48 2.5.6 Wound Management

Importance of Wound Management in LTC

• Integral to effective care in varied domains: education, research, leadership, consultation/collaboration, optimizing health systems (policy/legislation), role integration
• Intersects with many of the other competencies:
  • Person-centred care
  • Comprehensive primary care
  • Critical thinking
  • Acute episodic illness (cellulitis, skin tears, ED diversion)
  • Chronic disease management
  • Procedural care in LTC (ABPI, biopsies, debridement)
  • Palliative approach to care
  • Geriatric pharmacotherapy (treating cellulitis, osteomyelitis, skin cancers)^[1][2][3]

NP Role in Wound Management

Clinical:

• Ensure accurate diagnosis of wound(s) identified
• Treat/manage acute wounds: surgical sites, lacerations, skin tears
• Differentiate between chronic stasis dermatitis and cellulitis
• Treat/manage chronic wounds with evidence informed care: diabetic foot ulcers, venous/arterial/mixed leg ulcers, pressure injuries, maintenance/palliative wounds, malignant wounds, skin cancers
• Prescribe appropriate medications and treatments
• Preventing unnecessary transfer to acute care facilities
• Engaging in resident-centred care with a palliative approach to care to avoid unnecessary diagnostic interventions and  referrals to specialists
• Order specialized equipment for prevention and/or treatment of wounds

Ideally will involve a team-based, step process which involves a plan for continuous quality monitoring and reassessment.

• Assess and/or re-assess
• Set Goals
• Assemble the Team
• Establish and Implement a Plan of Care
• Evaluate Outcomes^[4]

Leadership Role:

• Health promotion/illness prevention in skin surveillance protocols, screening tool implementation/monitoring
• Understanding/promoting Quality Improvement Practices and key indicators of excellent care in the LTC sector
• Increasing capacity with bedside education of frontline staff
• Participating in an interdisciplinary wound care team for the facility

Researcher & Systems Influencer Role:

• Documentation and data analysis in regards to wound incidence and prevalence
• Improving documentation tools for wound management
• Considering trials for new care pathways which may have benefit for resident care
• Policy/political action (advocacy) for both the NP role, scope of practice barriers and to constantly improve resident care especially in terms of access to appropriate adjunctive therapies and advanced products
• Cost-effective care