Making the Impossible Possible- Enhanced Wound Dressing Protocol Through Reconstruction of Current Service for Limb Threatening and Wound with High Complexity

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Authors (including presenting author) :
Liu KW, Ma CM, Chan LY, Lam KY, Leung LC, Hui C, Fung OY, Li YN, Sum WK, Hui SS, Tam KT
Affiliation :
Department of Orthopaedics and Traumatology, North District Hospital
Introduction :
Complicated wounds with full thickness skin loss constituted a significant workload in our Department. Total 48 in-patients with complicated wounds contributed to long stay (average 28.5 days) from September 2017 to March 2018 that put a significant stress on the availability of beds for other patients requiring acute admissions.
Objectives :
To streamlines and integrates the current service through team collaboration, adoption of advanced wound management, standardization of care, use of Clinical Album in CMS for effective communication, resulting in enhancement of wound healing, shortening of LOS, and improvement in patients’ experience.
Methodology :
A new service model governed by orthopaedic specialists is coordinated by orthopaedic wound nurses in collaboration with community wound nurse. The scope of patients included those with full thickness skin loss due to pressure injuries, trauma, or benign ulcerations e.g. diabetes or peripheral vascular disease, and soft tissue defect following debridement. The patient would be recruited after initial assessment by the orthopaedic surgeon and the wound nurse then advanced wound management would be provided according to standardized protocol (Photo Guide) that was designed for various wound conditions. Surgical debridement, drainage, coverage or amputation would be arranged if clinically indicated.Once the infection and necrosis were under control, patient would be discharged to ward follow up under the care of wound nurse to closely monitor the wound condition and reduce SOPD workload. In collaboration with COST, patients would be referred to their wound nurse for further care.
Result & Outcome :
From 1st March 2018 to 31st December 2018, 142 in-patients with complicated wound problem were recruited. 19.7% (n=28) wounds beds were well prepared and were managed by delay primary closure. 12.6% (n=18) wounds were healed during hospitalization, 12.0% (n=17) wounds were discharged directly to ward follow up service and healed. 3.5% (n=5) patients died of medical condition despite improvement in wound condition. 2.1% (n=3) patients were transferred to Rehabilitation hospital with good wound progress. 50% (n=71) wounds were stabilized and were able to be downgraded for further care by CNS or GOPD. Orthopedic wound nurses were able to advance the date of discharge in 43.7% (n=62) of the cases, therefore the length of stay was shortened. As compared with the statistics last year for the same group of patients, the average LOS was decreased by 28.8% from 28.5 to 20.3 days. On the other hand, 310 ward follow ups were offered by wound nurses in this period. They included patients discharged from ward (n=17) and referred from SOPD (n=17). No SOPD follow up was required for this group of patient and therefore 102 SOPD sessions were relieved. No patient under our care required below knee amputation. Vigilant modification of current service for patients with complicated wound can shortened the LOS, hastened their recovery, improved their experience as well as relieving overcrowding of SOPD session.

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