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Wound Care - Donna Matheson, Director of Nursing

By Kimberly Butler,2014-06-17 17:01
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Wound Care - Donna Matheson, Director of Nursing ...

     19234 Wallingford Avenue North

     Shoreline, WA 98133

     Phone: 206 542 0748

     Fax: 206 542 2870

     Email: pacific.telemedicine@verizon.net

    Wound Care Fact Sheet for Home Health and Long Term Care

Introduction

The need for education in wound care is urgent in both the Home Health and Long Term

    Care arenas. The following information clarifies this need.

Background Wound Care

? Wound care has undergone intensive medical/scientific research over the past 20

    years. As a result, care techniques and products have been evolving rapidly.

? There are currently over 2000 wound care products on the market, none of which

    were available 15 years ago. In addition, there are many new techniques, making

    wound care complex.

? It is estimated that 10% or less of practicing doctors and nurses have kept pace with

    the changes in wound care.

? In modern wound care, there is no single “right way” to treat wounds. Healing is now

    known to be a dynamic process and treatment varies according to conditions present

    in each wound.

? Modern wound care has been shown conclusively to heal wounds quickly, with less

    chance of infection and greater patient comfort, all at reduced cost. Its only downside

    is the increased complexity and the consequent requirement for education of

    doctors and nurses in order to practice competently.

? Reality is that the most commonly used wound dressing technique, used across the

    whole of the United States today, is wet-to-dry saline and gauze, a technique that

    originated in the 1800s. Research has shown conclusively that this dressing

    technique impairs wound healing, increases patient pain and discomfort, increases

    chances of infection and costs more than most modern dressing techniques.

? In 1993, the Federal government issued a Clinical Practice Guideline (refer to

    AHCPR Publication No. 95-0654, Clinical Practice Guideline Number 15) in an

    effort to remedy the acute need for change in wound care practice. Today, ten years

    later, few home health or long term care facilities have been able to implement those

    guidelines due to insufficient staff education in modern wound care.

Impact of poor wound care on Home Health

    ? Modern wound care costs substantially less than the traditional saline and gauze

    technique.

    ? Medicare only reimburses home health at a level required to perform modern wound

    care consistent with the Federal Guidelines.

? Wound care is typically 25-30% of the home health case load.

    ? Typical Medicare reimbursement for a patient with a chronic wound is $350 per week.

    One home health nurse visit costs on average $110.

    ? Wet-to-dry saline and gauze typically requires daily or twice daily dressing changes

    i.e. between 7 and 14 home health nurse visits per week. The cost, in nurse time

    alone, is between $770 and $1540. Wound care product cost is additional. With

    expected reimbursement at only $350, this represents enormous loss to the home

    health agency. Over the course of the wound healing (on average 16 weeks), the

    home health agency would have a deficit of between $9520 and $21,840 per patient.

    ? Modern wound care dressings typically require two to three dressing changes per

    week i.e. 2-3 visits per week.

    ? At 2-3 visits per week, the cost is $220-$330 plus product cost. With expected

    reimbursement of $350 per week, the agency will be within budget, with occasionally

    a few dollars left over to cover contingencies.

    ? Due to the tight budget and complexity of modern wound care, it is essential that staff

    are well educated. Staff attempting to practice modern wound care with insufficient

    education make poor technique and product choices, costing agencies not only in

    products but also increasing the time to heal, reducing patient satisfaction and raising

    the risk of survey problems.

    ? Financially, clinically and ethically, it is imperative that home health agencies

    practice modern wound care but few have the educated staff to do so.

Impact of poor wound care on Long Term Care

    ? State and Federal regulators mandate that poor wound care is sufficient grounds to

    close any long term care facility.

    ? Medicare does not reimburse for any pressure ulcer (the most common type of

    chronic wound) developed in-house other than Stage 1. Without reimbursement,

    facilities have to carry the full cost of care.

    ? Medicare considers the above-mentioned wounds as caused by neglect and their

    presence is grounds for citation resulting in “stop-placement” (no further patients can

    be accepted until identified problems are remedied). This kind of citation has serious

    consequences financially and in public reputation.

    ? Federal and state surveyors perform annual surveys of care practices but they can also

    come, unannounced at any time. The care practices of any chronic wound can be

    cause of citation.

