WTA: WOUND TREATMENT ASSOCIATE ENHANCING WOC NURSE PRACTICE ANGELA GRAHAM RN, BSN, CWOCN ALACARE CARE HOME HEALTH & HOSPICE

CHALLENGES OF WOUND DOCUMENTATION AND CARE 1500 / 30% patients average receiving wound care 60+ NPWT patients daily Complex wounds

OUR MUTUAL CHALLENGES Assessment tools CMS OASIS Staff Education Terminology Cost of Care

THE GOOD ‘OL DAYS……. BEFORE PPS, Balanced Budget Act …….. 6 CWOCNs for the state coverage Digital Photo Program Defined areas Education

24 Branch offices Family owned since 1970 Services Provided Home Health Hospice ADC 4500 Home Health 600 Hospice Annual Admissions 17,550 Home Health 2900 Hospice

TODAY………. ONE!! 1 …yes, only 1 CWOCN for state wide coverage No digital program HELP!!!

WOC NURSE TO THE RESCUE!! Development of the WTA program Agency recognized need for Clinical Ladder Program Staff Development Mentor Program Retention Issues

WHAT IS THE WTA PROGRAM? Definition The Wound Treatment Associate (WTA) Program is a WOCN® Society endorsed wound care educational program geared to non-specialty licensed wound care providers WTA Program is not a certification program. It is a continuing education activity offering 21.0 contact hours upon completion. Role Non-WOC certified nurse provides optimal care for patients with acute and chronic wounds under the direction of a WOC specialty nurse, WOC APRN, or physician. Reference: WOCN, WTA Toolkit

AREAS OF STUDY A&P of Skin and Soft Tissue: Implications for Routine Care Skin and Tissue Loss Caused by External Factors Establishing Protocols for Prevention Legal and Regulatory Issues Physiology of Wound Healing Systemic Factors Affecting Repair Wound Assessment and Documentation Guidelines for Topical Therapy Assessment and Management of Refractory Wounds Management of Arterial/Ischemic Ulcers Management of Venous Ulcers Prevention and Management of Neuropathic Ulcers

WHAT DOES IT TAKE? Computer/printer access Time!!! Skills days /one on one competency assessments Access to CWOCN 90 days Time!!!

PLAN OF ACTION…… Introductory Meeting Agreement Requirements Review of program Scheduled Clinical skills days Test prep/review Contacted industry partners

INDUSTRY PARTNERS

RESOURCES

PROPS!!

BARRIERS Staff personal time/family Access to computer – rural areas Did take more than 90 days Employee turnover

SO WHAT HAS WTA DONE FOR US…… Increase in staff knowledge Reduced mileage expenses Improved documentation - ICC Improved patient outcomes Timely and meaningful consults

DOCUMENTATION We just began new EMR system Bates – Jenson Wound Assessment Education Improved Audits and a group of peers to help guide assessment

IMPACT ON MY PRACTICE…. Consults are more meaningful: No more 200+ miles to see a Stage 2 pressure ulcer Able to utilize critical thinking and assessment skills when discussing a consult Empowerment to fellow staff Time management – ease of auditing!! HUGE Improvement…. Focus on Ostomy Education/referrals Group to now utilize for trials and product sampling

EVEN MORE………………. Staff development Morale Clinical Ladder Recognition Staff Retention Pride And best of all…………………… …..

PRESERVING OUR INDUSTRY Growing baby WOC nurses! One enrolled in Emory program More considering ……. Our future!!!!!

OUR WTA TEAM… 17 active WTA’s who successfully completed program 2 WTA’s now in non-clinical roles Performance Improvement Outcome Specialist 5 currently enrolled and completing program TOTAL: 25 for the agency! Requesting 5 more enrollees!

TO DATE……. 100% Pass Rate

REAL QUOTES “I use it when looking at charts and if I see that they are using something that is not appropriate for the wound or the wound is deteriorating, I make suggestions to them on what they could try. It has also helped me understand better what changes are going on with the wounds when looking at ICC. I really like having the knowledge that I obtained from the program” --- G. C., Area Performance Improvement Manager

REAL QUOTES “ I am definitely able to utilize the WTA in my current role. I’m able to help the other OS’s with wound questions they have and I’m also able to help the branch nurses when they ask questions about wound classifications or care. And I’m able to easily catch incorrect wound classifications by reading assessments and ICC info—especially PU staging. Very glad to have done the WTA program” --- C.O., Outcomes Specialist

REAL QUOTES “I have had multiple visits with nurses that are just unsure of what they see. As nurses, by nature I think we desire to learn. When you are unsure of your assessment, it is nice to be able contact a peer and say, can you just come look at this with me and make sure I am on track. They have a better comfort in knowing they don't have to formally contact the CWOCN every time they have simple assessment questions. They learn as much from us at times as the patient does. I absolute love making wound visits with the nurses to offer that basic one on one bedside teaching” --- Sonya Hicks, RN (STUDENT WOC NURSE!! )

MANAGEMENT PERSPECTIVE Pt/Cg satisfied! Reduced Supply Costs Confident Staff Reduced time Improved Outcomes

OTHER SETTINGS….. Inpatient Long Term Care Rehab Skilled Facility Outpatient Clinics

You build a team with basic and specialty care skills and expertise As a leader, you strategize possible outcomes for your facility all the time. NO MATTER YOUR SETTING…… You recognized the need for specialty trained nurses, and hired WOC nurse(s) The WOC nurse is a huge asset to your workforce - - imagine what it would be like if you could enhance the team further and achieve even more positive clinical outcomes…

ENHANCE YOUR TEAM. Studies have shown that patients who were cared for by WOC nurses had better outcomes in terms of healing rates and/or costs of care compared to patients cared for by other nurses (Arnold & Weir, 1994; Bolton et al., 2004; Harris, & Shannon,2008; Peirce, Tiffany, Kinsey, & Link, 2008). Providing basic wound training to your non-specialty wound care providers will help WOC nurses achieve better outcomes.

OPTIONS: Find course site online -- can be done in one week setting and then testing Cost Travel CWOCN on staff who would be coordinator Adminstrative buy in Time Teach in facility as a group class Scheduling Offer to individuals as self paced program Motivation

REFERENCES: Wound, Ostomy and Continence Nurses Society. (2012). Wound Treatment Associate Online Course. Online Course Coordinator Tool Kit. Mt. Laurel, N.J. Author.

THANK YOU! QUESTIONS ?