The VNA of Care New England covers the full geographical area of Rhode Island (except for the islands). My position is that of a resource to all of the visiting nurses and my tasks include wound and ostomy education, recommendations for use of advanced wound care products rather than normal saline wet to dry dressings, and chart audits for compliance with quality measures. Two years ago, a Wound Team was developed to increase the quality of the care provided to our patients and their families. Nurses were chosen who expressed an interest in participating and who covered the various geographical areas. The Wound Team meets approximately every two months for a two-hour session which includes an educational component based on expressed needs of its members, case conferences on their complex wound and ostomy patients, and product updates. Over time, some nurses have left the agency, but new Wound Team members have been added to maintain a core group of 8 to 10 nurses. These nurses are expected to visit the more challenging patients in their geographical area. For example, the Wound Team members often visit ostomy patients who are having issues with leaking. They collaborate with the CWOCN to develop an appropriate care plan for use of ostomy products that will provide an appropriate wear time. After several visits to ensure that the new products are achieving the desired results, the usual case manager resumes the patient’s care. A poster will be displayed at Fall Conference which provides detailed information regarding the nurses’ confidence levels in the following areas that are measured via a survey over time: selecting advanced wound care products, applying compression wraps, applying negative pressure wound therapies, performing basic ostomy care, troubleshooting common ostomy complications, contacting providers with alternate wound care recommendations, and instructing other staff members on wound care. Upon completion of year one, confidence increased incrementally in all measured areas except one. Ostomy care declined at 6 months and was felt to be in response to the education provided as team members became more aware of deficits in this area. At month 12, confidence in ostomy care rebounded. The Wound Team is an ongoing effort and surveys continue to be conducted at designated time intervals.
Deborah Therrien, RN, MSN, CWOCN