    ? Wound care is one of the two top reasons for long term care facilities to face medical

    litigation.

    ? As in home health, poor product choices cost money in both product cost and healing

    time.

    ? Margins are so tight in long term care that all facilities are forced to keep staffing as

    low as possible while still maintaining the quality of care required. Registered nurses

    must perform skilled wound care but their time is at a premium. Modern wound care

    requiring 2-3 dressing changes per week are an obvious time and cost saver compared

    to saline and gauze dressings which are done up to 4 times a day (28 times per week)

    in the long term care setting.

    ? In long term care, the greatest imperative is a wound prevention program of high

    quality. Without knowledge of modern wound care, it is very difficult to develop an

    effective prevention program. At-risk patients must be identified on admission and

    assessed regularly for any deterioration or symptoms of wound development.

    Without a prevention program, facilities run the risk of poor surveys and litigation, as

    well as lost staff time, losses on product cost, increased patient suffering, all leading

    to budget strain and loss of reputation.

    ? Staff turnover is very high in long term care facilities. Staff education is an issue that

    never goes away. It is a constant, pressured struggle to find the funds to meet the

    levels of education required just to keep the doors of the facility open.

In light of the above facts, it is clear that education in wound care is essential to the

    survival of every home health and long term care facility. Wound care specialists

    are in high demand but short supply. Education programs designed for doctors and

    general nurses are rare. There is a specialty program at the University of

    Washington for Wound Care Certification but this can in no way meet the need

    state-wide to raise knowledge levels of all nurses in all health arenas. This problem

    needs urgent attention.

    Wound Care Excellence that is Accessible and Affordable Pacific Telemedicine is comprised of a network of expert, independent wound care

    specialists. Because we are a network, there is always an expert available to provide

    consultation in any location. We are affordable because our fees are stepped to ensure

    you only pay for the time and type of service you need without the overheads related to

    staff members, travel costs, etc. We provide the most cost-effective wound care available

    today.

All our programs are designed to provide the best possible outcomes at the lowest

    possible cost in time and money. Telemedicine technology is the tool that makes this

    possible.

Telemedicine

    Telemedicine technology, defined as distance delivery of expert medical advice via

    telecommunication technology, facilitates effective management of wound care. This is a

    critical issue for every care provider today. The deleterious effects of poor survey results, inefficient use of staff time and dissatisfied patients are all too familiar. Telemedicine

    has a proven track record with wound care. We are absolutely certain that the advanced

    techniques used by our experts will heal wounds faster, with less patient discomfort and

    disability, than traditional methods of care.

Consultation

    Pacific Telemedicine connects wound care experts with clinicians in real time, facilitating

    consultation that can provide:

    ? Clinical wound assessment

    ? Prevention assessment (based on the Braden Scale)

    ? Excellent documentation, including wound images

    ? Weekly, monthly or quarterly tracking and reporting of care and outcomes ? Education using our innovative and effective Invisible Education Program

Equipment

    The telemedicine equipment is easy to use and requires only a telephone line. There are

    several equipment options and we select what suits the needs of the patient, the wound

    and the facility best.

Services Provided

    To provide excellence in wound care, Pacific Telemedicine offers a raft of service

    options. Healthcare providers are able to select what they need and we tailor the service

    to achieve their desired goals. We offer:

    ? Expert wound care consultation, on an as-needed basis, via telemedicine technology,

    making it more cost-effective than full time, part time or contract employment of

    experts

    ? Set-up of telemedicine infrastructure for use by your experts or ours ? Comprehensive, facility-wide assessment of clinical, financial and administrative

    factors of wound care, culminating in a performance improvement plan ? Implementation of performance improvement plans

    ? Education in advanced wound care technique

    ? On-going, outcome based, quality improvement planning.

Financial Impact

    Wound care must be patient-centered first and foremost but it also must make financial

    sense. We have seen, all too often, facilities burdened with unnecessary wound care cost

    in both time and dollars. Areas where we can make a significant financial impact are:

    ? Maximizing reimbursement levels

    ? Minimizing cost on expert consultation

    ? Eliminating expensive “clean-up” efforts from poor survey results

? Minimizing risk of litigation with excellent documentation and best-available care

    ? Ensuring product selection and use is cost-effective

    ? Tracking wound care so wounds don’t get “lost” in the system and become hidden

    costs

    ? Tracking outcomes to ensure problems are identified and resolved quickly ? Making wound care efficient by using advanced technique, thus cutting nurse and

    doctor time input significantly

We Meet Your Needs

    Because we tailor our service to meet the needs of the facility, we can provide as little as

    individual patient consultations or we can expand to provide full, facility-wide programs.

