1. WOC Nursing and Pressure Ulcer Prevention History and Current Status Heath Brown RN, WOCN Wellstar Kennestone

2. History 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

3. Milestones in Role Development 1960s: 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

4. WOC Nursing in 2011: Statistics Approximately 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

5. Certification in WOC Nursing Pathways: ◦ Completion WOCN- accredited program (10 weeks full time: theory + clinical) ◦ Experiential pathway: 1500 practice hours + 50 CE hours for each area for which certifying

6. WOC 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)

7. WOC 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)

8. WOC 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

9. Changes and Challenges Increasing focus on role of consultant vs role of caregiver/educator Increasing 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

10. Pressure Ulcer Prevention Most PUP Programs are essentially the same: Catch ‘em at the front door (Assessment) Prevent ‘em while they’re here (Prevention)

11. Components of a PUP 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

12. 1 Initial Skin Assessments Every Admitted Patient Required by CMS to show what was POA Good Nursing Practice

13. Braden Scale ◦ Sensory perception ◦ Moisture ◦ Activity ◦ Nutrition ◦ Mobility ◦ Friction/shear

14. 2 Risk Assessment for PUs Daily or more often for all patients Different scores should reflect different preventive strategies

15. 3. Reassess Skin Daily Q Day or Q Shift

16. 4 Prevention: Manage Moisture Keep the patient dry Moisturize the skin

17. 5 Optimize Nutrition & Hydration Attend to the microclimate of the skin – calories, hydration, protein Registered Dietician Consults

18. 6 Minimize Pressure Turn Every 2 hours or more often based on clinical condition Use Pillows to redistribute weight Offload heels Use Pressure redistribution Surfaces to maximize the time/pressure ratio

19. On a Programmatic Level Monitor, Monitor, Monitor Continuously Re-evaluate your processes

20. 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

21. Questions