seeing the big picture: optimizing wound care management · objectives 1. identify the needs of...

SEEING THE BIG PICTURE:

Optimizing Wound Care

ManagementLaurajean Kudatzky, PT, DPT, ATP, CWS

Julianne Rece MSN, RN, CRRN, CWOCN

Objectives

1. Identify the needs of wound care patients transitioning

from acute rehabilitation to home.

2. Describe ways to expedite positive wound healing

outcomes through interdisciplinary collaboration.

Quick Background: Types of wounds

TraumaVascular

Incontinence/Moisture Associated

Surgical

Pressure Injury

Resources differ depending on wound type & patient

Our typical patient

Pain

Skin

Caregiver

support

Insurance Ventilator

Accessibility

Coping

Malnourished

Neurological

injury

Equipment

Bowel and Bladder

Discharge

Planning

Planning for the Transition

Transitioning home: Laying the Groundwork

Transitioning Home: Building a Support Network

Communication among

• Patient & Caregivers

• Nursing/CNAs/CWOCN

• Physicians

• PTs/OTs

• Case Management

• Dietitian

• Outpatient Staff

• VNs/CNAs

• Vendors: DME, software

Transitioning home: Preparing for Success

Transitioning Home: Surfaces

• Limited options from insurers/ vendors

• Group I: Preventative

• Group II: Treatment

• Group III: Air Fluidized

Buffers for home:

Air-filled positioning sling

Foam wedge

Offloading boots

Gel positioner

Disposable air-filled cushions

Transitioning Home: Wound Care

Realistic

Caregiver

abilities Insurance landscape

Out-of-pocket

abilities

Frequency

VN availability

Patient/Caregiver

teaching needs

Collaboration w/

VNSupplier collaboration

Prescriptive

coverage

Transitioning Home: Psychosocial Barriers

• Vulnerability

• Stress outlets

• Limited access

• Limited sitting

• Caregiver burnout &

availability

• Managing schedules &

transportation

Transitioning home: Structural Barriers

After discharge: Tailoring to patient needs

• Prioritizing needs/importance

• Must match the patient’s priorities to be successful

• Woundcare

• Nutrition

• Surfaces

• Vendors

• Variety of needs and concerns

After Discharge: Identifying Resources

• Seating clinic

• PT/CWS role in the wound care clinic

• Nutritional support and supplementation

• Access to CWOCN/CWS at every MD appt

• Case management

• Ongoing wound care supply orders

• Direct referrals

http://wiki.dpconline.org/images/f/f3/Template_clipboard.png

After Discharge: Creativity Counts

• Insurance

• Meeting insurance requirements

• frequency/formulary coverage

• Collaborating w/outside vendors

• Surgeons

• Wound Care supplier

• Equipment vendors

• Collaborating with clinicians

• Social service resources

• Donation/limited free care options

• Physical Therapist/Certified Wound Specialisthttps://www.zastavki.com/pictures/1680x1050/2010/World_France_Garden_maze_022035_.jpg

After Discharge: Lifetime Follow Up Support

• Phone access for questions

• Daytime/ off shift w/ Residents

• Multiple disciplines able to be accessed

• Onsite appointments

https://www.midweststreams.com/Content/img/shakinghands-icon.png

After Discharge: Lifetime Follow Up Support

continued

• Case Management services

• Wound care supply ordering

• Education

After discharge: Expedite wound healing

outcomes

• Efficiency

• Lifetime follow up

• Outpatient Resources

• Communication

• Education

• Biologics

• Modalities

Case Study #1

• 38yo female with longstanding paraplegia

• Chronic stage 4 coccyx pressure injury

• Active mother, works full time

https://wallpapercave.com/wp/K4MXWRF.jpg

Case Study #1: Resources

• Wound care

• Nutrition

• Surgeon consult

• Physical Therapy

http://www.crossfitpmi.com/wp-content/uploads/2014/12/nutrition.jpg

Case Study #1: Outcome

• Adapting to patient goals and lifestyle

• Creativity

Case Study #2

• 34 yo man w/ paraplegia

• Extensive chest & abdominal wounding

• Coccyx stage 4 PI and bilateral buttocks wounding

Conclusion….

http://physicalliving.com/img/success_meme.jpg

References

• National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory

Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment

of Pressure ulcers: Clinical Practice Guideline. Emily Haesler(Ed.).

Cambridge Media: Osborne Park, Western Australia; 2014.

• Moore Z, Butcher G, Corbett LQ, McGuiness W, Snyder RJ, van Acker K.;

Exploring the concept of a team approach to wound care: Managing

wounds as a team; J Wound Care. 2014 May;23 Suppl 5b:S1-S38. doi:

10.12968/jowc.2014.23.Sup5b.S1.

• Zena EH Moore, Joan Webster, Ray Samuriwo; Wound-care teams for

preventing and treating pressure ulcers; ReviewIntervention; The

Cochrane Library; 16 September 2015

Abington Hospital | Abington – Lansdale Hospital | Jefferson Bucks Hospital | Jefferson Cherry Hill Hospital

Jefferson Frankford Hospital | Jefferson Hospital for Neuroscience | Jefferson Stratford Hospital

Jefferson Torresdale Hospital | Jefferson Washington Township Hospital | Magee Rehabilitation Hospital

Methodist Hospital | Physicians Care Surgical Hospital | Rothman Orthopaedic Specialty Hospital

Thomas Jefferson University Hospital