by Janet Wolfson, PT, CLWT, CWS, CLT-LANA
by Holly Hovan MSN, APRN, ACNS-BC, CWON-AP
As a wound, ostomy, and continence nurse in long-term care, education is a huge part of my role working in our Community Living Center (CLC), Hospice, and Transitional Care Unit (TCU). Unit specific, evidence-based training and continued follow-up are integral to the success of our pressure injury prevention program. The unit-based skin care nurses (UBSCNs) are at the frontline of prevention, along with all nursing staff, especially nursing assistants (NAs).
In order for us to be successful in preventing and treating pressure injuries, diabetic foot ulcers, vascular wounds, surgical wounds, and other wounds, those on the frontline need to have a good understanding of why prevention is key (prevention of new wounds/pressure injuries, deterioration, infection, etc.). In addition to understanding, they also need to realize that their work truly makes a difference in the lives of our patient population (specifically veterans in our case).
Wound Prevention Starts with Education
Our CLC recently started a day-long education fair, taking place on World Wide Pressure Injury Prevention Day in November. Our initial World Wide Pressure Injury Prevention Day was a huge success, and centered on prevention/treatment of pressure injuries and skin tears, along with the importance of nutrition and accurate wound documentation. It was such a success, we decided to make it an annual occurrence!
We had learning stations on:
- Barrier cream (indications for usage, different types specific to our facility, and application)
- Documentation (correct and incorrect types of documentation for electronic medical records)
- Nutrition and supplements (our CLC registered dietitian and interns joined us to showcase and provide samples/tastes test of our nutritional formulary/offered supplements and indications)
- Shear station where we discussed friction vs. shear (and causes)
- Skin tears (prevention and treatment)
- Our newly developed consistent weight process (obtaining timely and accurate weights is often a struggle in a long-term care setting, given the variation in weight measurements: standing scale, wheelchair, lift scale, how many pillows were on the bed, etc. - development of a standardized weight process was initiated and written up by one of my own UBSCNs, specific to her dementia unit, and has now cascaded across the CLC floors to become a standard of practice with modification specific to each floor (a topic I will address in a future post!)
Our World Wide Pressure Injury Prevention Day focused on a “healthy” theme, with the new staging definitions from the National Pressure Ulcer Advisory Panel conveyed with fruits and veggies (pears, apples, avocados, tomatoes). Skin tears were demonstrated using the fragile skin of a plum, comparable to many of our geriatric and compromised veterans.
The UBSCNs were integral because they were each assigned to a station, presenting to their peers. The nurse managers from each of the neighborhoods (and nursing leadership) contributed healthy snacks to add to the theme of the day. Nursing staff (RNs, LPNs, and NAs), therapists, providers, MDS nurses, dietitians, and nursing leadership attended—and overall, everyone really liked the hands-on stations and fun theme.
Our leadership team values education, and puts a huge emphasis on the importance of prevention. The keys to our success are support from management and leadership, consistency, follow up, teamwork, and ongoing wound education. Although I serve as the educator and facilitator for many of our wound specific needs, our success would not be possible without each member of the team!
About the Author
Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.