Wound Care Alliance: Leveraging the Collective Effort of the Wound Care Expertise to Improve Complicated Wound Management: a Pilot Project in New Territories East Cluster

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Authors (including presenting author) :
Li YN (2) (11), Chim CK (11), Lam YY (3), Tong SY(7), Chan KW(8), Lai KY(9), Chan YF(10), Tong LW(5), Lam SW(6), Lee KK(4), Lee MY(1), Liu KW(2), Ngai MY(11), Tam SOF(11), Chan TJ (12), Li CSY (12), Cheung HM (12), Ho BPY (12).
Affiliation :
(1)Department of Medicine, North District Hospital (2)Department of Orthopaedics & Traumatology, North District Hospital (3)Department of Surgery, North District Hospital (4)Department of Medicine & Geriatrics, Tai Po Hospital (5)Department of Medicine, Alice Ho Miu Ling Nethersole Hospital (6)Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital (7)Department of Surgery, Prince of Wales Hospital (8)Department of Orthopaedics & Traumatology, Prince of Wales Hospital (9)Department of Medicine & Therapeutic, Prince of Wales Hospital (10)Department of Surgery, Shatin Hospital (11)Nursing Workgroup on Pressure Injury Prevention, NTEC (12)Central Nursing Division, NTEC
Introduction :
Management of complicated wound posts a considerable challenge to the nurses in in-patient setting. The wounds are not easily managed with available resources or extend beyond ordinary nurses ‘experience or basic knowledge. Besides, one-day cluster-based survey on 31 Dec 2016 showed increasing wound burden including rising trend of patients with complicated wounds in cluster hospitals; and hidden costs of wound care workload towards nurses’ in terms of nursing time in wound management. In this regards, a cross specialties workgroup was formed and initiated a pilot programme on wound care alliance in NTEC in 2018 aiming at leveraging the collective effort of the wound care expertise to improve the complicated wounds practice in cluster level with better support to frontline nurses and patients.
Objectives :
1. To facilitate effective use of advanced dressing products in complicated wound management 2. To enhance wound healing 3. To evaluate nursing time and dressing frequency; and frontline nurses’ acceptability
Methodology :
1. A workgroup was set up involving wound experts in cluster hospital 2. Developed special dressing selection guidance for ward nurses in complicated wound management 3. Designed operational workflow including wound round, photo taking for continue monitoring after application of the special dressing. 4. Outcome evaluation including pre-post of dressing time, dressing frequency and healing status of the wounds was studied 5. Staff satisfaction survey was also conducted
Result & Outcome :
From 5th Dec 2018 to 28th Feb 2019, 272 patients’ wounds were recruited including 11 dropped out. Total 261 wounds were analysed.Mean age was 68.5 with 135 (51.7%) males, 126 (48.3%) female. Wounds types included pressure injury >stage3 had 120nos(46%); 37 (14.2%)Diabetic ulcers; 7(3%)Carbuncles; 34(13%)Gapped wounds;2(1%)fungating wounds and 61(23%)other wounds. The outcome showed that 66%(n=172)wound conditions were improved;7%(n=18) healed; 9%(n=24)wound beds improved for surgical closure; 15%(n=38)wounds were static and 3%(n=9)were deteriorated. The total dressing time was decreased by 21.2% (from 37785mins to 29785mins); and the total frequency of dressing change was reduced by 35.9% (from 2621 to 1679 episodes). 98.4%(n=217)nurses satisfied with the program in particular on enhancing their confidences, knowledge and skills in managing complicated wounds.

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