    In all cases, the aim is the same: to provide excellent results with the best financial

    margins.

Please contact us if you would like more information on our services and how we provide

    them.

Pacific Telemedicine

    19234 Wallingford Ave N, Shoreline, WA 98133

    Phone: 206 542 0748 Fax: 206 542 2870

    Email: pacific.telemedicine@verizon.net

    OVERVIEW of the

    INVISIBLE EDUCATION PROGRAM

    Teaching Methods, Strategies, Materials and Resources

The Invisible Education Program (IEP) is very unique and differs from normal in-service

    education programs. Therefore, the following is an overview that explains how this

    program is different and how it intends to achieve its educational aims and objectives.

The program is called “Invisible” because knowledge is delivered in very small

    “nuggets”, in the care environment rather than in a classroom environment. Nurses learn

    about wound care while they consult with an expert on care for their patients. The

    learning is worked seamlessly into their patient care routines in such a way that it hardly

    seems to be there at all; it is virtually invisible.

Advanced wound care is a complex and difficult subject. Our experience with standard,

    passive education on this subject is that most of it slips away from the learners mind with

    barely a trace left behind. This experience prompted us to develop a program that really

    gets through and is retained. Four educational techniques are employed:

    1. Just-in-Time-Information - Our experts educate during wound care

    consultations, intermingling education with hands on case review; knowledge is

    given at the time it is used, making it completely relevant and significant.

    Knowledge is given in small, meaningful nuggets of roughly 5 minutes duration

    so the learner is not overwhelmed with detail.

    2. Knowledge Sharing We work with our clients (healthcare providers) to set up

    opportunities for nurses to share what they are learning with their colleagues. To

    teach what they know to someone else is one of the best ways to cement their

    understanding, as well as “spread the word.” This also improves the cost-

    effectiveness of the program. For example, the nurse could be given a 5-minute

    slot in a weekly team meeting to share one “nugget” that she gained that week

    with the team such as how enzymatic debridement is being used for her patient

    with a pressure ulcer.

    3. Knowledge Feedback Cycle Our experts track the information they have given

    the nurses and look for an opportunity to have the nurse retell that information

    back to them under relevant circumstances. For example, while discussing a

    pressure ulcer with the nurse, the expert may ask, “Can you remember our reasons

    for using enzymatic debridement last week?” The response validates that the

    learning has taken place and provides the opportunity to reinforce it again. The

    teacher and the learner both keep track of what topics have been covered and what

    topics the learner has successfully demonstrated later. The program is completed

    when all topics have been covered and successfully demonstrated. Refer to the

    “Wound Care Bingo” Education Tracking Chart from the Clinician Workbook. In

    the event that no patient with a wound of a type covered in the program is present

    in the facility, a patient with the underlying disease process can be identified and

    considered from a wound prevention perspective. This is an extremely valuable

    perspective for all nurses to gain.

    4. Self-guided Reference Building During our program, the nurses build their

    own workbook with study materials we provide, digital images of wounds they

    know, their own notes and ideas, product samples they collect and reference

    material they choose to gather. This workbook becomes a long-term reference for

    them as well as a trigger for any knowledge they may not employ everyday.

The important point of these techniques is that the nurse is directly interactive with each

    piece. All knowledge is used, handled, manipulated and retold so it is never passive.

The Invisible Education Program has 4 modules:

    1. Moist Wound Healing

    2. Wound Assessment

    3. Wound Diagnosis

    4. Product Selection

    We consider these the core areas for baseline competency in advanced wound care.

Telemedicine Delivery

Invisible Education is unique in another way. It has been designed to be delivered via

    telemedicine communication. The number of available wound care experts to teach this

    valuable program is far below the number needed to physically travel to all the

    communities and healthcare providers who need wound care education. However, using

    telemedicine technology, those same experts can reach any community on the globe.

