A Team Approach to Improve Wound Care Quality in Long-Term Care

Abstract

Problem and Purpose: Elderly long-term care residents are vulnerable to developing chronic wounds as a result of multiple factors related to aging, immobility, nutritional deficits, and medical comorbidities. Chronic wounds may result in uncontrolled pain, infection, hospitalization, amputation, and increased mortality. On one long-term care unit, lack of adequate wound surveillance and treatment has resulted in delayed healing rates. The purpose of this quality improvement project was to implement a wound care team, consisting of a nurse practitioner and licensed practical nurse to provide direct wound care surveillance and treatment for all residents of one long-term care unit, and collaborate with the inter-professional team to improve outcomes. Methods: On a weekly basis, the team assessed all active wounds, collecting measurements (length, width, depth in centimeters), and data on wound quality (tissue type, drainage, and etiology); and reviewed current treatment modalities. This data was recorded by the licensed practical nurse in the unit wound book, and presented weekly during inter-professional safety meetings, including physical therapy, social work, nutrition, and unit management, with the goal of developing a collaborative, resident-centered plan of care. Results: An average of 5 residents weekly were seen by the wound team. Over the 13-week implementation period, weekly data analysis revealed no overall change in wound incidence or prevalence. The accuracy and completion of nursing documentation improved from nearly 50% at the start of the project, to nearly 90% in the final weeks of data collection. Improved data accuracy allowed better inter-professional team decision-making. Changes facilitated by the inter-professional team process included enhancing the use of offloading devices, nutritional interventions, increasing access to high-quality wound supplies, and clarifying resident and family goals of care. Conclusion: A team approach is a feasible way to improve wound care quality in the long-term care setting. This process allows increased inter-professional communication and collaboration through enhanced data sharing, and enables needed changes made with group decision-making. Longer term studies could provide more insight into the effect of this process on wound incidence, prevalence, and healing rates.