Recipe for Success: Skin and wound care program

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North York General Hospital knows the impact collaboration, systematic innovation and education, can have on improving the quality of patients’ lives. This recipe for success has changed the face of skin and wound care management at North York General Hospital, bringing the organization’s “Pressure Ulcer” prevalence rate down from 21 per cent to 13.5 per cent in just three months.

At a conference held at North York General Hospital on June 6th, 2008, the hospital, in partnership with Smith & Nephew and the Community Care Access Centre (CCAC), proudly shared their journey towards innovative wound care management with international delegates from the Third Congress of the World Union of Wound Healing Societies. The congress was held June 4th to 8th, 2008, at the Metro Convention Centre, with more than 80 representatives from 30 countries.

North York General Hospital’s event’s theme was Transforming Practice and Outcomes in Wound Management – Organizational Implications and Impact.

“Collaborating with industry, Smith & Nephew, the community, the CCAC, and involvement of the hospital at all levels has led to the success of the wound management project and will provide patients with best practice quality care,” says Karyn Popovich, Director, Medical Program, North York General Hospital and Skin and Wound Steering Committees’ lead. “This conference was an opportunity to show our peers what is possible and achievable in such a short period of time.”

This collaboration has seen the standardization of skin and wound care products, the implementation of evidence based best practice, and the transfer of knowledge to both the bedside and into the community.

Theresa Hurd, (APN) Nursing Practice Solutions, and a consultant for Smith & Nephew, worked with North York General Hospital and the CCAC to educate staff on best practices.“North York General Hospital had the fastest results I have seen,” says Hurd. “The organization’s culture was fast to adapt to it – to have that kind of success it takes full support across the organization.”

North York General Hospital rolled out their skin and wound program in March 2008 which focused on prevention, treatment and cost reduction. Paula Tohm, Project Manager, Skin and Wound Steering Committee, says in May 2007 the hospital conducted prevalence tests to establish benchmarks. “The prevalence results revealed the hospital’s pressure ulcer rate was 21 per cent,” says Tohm. “The national prevalence is 26 per cent.”

From the results, Tohm said the steering committee set a 50 per cent reduction goal, or 10.5 per cent prevalence rate, by March 2009. At that time, North York General Hospital had seven in-patient pressure ulcers at stage 3 and above. Popovich said the potential cost to manage these seven patients was $277,400 and 249 excess bed-days. “A reduction of just one case could save an average of $40,000 and 36 excess bed-days,” says Popovich.

To achieve these goals North York General Hospital’s Skin and Wound Steering Committee applied the LEAN methodology, a systematic approach used to eliminate waste in a process; a Vertical Value system, a project management tool to map process.

“Our biggest hurdle has been to change current practice to best practice and then spread that knowledge across the organization,” says Popovich. “In the past there was not a consistent teaching and learning mode to build capacity across all front line staff. Staff now feel empowered to make evidence-based treatment decisions.”

Popovich says it is a lengthy process to transfer that knowledge to the bedside and it takes a commitment from the hospital’s administration to ensure every nurse has been given two days to take the four training sessions. To date, 70 per cent of frontline staff have taken the first two sessions and 25 per cent have taken the final two. A final goal of hospital-wide training has been set for March 2009.

“These training sessions, which consist of classroom, theory and hands-on learning, provide the education model that will allow for consistency in product use and treatment,” Popovich says. “Evidence based research has shown that consistency with best practice ensures quality patient care.”

Dr. Petra Schiller, Plastic Surgeon, North York General Hospital, and physician representative on the Skin and Wound Steering Committee points out that physicians are also excited about this evidence-based practice. “This program is unique and it’s sound practice,” she says. “This is a huge step forward for this hospital and our patients.”

In addition to standardized practices and product use, North York General Hospital has developed and implemented a Wound Assessment Form; created five standardized patient plans from prevention to stage four pressure ulcers; revised organization wide skin and wound policies; and streamlined assessment and documentation wools with other corporate initiatives such as eCare.

In November 2008, the hospital will do another prevalence test to ensure the sustainability of the program continues. “We’ve had fantastic success in a rather short time frame,” she says. “Hopefully we can continue to bring this rate down lower than our initial target.” A key to this best practice is to ensure consistency of wound treatment continues into the community.

Mary Burello – Cordovado, Senior Manager, Client Services, Central CCAC, says: “This program really targets the gaps in the system, from hospital to hospital and between community case managers. The team worked to develop tools, process and pathways so patients received seamless, quality care not only in the hospital, but in the community too.”

For the CCAC venous leg ulcers were found to be a big problem in the community, with only 15 per cent being treated properly and on average they lasted up to 65 weeks. Early results showed $1.8 millions in savings for the CCAC, with almost 50 per cent being costs of medical supplies and treatment. “We’re very excited to see more results and successes, especially in reducing the length of stay of clients on the programs,” she says.

“In the end it is the patient we are serving and who gets the positive effect of these practices.”