    Location ceases to be an issue. This program has been designed to be delivered over the

    phone or the internet, depending on the technology available at a given site. One live person contact is made initially to introduce the program and familiarize learners with how it all works. That person does not need to be a wound care expert. From that point forward, the experts take over and have weekly, bi-weekly or otherwise-scheduled consultation and education teleconferences. The learners take digital images of their wounds and fill in a standardized assessment form. The image and assessment are transmitted electronically to the expert and become the starting point for each consultation/education session. This program can be delivered equally well in circumstances where there is a resident wound care expert. The same educational techniques would be used but in-person consultation/education sessions would replace the electronic ones.

    Kim Adams, the designer and initiator of this program, has been involved in telemedicine wound care and education for 3 years and has seen the positive impact of this method. However, this is the first time that the education has been developed into a formal program with workbooks, guidelines and tracking.

    We expect the program to take roughly 2 months for each nurse. However, we would like the option to extend it in order to cater for the varying motivation and learning ability of the nurses. Because the education is combined with consultation, it does not represent a financial burden to the facility to pay for this length of time. In fact, it is highly cost effective because they literally get “2 for the price of 1” i.e. education mixed in with consultation at no extra cost. The purpose of this open timeframe is to get away from the problem of giving nurses information that they can’t use at the time. Information that

    isn’t used is lost and represents a waste of everyone’s time and energy. The information given in this system is used immediately, lending it relevance to each learner.

    One of the ways that the IEP can accelerate the program, if needed, is through small group teleconferencing. For instance, if there were 3 patients in a facility with wounds and one was a diabetic, one had venous stasis and one had a pressure ulcer, we can work with 3 nurses caring for those patients as a small group. The case review and consultation can be shared so all learn about the others’ cases. All 3 nurses can get the hands-on exposure to relevant information and progress quickly through the required topics.

    It is important to note here that Pacific Telemedicine has taken great care that the privacy and security of patient information is fully protected at every point. All components of this training comply with current HIPAA standards.

Teaching Materials

    The Clinicians Workbook is a carefully constructed compendium of learning materials that support and augment the verbal teaching by the experts. Its contents are discussed in detail below.

    Section 1 Moist Healing

    ? Colorful Illustrations and Bulleted Key Points - This supplement to the

    first day overview is an easily accessible reminder of the learning points

    covered. It also provides references for those who wish to take their

    learning a step further.

    Section 2 Diagnosis

    ? Plastic Sleeves for Wound Images These allow nurses to collect and

    retain images of wounds. These personal reminders from patients/wounds

    they have known are far more powerful than images from unknown

    patients, as found in most textbooks and guides.

    ? Laminated Diagnostic Checklists These are re-usable with dry erase

    pens. For future reference, the nurse can use these charts for any wound to

    help her distinguish wound type.

    Section 3 Assessment

    ? Wound Assessment and Companion A standardized wound assessment

    tool* is paired with a “Companion” that explains key points of the

    assessment. Each nurse will use the standardized wound assessment tool

    on a weekly basis to document her patient’s wounds. The Companion

    gives depth of understanding, making the assessment a far more

    meaningful tool. The points covered in the Companion will also be

    covered by the expert in the consultations. Thus, the Companion

    reinforces topics covered in the program.

    ? ABI Calculation Sheet A laminated, reusable tool for calculating an

    Ankle-Brachial Index. This Sheet walks the nurse through the calculation

    as well as provides a reference to interpretation of scores.

    Section 4 Products

    ? Product “Cards” - these are used to staple in product samples as reminders

    and for future reference. The nurses collect these samples as they use

    them in patient care, making notes on the cards of how and why the

    product was used. Further product information (e.g. leaflets) can be glued

    on the back, keeping it handy for future reference. Note: Invisible

    Education and Pacific Telemedicine do not support or advertise any

    particular brand of product. The program teaches generic product type

    and refers nurses to the products nominated in their facility product

    formulary.

    ? Fill in Formulary Blanks the product functionality sheets have fill-in-

    the-blank spaces for nurses to find out and fill in their facilities product

    formulary for each functional area. This is an active learning activity that

    ties product function with the name and storage location of the products

    that will be used most often.

