Case Studies in Wound Care Mary Farren, RN, MSN, CWOCN Centers of Excellence

Keys to Success Collaboration Technology Evidence-Based Protocols

Wound Management Goals of care: –Healing –Palliation Co-morbidities Infection Pain management Laboratory data: Hgb, Hct, Albumin Home care services: SN, PT, OT, SW, HHA Learning potential of the patient & family

Pressure Ulcer: Nursing Care Components Address all risk factors Secure needed support surfaces Evaluate rehabilitation needs Provide family support and education

Home Management of a Pressure Ulcer Home Visit by MD Wound debridement in the home Curasalt Hypertonic Saline Dressing QD Group 2 Support surface Interdisciplinary collaboration 7/26

Home Management of a Pressure Ulcer Post debridement Treatment & dressings modified over time Family education was successful 8/16

Successful Achievement of Outcomes Appropriate support service Effective wound treatment Healing in 7 weeks 9/13

Technology in the Home: Surgical Wound Vacuum assisted closure Wound measurement: 12.5 x 5.5 x 4cm Mesh exposed, sutures visible 5/13

Successful Achievement of Outcomes Effective wound treatment Ostomy management Healing in 6 weeks. 6/23

Home Management of a Surgical Wound Clinical specialist consultation Exposed tendon Treatments modified over time –silver impregnated hydrogel 4/28

Successful Achievement of Outcomes Diabetes adherence addressed Healing in 14 weeks 8/04

Criteria for VNSNY Clinical Specialist Consultation Stage three, four, or unstageable pressure ulcer Wound worsening under care Unconventional treatment Assistance needed with palliative care options RN/MD collaboration for evidenced based treatment Nurse requests support for complex care management issues Request for VAC therapy

Interdisciplinary Communication and Collaboration Collaboration Improved patient outcomes Avoidance of hospitalization Improved compliance with regulatory requirements