Module 2: Direct Comprehensive Primary Care in the LTC Setting
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