    Section 5 Learning Tools

    ? Knowledge Assessment Test used as both a pre- and post-test.

    ? Wound Care Bingo Card education tracking tool to ensure all topics are

    both covered and reverse demonstrated. These also serve as a reporting

    tool to nursing management to show progress through the program.

    ? Wound Care Tracking Charts individual nurse and whole facility

    versions. These are made available to all facilities in electronic form

    because Pacific Telemedicine recognizes that an effective wound care

    program within any healthcare facility should include tracking of wound

    care so that care can be easily overseen and monitored for weakness and

    improvement. Personal and facility-wide changes in care provide

    powerful learning feedback.

    ? Circular Wound Measurement Tool this clear plastic, reusable

    measuring tool assists the nurse to assess change in a wound with

    consistency. Consistency of measurement is a very important factor in

    gauging improvement or degeneration of wounds.

*We use the Bates-Jensen Wound Assessment Tool, by permission from Barbara Bates

    Jensen.

    Invisible Education - Management Perspective

Pacific Telemedicine’s education program is unique, as is reflected in its name

    “Invisible”. We utilize a number of educational techniques that are known to be highly

    effective but very different from the traditional classroom style of learning. The

    education appears invisible. It is delivered slowly, in small segments, as the nurse works

    so that it works seamlessly with actual clinical practice. Our experience with traditional

    in-service education is that most of it “goes in one ear and out the other,” and that

    passively learned knowledge often slips away without a trace. This experience led us to

    employ our unique approach. Our program uses 4 techniques that provide an education

    that really sticks:

    1. Just in Time Information Our experts educate during wound care

    consultations, intermingling education with hands on case review; knowledge

    is given at the time it is used, making it completely relevant and significant.

    2. Knowledge Sharing We work with you to set up opportunities for nurses to

    share what they are learning with their colleagues. To teach what they know to

    someone else is one of the best ways to cement their understanding, as well as

    “spread the word”. This also improves the cost-effectiveness of the program.

    3. Knowledge Feedback Cycle Our experts track the information they have

    given the nurses and look for an opportunity to have the nurse re-tell that

    information back to them under relevant circumstances. This validates that

    the learning has taken place and provides the opportunity to reinforce it again.

    4. Self-guided Reference Building During our program, the nurses build their

    own workbook with study materials we provide, with digital images of

    wounds they know, with their own notes and ideas and with reference material

    they choose to gather. This workbook becomes a long-term reference for

    them as well as a trigger for any knowledge they may not employ everyday.

The important point of these techniques is that the nurse is directly interactive with each

    piece. All knowledge is used, handled, manipulated and retold so it is never passive.

The Invisible Education Program has 4 modules:

    5. Moist Wound Healing

    6. Wound Assessment

    7. Wound Diagnosis

    8. Product Selection

Our experts work through the curriculum, but deliver each module as it becomes relevant

    to patient care, meanwhile tracking the nurses’ progress so that regular reports of that

    progress can be shared with the nurses and supervisors.

The Invisible Education Program provides 9.3 Contact Hours for Continuing Education

    Credit from the Washington State Nurses Association. The American Nurses

    Credentialing Center’s Commission on Accreditation backs all WSNA credits so that

    they are nationally recognized.

Each module covers the essential topics that will give the nurses the knowledge they need

    to not only treat the wounds in their care with understanding, but also arm them with the

    knowledge they need to fill in Medicare documentation accurately, seek timely advice if

    their wounds fail to progress and select products and procedures that are truly cost-

    effective.

We expect providers to gain many advantages from this program, in addition to the

    improvement of staff knowledge and performance. They include:

    ? Increased patient satisfaction, due to faster healing and greater comfort

    ? Better reimbursement from Medicare, due to more accurate diagnosis

    ? Significant savings on modern products from better selection and usage

    ? Huge savings from elimination of saline and gauze dressings

    (remember, saline and gauze dressings are the most expensive and least

    effective dressing technique in use today)

    ? Reduced need for traditional in-service education on wound care

    ? Improved accreditation review results regarding wound care

Pacific Telemedicine

    19234 Wallingford Ave N, Shoreline, WA 98133

    Phone: 206 542 0748 Fax: 206 542 2870

    Email: pacific.telemedicine@verizon.net

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