Wound care programs are becoming more prevalent and may exist in a variety of health-care settings. In general, the program will either be inpatient based or outpatient based, thus serving two distinct patient populations, each with its own set of challenges.
In the inpatient setting, there really is no question as to whether to start a program. At the very least, a plan to prevent skin breakdown should be in place. In most facilities a formalized wound care program is also a necessity.
Outpatient wound care programs are not quite as clear-cut. Many factors need to be taken into account. These will be explored in more detail later in the chapter.
Inpatient Wound Care Program
Based on the type of inpatient facility, the extent of the wound care program may vary. For example, due to a shorter average length of stay, a short-term acute care program would usually be different from a program in an intensive care unit or a longterm acute care facility in which patients remain longer. The components listed in this chapter will illustrate a very comprehensive wound care program. The reader will need to identify the interventions most appropriate for the specific patient population to be served.
Getting the right combination of health-care practitioners is vital to the success of any wound care program. Choose clinicians that have a passion for wound care and who want to be team players. Appointing someone to head a wound care program or to be a member of the wound team rarely works. A significant commitment needs to be made to properly managing patients with wounds as well as staying informed of the rapid changes occurring within this specialty. A clinician without the interest and drive to follow through in these areas can be a detriment to the program as a whole, and patient outcomes will likely suffer.
Likewise, wound management programs are not as successful when there is only one person who ostensibly "holds" the same knowledge as a transdisciplinary team. What happens during times that clinician is not available? No single person can be present 24 hours a day, 365 days a year. There needs to be a team approach so that patient care is consistent and thorough. Only a transdisciplinary team consisting of several practitioners with experience in specific areas of expertise can ensure that patient wound care is optimal.
What should be the makeup of this team of experts? Possible members include therapists (physical and/or occupational), dietitians, nurses, nursing assistants, orthotists/pedorthists, and podiatrists, as well as case managers, social workers, materials managers, and billing and coding specialists. In addition, there are a multitude of physicians that may be a part of the team. These may include infectious disease specialists, plastic surgeons, vascular surgeons, internal medicine physicians, dermatologists, hyperbaric medicine specialists, ...