures a healthcare organization can take to improve patient safety and quality of life, and they allow for the reduction of expenditures and re-allocation of funds into other important areas. The Skin and Wound Care Program was designed to create and maintain resources within NYGH to ensure the delivery of consistent, best-practice wound prevention and management. The program has successfully sustained a significant reduction in the prevalence of pressure ulcers. Benefits of the program include improved patient safety, health and quality of life.

The Skin and Wound Care Program has seen the transfer of knowledge and evidence-based best practices to both the bedside and the community. Extending the collaborative effort beyond the walls of NYGH has helped the hospital gain further insight into and experience with our community partners to spread skin and wound best practices across the healthcare continuum. Lessons learned have been shared with other healthcare organizations in forums such as the Congress of the World Union of Wound Healing Societies, thus contributing to the advancement of continuous improvement in healthcare.

Pressure ulcers, defined as ulcerations of the skin and/or deeper tissues due to unrelieved pressure, currently affect one in four patients in Canadian healthcare organizations. Given this high prevalence rate, the prevention and proper treatment of pressure ulcers are of critical importance to the Canadian medical community. In addition, pressure ulcers represent a serious risk to patient safety and a growing litigation risk for healthcare workers. Chronic and debilitating wounds are common across all sectors of Canadian healthcare. For example, the prevalence of pressure ulcers is 26–31% in acute care, 28–31% in long-term care and 15% in the community (Woodbury and Houghton 2004).

As a multi-site teaching hospital, North York General Hospital (NYGH) continually strives to improve safety, quality of care and the overall patient experience through the use of evidence-based best practices. NYGH has collaborated with Nursing Practice Solutions – advanced practice nurses with wound experience and proficiency – Smith & Nephew and the Central Community Care Access Centre (Central CCAC) to implement a program in skin and wound care that has made best-practice, evidenced-based wound care prevention and management possible, affordable and sustainable.

The majority of pressure ulcers develop in patients in acute care centres; but regardless of whether these ulcers develop in patients in acute care, chronic care or at home, they have an impact. Along with estimated costs of over $10 billion annually throughout North America (Swanson 1999), pressure ulcers represent a drain on healthcare resources and a major burden in terms of morbidity and reduced quality of life for patients of all ages. Discomfort, low self-esteem and poor body image can cause personal suffering. Osteomyelitis and life-threatening sepsis are associated major complications (Culley 1998). Pain, loss of function and mobility, amputations and death are further consequences of pressure ulcers (Lee 2005).

Currently, healthcare organizations in Ontario and other regions of Canada are under unremitting pressure to match available financial resources with the growing demands of healthcare. Similar to healthcare centres throughout Canada, at NYGH care requirements combined with persistent shortages of qualified clinical staff place an overriding constraint on the usage and allocation of hospital beds.

The increasing complexity and acuity of hospitalized patients, coupled with the aging population and the escalating incidence of chronic diseases, result in a continual escalation in healthcare challenges. Although often hidden and misunderstood, the human and financial costs of wound care, both to patients and healthcare organizations as a whole, are exorbitant. In spite of this, the assessment, protection and support of skin integrity are lost among the many priorities managed by healthcare providers. Skin care becomes a top concern only when the impact of wounds is considered with respect to infections, morality rates, quality of life, limb amputations, pain and healthcare costs. Hospital-acquired pressure ulceration represents a major failure in systems to secure patient safety and quality of care. A high proportion of pressure ulcers are avoidable with adequate risk assessment and pressure-relieving interventions such as regular turning.

A Southern Ontario Acute Care case study demonstrated that stage III pressure ulcers result in an average length of stay (LOS) of 18.8 days and a total cost of $19,213. stage IV pressure ulcers necessitate an average LOS of 27.7 days and $29,208 and stage X ulcers with bone and necrotic tissue involvement result in an average LOS of 73.1 days with a total cost of $85,436 (Hurd et al. 2008).

Outcomes

Nurses have reported and demonstrated empowerment and autonomy in delivering wound care according to best practices. Positive partnerships have developed with both internal and external stakeholders. Physicians and surgeons have participated in and continue to lead wound steering committee meetings and educational sessions in collaboration with the advanced practice nurses.

Unique to this program has been the successful spread into the community through a partnership with the Central CCAC. The CCAC has identified an 85% decrease in patients discharged with hospital-acquired pressure ulcers. NYGH has provided education sessions for interdisciplinary students both in the classroom and at the bedside for partnering universities.

Read the full article online at Longwoods: Healthcare Quarterly, 13 (Sp) 2010: 42-46