woc nursing and pressure ulcer prevention history and current status heath brown rn, wocn wellstar...
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WOC Nursing and WOC Nursing and Pressure Ulcer PreventionPressure Ulcer PreventionHistory and Current StatusHeath Brown RN, WOCNWellstar Kennestone
HistoryHistory
1958: Dr. Turnbull created role of “ET” (Enterostomal Therapist)◦ Purpose: Provide
rehabilitative care to new ostomy patients
◦ First ETs: individuals who had an ostomy or a family member with an ostomy
Milestones in Role Milestones in Role DevelopmentDevelopment1960s: Formal
training programs developed
1976: RN established as “entry into practice”
1983: Baccalaureate degree required for entry into practice
Scope of practice expanded to include wound care and continence care
WOC Nursing in 2011: WOC Nursing in 2011: StatisticsStatisticsApproximately
5000 WOC nurses in US
60–70% prepared at baccalaureate level – 30 – 40% at master’s level or higher
Practice settings: acute care (majority); HH; outpatient
Certification in WOC Certification in WOC NursingNursingPathways:
◦ Completion WOCN-accredited program (10 weeks full time: theory + clinical)
◦ Experiential pathway: 1500 practice hours + 50 CE hours for each area for which certifying
WOC Nurse Role in 2011WOC Nurse Role in 2011
Wound Care primary focus for most WOC nurses◦ Diabetic foot care◦ Fistula
management◦ Consultation/mgmt
regarding wound mgmt
◦ Pressure ulcer prevention (agency wide programs)
WOC Nurse Role in 2011WOC Nurse Role in 2011
Ostomy Care◦ Preop counseling/
stoma site marking◦ Postop: pouch
selec- tion/instruction in self care
◦ Rehabilitative care and counseling (sexual counseling)
WOC Nurse Role in 2011WOC Nurse Role in 2011
Continence Care (Setting Dependent)
Acute Care◦ Staff education re:
CAUTI prevention◦ Staff education re:
correct use indwelling bowel dng systems
◦ Skin care and containment
Changes and ChallengesChanges and ChallengesIncreasing focus on role of consultant vs
role of caregiver/educatorIncreasing responsibility for development
agency-wide programs for pressure ulcer prevention and evidence-based WOC care
Increasingly complex wound and fistula care (e.g., negative pressure wound therapy) and more challenging stomas
Advanced Practice WOC Nurses increasingly common in outpatient care
Pressure Ulcer PreventionPressure Ulcer Prevention
Most PUP Programs are essentially the same:
Catch ‘em at the front door (Assessment)
Prevent ‘em while they’re here (Prevention)
Components of aComponents of aPUP ProgramPUP Program
* Initial skin assessment on admit* Daily Risk Assessment for all patients* Reassess skin daily or more often* Manage moisture – keep dry and moisturize skin* Optimize nutrition & hydration* Minimize pressure
1 Initial Skin Assessments1 Initial Skin Assessments
Every Admitted Patient Required by CMS to show what was POAGood Nursing Practice
2 Risk Assessment for 2 Risk Assessment for PUsPUs
Daily or more often for all patients
Different scores should reflect different preventive strategies
5 Optimize Nutrition & 5 Optimize Nutrition & Hydration Hydration
Attend to the microclimate of the skin – calories, hydration, protein
Registered Dietician Consults
6 Minimize Pressure6 Minimize Pressure
Turn Every 2 hours or more often based on clinical condition
Use Pillows to redistribute weightOffload heelsUse Pressure redistribution
Surfaces to maximize the time/pressure ratio
On a Programmatic LevelOn a Programmatic Level
Monitor, Monitor, Monitor
Continuously Re-evaluate your processes
Monitoring our programs by conducting quarterly prevalence surveys
Monitoring and conducting RCAs of HAPUs
Participating in almost every aspect of nursing with an eye towards protecting patients skin from pressure and reevaluating processes
Device related pressure ulcers
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