Building a Successful Wound Care Program Jennifer Gullison, RN BSN, MSN Chronic Care Specialist
Outline Why build a wound care program? How to get management buy-in How to identify wound care leaders/training How to utilize wound care specialists Wound care training program Wound care delegation to LPNs/Rehab/LNAs Management of a wound care program Barriers and Successes
History Cornerstone VNA was founded in 1913 and is an Independent Non Profit VNA Average daily census 310-330 Homecare/Hospice/Palliative Care and Private Duty (Life Care) WCC (5 RN, 2 RN s and 2 LPN), Certified IV nurse, Certified Psychiatric RN, Certified Diabetes Educator, (2) OMS Ostomy RNs, (2) Certified Palliative Care Registered Nurses SN, PT, OT, ST, MSW, LNA
Why a Wound Care Program Cornerstone VNA has had a wound care program in place for over fifteen years Purpose of the program was to reduce SN visits, reduce supply costs per episode and to deliver highly skilled nursing care Changes in clinical practice, patient needs, and financial resources prompted the implementation of a wound care program and training of certified wound care nurses
Savings- Agency buy-in On average, episode costs can be reduced by (1-4 SN visits per week) Costs by #SN visits: 45 40 35 30 25 20 15 10 5 Costs in a 60 Day Episode by #SN visits 0-2,597.85-2100.13-1949.25-1837.96
Development of a Successful Wound Care Program Identify wound care leaders Nurses committed to excellence Strong wound care skills Good at documentation Respected by their peers Developing a comprehensive wound care training program Ensuring wound care competency at hire and annually
Wound Care Specialists 5 WCC s RNs and 2 WCC LPN s Wound Care Certification through the National Alliance of Wound Care and Ostomy Ultimate goal is WOCN certification through the Nursing Society: Challenge of WOCN certification is time, cost and commitment to achieve
WCC Certification Pathway https://www.nawccb.org/wound-carecertification
How to Use Wound Care Specialists Do you have a comprehensive wound care training program for new hires? WCC s do a 4 hour comprehensive wound training for clinical staff including therapists and LNA s Do you have a clinical team that reviews patients wound supply and visit utilization? WCC s review a supply dashboard monthly to drill down on high supply costs, clinician spending and product utilization Who ensures that nurses are competent in complex wound care such as VAC s and compression? WCC s check off nursing staff to ensure best practices are followed
How to Use Wound Care Specialists Who is involved in complex patient care conferences for patients with wounds? WCC s attend complex wound care patient conferences Who makes wound care recommendations to Providers? WCC s do in home consults and make wound care recommendations based off best practices and work closely with Providers and local Wound Centers They also follow up with the RN case manager to provide education on product recommendations
Activities Delegated to Therapists, LPNs, LNAs RN s must know each State s delegation rules and scope of practice Each agency must know direct patient care activities that can be delegated For example: In the state of NH delegating stable wound care is within the LNA scope of practice.
Delegation of Nursing Tasks RN must determine the following prior to delegating tasks: Skill is considered safe and routine for specific patient populations Skill poses little potential hazard for the patient The skill can be performed with a predictable outcome The skill involves limited degree of potential patient discomfort The skill does not require a substantial amount of scientific knowledge and technical skill The skill is performed on a stable patient
Training of Nursing Staff The health care agency is ultimately responsible for the orientation and training of the nurses and other clinical staff Nurses should be found competent in wound skills initially and skill testing annually Cornerstone requires an on-site check off for VAC s and compression due to complexity of the task and risk for complications
Components of a Wound Care Training Program Cornerstone VNA provides a comprehensive wound care training program that includes:
Training Program More in-depth overview: Types of wounds- Pressure ulcers, Venous wounds, Arterial, Neuropathic, Surgical, and Traumatic Wounds Wound care products- Hydrogels, Gauze, Films, Hydrocolloids, Foams, Collagens, Alginates, Composites, Contact layers, Antimicrobials
Role WCC WCC role: Performs co-visits any time a competency visits with new hire nurses and as needed Review wound care patients and utilization monthly Meets with nurses to make recommendations related to supply and visit utilization, documentation, or any identified areas of concern
Role of Manager/Supervisor Supply Management Utilize supply thresholds/alerts follow Medicare guidelines for product utilization Work with WCC s to ensure products and frequency are appropriate
Role of Manager/Supervisor Supply Management Cont Work with Supply vendor to: Build a strong formulary and monitor through established thresholds/alerts Do routine monthly/quarterly supply reviews Utilize dashboards if they are available
Role of Manager/Supervisor Visit utilization Utilize dashboards and reports to monitor wound care frequency Meet with clinicians 1:1 to review best practices for wound care/ consult Meet with Wound Care Centers/Providers to discuss different strategies for dressing products
Role of the Supervisor Ensure that providers/clinicians and patients understand Medicare regulations Medicare Benefit Manual Chapter 7 40.1.2.8 - Wound Care For skilled nursing care to be reasonable and necessary to treat a wound, the size, depth, nature of drainage (color, odor, consistency, and quantity), and condition and appearance of the skin surrounding the wound must be documented in the clinical findings so that an assessment of the need for skilled nursing care can be made.
Role of the Supervisor- Cont.. Physician has ordered appropriate active treatment (e.g., sterile or complex dressings, NPWT, administration of prescription medications, etc.) of wounds with the following characteristics, the skills of a licensed nurse are usually reasonable and necessary. 40.1.3 - Intermittent Skilled Nursing Care Medicare will pay for part-time (as defined in 50.7) medically reasonable and necessary skilled nursing care 7 days a week for a short period of time (2 to 3 weeks).
Barriers Retention of WCC/WOCN s Pay and competitive market Wound Centers- don t always follow manufacture recommendations or use products off label LPN WCC certification- limitations in scope of practice, know your states scope of practice surround LPN and LNAs
Successes Increase in clinical skills for wound care application Referral confidence- experts on staff and clinicians provide high quality patient care Decrease in supply costs and decrease in nursing visits Mixed wound care model- consider therapists, LPN s and LNA s for simple stable wound care
Summary A successful wound care program is a cost effective strategy to reduce episode costs, increase nursing competency while still maintaining high quality standards for delivering safe and competent nursing care. Cornerstone VNA has been able to reduce nursing visits and decrease supply costs while also maintaining high quality outcomes as well as strengthen facility/provider relationships
Take Away Identify wound care leaders and empower field clinicians by increasing skills and knowledge Work with your supply vendor to help monitor and control costs What types of thresholds you can set up to control order frequency, formulary and cost Review supply dashboards monthly to see trends and opportunities for improvement
Questions Contact: jgullison@cornerstonevna.org