Focus On…Wound, Ostomy, and Continence
focuson Wound, Ostomy, and Continence
The case for hiring a wound care professional
Janet Stoia Davis, RN, CWOCN, sheds light on the down- and upsides of partnering with a wound, ostomy, continence nurse consultant
| Can your facility afford a wound, ostomy, continence nurse (WOCN) consultant? More importantly, can it afford not to contract with one? WOCN specialists, unfortunately, are not standard in long-term care, primarily for financial reasons. The services of a WOCN consultant are an out-of-pocket, nonreimbursable expense. Although many nursing homes see the need for the services of a WOCN consultant, they usually have not budgeted for them except possibly on a short-term, as-needed basis. Even though an increasing number of WOCNs today are becoming nurse practitioners, which means they may be able to bill Medicare to alleviate some of the financial burden for the organization, WOCNs are still valuable in their own right, and worth considering.
Who Is a WOCN Consultant?
According to the needs of the nursing home, a WOCN consultant can serve in a variety of capacities. Some facilities have the nurse consultant go on rounds either weekly, every other week, or on a monthly basis, while other facilities have the WOCN sit in on committee meetings to review and discuss cases. As a value-added service, the WOCN may also conduct in-services on issues and relevant techniques related to each area of care.
Facilities are becoming increasingly aware of the value of the WOCN consultant. Often we are called in when there is a challenging case-for example, dealing with family issues or a noncompliant patient. I feel that our primary role in the long-term care setting is to teach staff to be more thorough and accurate in documenting care, which ultimately improves care, costs, and reimbursement. Documentation is not limited to local care but extends to documenting all that the facility does to prevent pressure ulcers. In my experience, I find that WOCN consultants are engaged primarily by a nursing home for wound management.
The wound component. Nurse consultants often are used on an as-needed basis, perhaps when the wound is stage III or IV, or if specialized treatment is required for a nonhealing or recalcitrant wound. In addition to the previously mentioned functions of a WOCN, a facility can avail itself of the WOCN’s expertise to conduct an overall evaluation its wound care program. This involves face-to-face interviews with everyone on staff, from nurses to housekeepers to central supply, in order to evaluate how they are servicing residents. Based on observation and interview responses, the WOCN gives the facility a written proposal on how to improve or revamp its wound care program. In some cases, the facility continues to manage the program and implement changes, but other organizations may need to have a WOCN consultant or an outside company spearhead the initiative to make the program run efficiently and cost-effectively.
I take a holistic approach to wound care in my practice. When I’m in a skin care meeting at a facility and we are reviewing cases, I throw out lots of questions. The treatment nurse (who must have good assessment skills) usually presents the wound: whether it is improving, deteriorating, or plateaued. As part of the discussion I may ask: “What else are we doing to promote wound healing?” “How are we relieving pressure?” “Why is this wound refusing to heal?” The next component is to determine if we have documented what we have done. The chart should be a “picture” of what we are doing for the patient. It should communicate our holistic approach. Why are we doing what we are doing, and does it correlate with the standards of care? In this way, as a WOCN I teach not only what to do but how to critically think through the issue.
The ostomy component. In this area, the nurse consultant is generally hired for crisis intervention, perhaps when a facility is having trouble keeping a patients’s pouch in place. If this is required, the nursing home and consultant enter into an agreement with a Memorandum of Understanding, and then the consultant can assess and assist the patient in question. Regardless of the consultant’s fee, the WOCN will save the facility significant dollars in care costs, both in supplies and additional nursing time. The value of patient and family satisfaction, as well as lower staff stress, is known to all in the healthcare profession.
The continence component. Like wound care, facilities are getting a handle on continence issues. Treatment nurses have become more knowledgeable and have benefited from the wealth of literature available and the in-services sponsored by product representatives. Yet with all the improvement, continence consultants are still important in managing difficult cases and helping to individualize programs for patients. Because of their specialization, they keep abreast of new products, technology, and protocols to address this manageable condition and head off complications.
What Makes a Great WOCN Consultant?
Where Can You Find a WOC Specialist?
Many facilities recognize that although the WOCN consultants’ services are an out-of-pocket expense, their value is enhanced because they provide more than local care and product information. Their services help with survey preparation, aid in comprehensive documentation, decrease citations and, if necessary, assist with legal issues.
In the final analysis, the best benefit is that the patient is receiving quality care; staff is being educated on the who, what, when, where, and why of treatment; and the facility is enjoying the reputation of providing quality care.
Janet Stoia Davis, RN, CWOCN, has been a certified WOCN since 1985 and has been in private practice for 10 years. She is based in Riverside, California. For more information, call Stoia Consultants at (951) 756-2202. To send your comments to the author and editors, e-mail firstname.lastname@example.org.
| Suspension Boots
DM Systems, Inc.’s new Heelift design includes extended stitching along the top rim of the boot to narrow the forefoot, offering improved protection against foot drop, equinus deformity, or heel cord contracture. The extended stitching also prevents the foam from tearing through the ventilation holes. The simplified strap design permits one-handed closure and easier adjustment of the strap’s tension.
