Authors (including presenting author) :
Sarah SW Chu (1) Polk CK Wan (1) Tang KT (1) Cheng SK (1) Shih YH (1) Ma HM (1)
Affiliation :
Accident & Emergency Department, North Lantau Hospital (1)
Introduction :
Emergency wound management team is established to manage complicated wounds of patients to reduce the inter-hospital transfer for admission and re-attendance of A&E department. It has been established in the Accident and Emergency Department of North Lantau Hospital since July 2017 till now, over 500 patients were managed by emergency wound management team. This enhanced wound management service targeting patient with acute and complicated wounds conditions, which may be traumatic (e.g. burn, laceration, crush injury, or animal bite etc.) or non-traumatic (e.g. infected wound, abscess or cellulitis etc.).
Objectives :
(1) To provide advanced and safe emergency nurse practice on wound care under department protocols (2) Promote evidence-based wound management with data collection, analysis and research (3) Enhance advanced wound management knowledge by providing case sharing sessions and workshops (4) Provide continuity of care at local hospital and reduce inter-hospital transfer for wound management
Methodology :
We retrospectively reviewed the clinical service provided to patients who attended from July 2017 to June 2018. Wound team service is implemented by Ward Manager, one Advanced Practice Nurse and seven Registered Nurses, supervised by Consultants and three Associate Consultants. Clinical guidelines are set and endorsed by A&E Department, NLTH. One session of clinic (opening hour 9AM-5PM) per week. Cases with complicated wound condition will be recruited by the Advanced Practice Nurse (APN) or referred from doctors or triage nurse. History taking, physical examination, wound assessment or interventions (e.g. suturing or selection of special dressing materials) as well as discharge plan will be formulated by the APN. Ordering of investigations and prescription of medications will be done by a designated Associate Consultant. The nursing interventions and management process, and the times of attendance in those cases managed by the wound team were recorded.
Result & Outcome :
In the one-year period, total 500 patients were managed in 44 sessions, average follow-up 1-2 times per case. Case distribution by age with median 21-30 years old. Wound condition managed mainly in complicated scald wound and crushed injury. In order to promote advanced wound management in A&E Department (NLTH), workshops on special wound management (e.g. application of tissue adhesives or methods of hydrolytic debridement) were commenced for all doctors and nurses. Evidence-based practice in wound management were implemented by a cross-sectional, self-administer survey on current practice of acute burn wound management – “How evidence-based is our practice on outpatient management of acute burn wounds in A&E of HK?” Conclusion Enhanced Wound Management has been successfully initiated in A&E Department, NLTH. In order to provide advanced and safe emergency nursing practice, and protocol-driven nurse practice targeting patients were emphasized. Emergency wound management team can deliver a comprehensive care to those who have complicated wound conditions. A satisfaction survey is planned to further investigate if the service is associated with a better satisfaction of this group of patients.
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