Use of Bordered Polymeric Membrane Dressing to Promote Patient Participation in Their Own Wound Care in the Home Setting

Clinical Problem: One of the areas that insurance companies and home care agencies consider when working with wound care patients, is the ability for the patient/ or family to participate in wound care treatment in-between the needed Skilled Nurse (SN) assessment. There are often barriers to patient wound care participation, such as: 1. Location of the wound; 2. Limited dexterity, 3. Inability to perform multiple step procedures. I looked at 5 patients between the ages of 20-85 with multiple and diverse comorbidities. Their wound care was at least 3x/wk. We were using different products with a multi-step procedure for each of these patients.

Description of Past Management: Multi–step wound care was more difficult for the patient/families to participate in wound care in-between their need for a SN assessment of the wound.

Current Clinical Approach: The goal is to enable the patient to be independent in wound care between SN home visits. Since polymeric membrane dressings (PMDs) contain continuous cleansing and a debriding system, the need for manual cleansing was eliminated. PMDs border with a transparent or cloth adhesive border, so the need for wraps/ tape was eliminated. All were receptive to do their own care. 4 patients and 1 caregiver were instructed in dressing changes, what to look for and when to contact trained staff with observed concerns.

Patient Outcomes: All patients and caregivers found the PMDs very easy to apply, even in difficult wound locations and appropriately performed wound care. SN visits decreased from 3x/wk. to 1x/wk. and wounds closed.

Conclusions: Patients who previously needed a skilled nurse to perform wound care were able to actively participate in their wound care, which resulted in increased satisfaction levels. Additionally, the agency nurses were then able to see other patients once the patients were taught the dressing change skill.

References
Benton N,Harvath T, Flaherty-Ross M, Medcraft M, McWhorter, McClelland F, Joseph C, Mambourg K. et al. Managing chronic, nonhealing wounds. Using a research-based protocol. Journal of Gerontological Nursing.2007;November: 38-45.
Harrison J. An independent evaluation of a new mesh-reinforced silver rope dressing. Poster presented at the 41st Annual WOCN Conference Poster #3332 June 6-10, 2009 St Louis, MO USA

Hurd T, Zuiliani N, Posnett J. Evaluation of the impact of restructuring wound management practices in a community care provider in Niagara, Canada. International Wound Journal. 2008;5(2): 296-304.