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

Braden ScaleBraden Scale

◦Sensory perception◦Moisture◦Activity◦Nutrition◦Mobility◦Friction/shear

2 Risk Assessment for 2 Risk Assessment for PUsPUs

Daily or more often for all patients

Different scores should reflect different preventive strategies

3. Reassess Skin Daily3. Reassess Skin Daily

Q Day or Q Shift

4 Prevention: Manage 4 Prevention: Manage MoistureMoisture

Keep the patient dry

Moisturize the skin

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

QuestionsQuestions