Uncovering Gaps in Wound Care across a Region: aDRESSING the Needs

Background: Wounds create a personal burden to individual health and quality of life, while also creating an economic cost and toll on the healthcare system. In a midwestern community health system primary care practice, 69% of regional clinic nursing staff at eight sites see patients for wound care once a week and up to several times weekly. There are variations in wound care products and processes at each of the sites, as well as disparities in the knowledge of staff regarding identification and care of wounds, the importance of photographing wounds, location of wound care resources, and documentation and billing resulting in variable patient outcomes.
Purpose: To improve nursing wound care processes across a regional primary care practice.
Methods: The DMAIC (define, measure, analyze, improve, and control) quality improvement framework was used with interdisciplinary team members to impact wound care in community primary care settings. Pre- and post-intervention surveys of nursing staff were completed to measure improvement. Stakeholders were assessed to be inclusive of all team members’ needs. Root causes were determined by the team and assessed for the greatest impact before implementing. Processes were clarified and a toolkit for wound care in primary care was created and this was presented along with streamlined education to staff.
Results: The main findings from the surveys, root cause analysis, and team discussions were the need to improve wound photography processes, wound and care-appropriate product identification, accessible wound care resources, and documentation standardization. Overall, there was a 31% improvement in reported confidence of identification of different types of wounds and ability to find resources for wound care, products, and contacts and choose the proper treatment for different types of wounds.
Implications for practice: Nurses engaged in their practice and quality improvement present the best opportunity to impact patient outcomes. This project was brought forward by staff excited about improving care for their patients. Wound care is an overall gap for outpatient care teams expected to provide high quality care. This project supported staff needs and ultimately impacted patient outcomes and can inform for others that may need to enhance wound care practices in primary or other ambulatory care areas.