Heelift and Heelift Smooth Suspension Boots are used to prevent and treat heel pressure ulcers. Pressure is eliminated from the heel by lifting it with an elevation pad and suspending the heel in protective space. In prevention regimens, Heelift can be used with residents who are immobile, postoperative, or suffer from diabetes, cardiovascular disease, or dietary deficiencies.
| Antiseptic Skin Cleanser
Care-Tech« has introduced CC-500« Antiseptic Dermal Cleanser, designed for patient care after surgical procedures. A mild, gentle, nontoxic, antimicrobial agent that protects against topical and nosocomial infection, CC-500 controls skin eruptions and topical infection in patients with compromised immune systems, as well as diabetic, HIV, dialysis, and oncology patients. The concentrated cleanser reduces the risk of skin breakdown while removing organic material, including oil pockets that may harbor harmful pathogens.
| Nutritional Supplement
Good nutrition is essential to skin integrity, and complete cell development plays an important role in wound repair. QCE Laboratories offers Decub-AmineÖ protein supplement, enhanced with L-arginine and L-glutamine plus essential fatty acids, providing elements necessary for cell growth and replication.
Decubi-Vite« three-in-one combines the typical protocol of a therapeutic multivitamin plus 500 mg vitamin C and 220 mg zinc sulfate in one capsule. Simply open the Decubi-Vite capsule and add it to Decub-Amine protein powder for a nutritional supplement program complete with protein, essential fatty acids, and vitamins.
| Spray-On Moisture Barrier
Touchless Care Systems’ Rash Relief« protects skin with its concentrated 25% zinc oxide and 20% dimethicone formula. Spray-on, no rub-in application only takes a few seconds, saving nursing time. Additional savings are achieved by eliminating the residual waste and cleanup expense of traditional products. Each 4.5-oz bottle delivers more than 100 adult applications.
| Innovative Heel Support
The HeelZupÖ Therapeutic Heel Elevating Cushion from Intensive Therapeutics, Inc., exceeds AHRQ and NPUAP guidelines; elevates heels a minimum of 1″ off the surface, while supporting the lower leg; avoids hyper-extension of the knee; stabilizes legs with raised side bolsters; does not need constant maintenance and adjustment; is available in reusable and disposable models; has a nylon cover that is friction and shear reducing; is made of high-density, antimicrobial, hypoallergenic, and latex-free foam; and increases compliance and decreases incidence.
| Barrier Cream
DawnMist Barrier Cream from Donovan Industries protects the skin by using an effective yet gentle formula that allows the skin to breathe naturally. Formulated with aloe, lanolin, and petrolatum, it allows the air transmission to the dermal layer, unlike other zinc-based formulas.
| Adjustable Bed
Sunrise Medical offers the Joerns« 330 bed, the newest addition to the Joerns bed family. The 330 can be configured to be secure or mobile at any height and has virtually zero horizontal translation. This all-around performer has a travel range of 8 1/4″ to 26″ and a weight capacity of 450 lbs.
| Odor-Control Briefs
Unpleasant odors associated with incontinence can compromise both resident dignity and nursing home image, which is why TENA« has developed OdaSorb PlusÖ, specially treated fibers that minimize the growth of odor-causing bacteria. Now TENA« Ultra, TENA« Super, TENA« Bariatric/XL, and TENA« Small Briefs feature OdaSorb Plus in addition to the InstaDri Skin-Caring SystemÖ.
| Skin Ointment
Calmoseptine Ointment from Calmoseptine, Inc., is used to prevent and treat skin irritations from moisture, such as urinary and fecal incontinence. It is also effective for irritations from perspiration, wound drainange, fecal and vaginal fistulas, and feeding-tube site leakage. Calmoseptine Ointment temporarily relieves discomfort and itching.
| Precut Wound Dressings
Ferris Mfg. Corp., makers of PolyMem wound care dressings, has introduced ShapesÖ to its lineup of QuadraFoam dressings. Shapes are easy-to-use, precut dressings that enable healthcare professionals to choose the best fitting dressing for each particular wound.
QuadraFoam addresses the four key elements of healing (cleanse, fill, absorb, and moisten) in one convenient dressing. Because Shapes is a QuadraFoam, it can replace a number of traditional wound dressings, including polyurethane or silicone foams, hydrogels, alginates, hydrocolloids, transparent films, gauze, and other traditional dressings.
| Bladder-Assessment System
Available from Direct Supply, the BladderScan BVI« aids in compliance with F-tag 315 revisions. The noninvasive BladderScan measures post-void residuals. Incorporating ultrasound technology in an easy-to-use system, the BladderScan allows staff to accurately diagnose the type of urinary incontinence and develop customized treatment schedules for each resident based on bladder volume.
| 3-in-1 Wash Cream
GOJO Industries’ PROVON« 3-in-1 Wash Cream is a single product that is used for complete perineal care and bed bathing. Designed to help LTC facilities deliver effective and efficient incontinence care, the new wash cream helps maintain skin integrity, increases skin moisture, and leaves a fresh, clean fragrance after use. No rinsing, soaps, or additional creams are necessary.
3-in-1 Wash Cream is available in 12-fl.-oz. pump bottles with the available PLACESÖ holder and PROVON 1,000-ml dispensers.
Topics: Articles , Clinical