Ask wound care nurses in the LTC setting how they do their jobs and they’ll likely respond, “It’s all about getting more done with less.” Financial pressures, along with MDS 3.0 and other compliance and regulatory initiatives, are intensifying scrutiny of wound care practices.
In the following article, wound care nurses from three facilities share how the use of an electronic point-of-care documentation system is transforming their jobs and enabling them to achieve better outcomes.
EMERGING FROM A SEA OF PAPER
Jennifer Kleinert, WCC, LPN, began her career as a wound nurse at Provena Heritage Village in Kankakee, Ill. The facility had just made the decision to purchase electronic wound documentation and a care management system when she arrived. Kleinert’s predecessor was known for working 50-60 hours a week, with at least half of her time dedicated to redundant paperwork and reporting.
“At the end of the day, she would have all these little pieces of paper with notes written on them,” Kleinert says. With the automated documentation system that was installed after her arrival, Kleinert was able to get that same job done without overtime and, most importantly, with more time available for direct patient care. “Automated documentation means I enter data once, then the system automatically completes my charting and reports, saving me at least 8 to 10 hours per week on paperwork,” she estimates.
Diana Easton, WCC, RN, a wound care coordinator for Provena Villa Franciscan in Joliet, Ill., also knows the pain of a paper-based documentation system. “It used to take at least an hour to do a weekly wound report for each resident, and now it’s just a touch of a button with the automated system,” she says.
Even more difficult were the quarterly Quality Assurance (QA) reports and the MDS reports for residents with wounds. Easton often found herself packing in an extra shift just to prepare the QA report, having to pull information from various sources, calculate percentages of facility-acquired versus community-acquired pressure ulcers and keep a tally of the number of residents experiencing pressure ulcers by each stage. Today, Easton does daily reporting for MDS 3.0 Section M using a simple electronic interface, eliminating the paperwork process that used to take hours.
EFFICIENCIES AND OUTCOMES
Provena Heritage Village conducted an Institutional Review Board-approved study on its electronic wound management system in 2008. Nurses were given mobile devices to capture assessments and wound images at the point of care, then provided a secure website for accessing clinical documentation, analysis and reports online. The study showed that nurses not only adopted the mobile device technology, but reported greater ease of use and greater effectiveness in managing wound care with the electronic solution. “In the six months following the pilot, the incidence of new facility-acquired pressure ulcers decreased by more than 80 percent,” Kleinert reports. She attributes the decrease to having more time to focus on patient care and wound prevention.
Kleinert has since joined the wound care team at Lexington Health Care’s 278-bed skilled facility in Orland Park, Ill. Lexington has the same wound management system as Provena Heritage Village, which has allowed Kleinert to streamline her workflow. “When I come to work each day, the wound system tells me which patients need to be seen and which assessments need to be done,” she says.
At resident bedsides, Kleinert uses a mobile device to enter assessment data. The electronic system also provides reminder tools to keep the care plan proactive and on track according to best practices. “I can see the wound measurements and the PUSH [Pressure Ulcer Scale for Healing] score from my last assessment, so I know if the wound is healing or if I need to change the intervention,” she says. “If a patient presents with an excoriated bottom, I can set a daily reminder to monitor and ensure the situation doesn’t get worse.” Kleinert also uses trend reports to see patterns within the facility, such as skin breakdown on a certain wing, allowing her to focus the nursing team on prevention in specific areas.
HIT ENABLES TEAMWORK
Movelle Das, CWCN, is a wound/skincare specialist at Presbyterian Homes in Evanston, Ill. “I’m a traditional nurse and it’s important to me that I communicate with the resident,” she says. “I can do more of that now because I have time—our electronic wound management system has made me faster.”
Das admits that she was initially “fearful” of an electronic system because of her limited computer literacy, but gained confidence through constant learning along with support and encouragement by others at her facility. With wound system automation, Das was able to train floor nurses to do Braden Risk Assessments electronically, which let her focus more time on higher-acuity patients.