An Acute Care Multidisciplinary Team Approach to Wound Care: Providing Best Practices and Cost Savings

Kirkland-Walsh, Holly

Monday, July 11, 2011: 1:45 PM

Holly Kirkland-Walsh, RN, FNP, MSN
Wound Care NP, University of California at Davis, Sacramento, CA
James Denman, RN, BSN
Cnr, UCDMC, Sacramento, CA

Learning Objective 1: recall the key participants needed for a wound care multidisciplinary team.

Learning Objective 2: recall the cost savings involved in providing best practices in a timely manner.

Purpose: A wound management pathway was designed by a multidisciplinary team of nurses, physicians, surgeons, dieticians, discharge planners, and physical therapists, to decrease the length of stay while providing evidence based wound care for patients with chronic pressure ulcers. Ten patients were admitted with primary diagnosis of chronic stage III and stage IV Pressure Ulcers during the first quarter of the year. Those patients stayed a total of 257 days during the first quarter (range 4 days to 60 days). As Medicare limits reimbursement for acute care hospitals managing chronic wounds and many patients loose their facility placements after 5-7 days, a pathway was created to guide best practices and shorten length of stay.

Methods: To begin the wound management pathway, the Emergency Department physician contacts the nurses on the wound team. The wound nurse implements the Chronic Wound Management physician order set. Each team member is provided with information on best practices to aid with the development of the physician order set. To evaluate our pathway, the multidisciplinary team chose the goal of a 5-7 day length of stay for all patients with chronic pressure ulcers if patients did not have evidence of sepsis. The wound nurse performed teaching, organized home supplies, and provided follow up phone calls.

Results: In the first quarter following implementation of the Chronic Wound Management pathway, there were 10 patients included in the pathway. The 10 patients stayed a total of 19 days (range from 0-6 inpatient days). While in hospital, patients had nutritional, wound, and physical therapy consults. Patients were discharged with follow up phone calls from the wound nurse.

Conclusion: A Multidisciplinary team devoted to managing chronic pressure ulcers can provide best practices efficiently and decrease length of stay.

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