Caring about wound care.

SEVEN YEARS AGO, WHEN MY DON AT Hillcrest Medical Nursing Institute, Knoxville, Tenn., offered me a position as a skin-treatment nurse, I was hesitant, then intrigued. This was a job I had never done before, and I knew little about pressure ulcers and how to treat them. At the time, the treatment protocol was to rinse the wound with half-strength peroxide and water, then apply half-strength Betadine and a gauze dressing. I had seen wound-care products such as hydrocolloid dressings but didn't know very much about using them. I told the DON I would accept the position, but on a trial basis.

My first task was to identify who would need the care of a skin-treatment nurse. I reviewed all the residents' records and identified those who had wound-care treatment orders. When I finished, I had a list of 50 residents. Now that I could see the need for this care, my desire to learn more about wounds and how to treat them increased.

My introduction to wound care came from books such as The Nurses' Clinical Guide to Wound Care, first edition by Cathy Thomas Hess (Lippincott Williams & Wilkins, Hagerstown, Md., 1995). The articles in wound- and ostomy-care magazines were another useful resource. I also found attending training seminars and symposiums to be of great value. I met Steve Wesley, a sales representative for ConvaTec, when he paid a sales call to our purchasing clerk. The company offers a line of wound-care products and Wesley was able to explain to me the different types of wound dressings and their uses. Hydrocolloid dressings were no longer a mystery.

Seeing how disease processes, infections, nutrition, and lab test results that indicated blood conditions such as low albumin, low red blood count, and high white count play important roles in wound healing, I learned to look beyond the wound and see the whole resident. The result of my efforts was that the residents' pressure ulcers were healing faster.

Make a team of it

Hillcrest Medical Nursing Institute is composed of three facilities: North, South, and West. News of the wound-care success in my facility, North, spread to Hillcrest's other facilities. We formed a skin-care team consisting of the DONs from each facility, the skin-treatment nurse from each facility, and nurses from the skilled units. It was the first time staff members from all three facilities were working together as one team. As a team, we developed wound-care management protocols and set goals for ourselves. We aimed to improve care through educating all staff and instituting pressure-ulcer prevention measures. Team meetings are held every three to four months.

As nurses, we see each resident for about 20 minutes a day. The CNAs, however, have continuous contact with the residents. This would make the CNAs a key to our successful skin-care efforts. Staff workshops were provided for the CNAs to educate them on how pressure ulcers form and how to prevent them.

As part of our preventive measures, we had a goal of providing support surfaces on every bed. Relying on the Agency for Health Care Research and Quality (AHRQ, formerly ACHPR) guidelines, we selected high-density foam mattresses. When a resident presents with a pressure ulcer, a total assessment of the resident is performed to determine the cause of the wound. This allows us to determine the best method for treating the resident, especially if a change may be needed in the type of support surface on the resident's bed.

Learning is never-ending

My experiences as a skin-treatment nurse gave me the push I needed to go back to school to earn my RN degree. I was then offered different supervisory positions at Hillcrest, but I wasn't interested. I felt I had found my niche in wound care. I continue to expand my wound-care knowledge and improve my skills by attending professional seminars and reading industry journals. The AHRQ guidelines have become my lifeline.

Our skin-breakdown rate decreased by 2 percent in the first six months of our team's efforts. The skin breakdown-rate at Hillcrest is now at an all-time low: 4-6 percent. As I look back on my seven years as a wound-care nurse, I see the difference that working as a team can make.

Tracy Widby RN, CWCN, is a wound-care coordinator at Hillcrest Medical Nursing Institute, Knoxville, Tenn.