I have worked SNF where there was no such thing as a Wound/Treatment nurse or a wound team... floor nurses did all the Tx as well as meds and other stuff. However, I was given a position as a wound nurse at a facility which does have a wound nurse (I say nurse, and not a "team", as when I am off work there is nobody else scheduled to do wound care). The floor nurses each have up to 25 patients and just don't have the time. Since the treatment record is separate from the floor nurse tools, the floor nurses may not even be aware of a wound or treatment. The Aides generally have 12-13 patients, so forget about proper turning, heel floating, incontinence care and skin checks.
This facility operates on paper still and because of this antiquated system I find many opportunities for mistakes and dropping of balls when it comes to patient care. As wound nurse I have been busy treating wounds I have been notified about by the floor nurses. They tell me there is a wound, I take it from there, assessing the wound, developing the Tx, implementing the care and documentation. Once a wound is taken over by me, it seems to be forgotten by the floor nurse. Well, there are 56 wounds (that I know about, I am sure there are actually many more undocumented, untreated wounds!). I have been cleaning up the documentation that had not been done by the prior nurse in this position and suddenly it appears there are more than twice as many wounds on the records as before I started. This is not because there are more wounds, but because the wounds we have/had are now properly documented/tracked. This, of course, makes the facility look bad and state is coming in a few weeks.
I have not been adequately trained in the corporate expectations of documentation and no doubt have been making mistakes and completely forgetting or not knowing to complete certain forms. I swear each wound requires 6 different pieces of paper that all go in different places! Not to mention wound care is simply NOT getting done on days/shifts when I am not there. I am the only nurse assigned for the wounds in the entire facility. Apparently many of the sacral pressure ulcers I have identified are now called by management as "incontinence ulcers", probably so as not to be counted as a ding against the facility. This confuses me, because if patients were adequately cared for by the aides, and the floor nurses knew about the wounds in the first place, there would be much more continuity of care and a reduction in these types of wounds, which yes, I consider to be caused by pressure and exacerbated by incontinence. Forget about the fact that I have not had the time to delve into patient's charts to find out their comorbid diagnoses, lab status, and medications. I see the wound, and only the wound and have only been able to speculate the rest, for lack of time on my part to get the bigger clinical picture of the patients.
So, being that state is coming and apparently I have made myself a liability in my position, I have been rescheduled to the floor and no longer to wound care. Fine by me, because their wound program so far seems like a bit of a joke. There is no team. There is no follow through (other than me, and what I have been able to piece together in my short time in this position). And when I have been able to follow through and be consistent it shows the deficits in the entire care program provided by the facility that the state will probably shoot holes through and tag us. Which, IMO, they probably should. Not that I want the facility to suffer, but there are some serious short comings in care provision that are becoming quite obvious to me. Far be it for me to say aloud. I so far, am happy to not have the weight of the wound care issues on my shoulders anymore.
My question for you is: Does your facility have a wound program? If so, is it a TEAM of people specifically dedicated to wound care? How does this integrate with the floor nurses duties? Any other thoughts?
Feb 6, '12
I have an assigned wound nurse. She evaluates each wound once weekly and documents on specific forms in the resident chart. She can make recommendations for changes in dressings. I am WCC and she the wounds once each month and more frequently if needed. The floor nurses are responsible for all dressing changes. the aides do turn and reposition the freq determined by the wound nurse.
What they have you doing is not feasible as far as I see.
Feb 6, '12
We have a wound team at my facility that consists of myself, my DCDs and the dietician. We round weekly and measure and document on the pressure ulcers. The floor nurses are responsible for the day to day dressing changes. Also, the floor nurses measure wound that are not pressure related the day before we do wound rounds, and we check that it is done during rounds. We also make treatment recommendations and obtain surgery consults if needed. I have worked where there is a wound nurse before, and have seem the same thing you are talking about happen. For whatever reason, the floor staff think because there is a wound nurse, they are not responsible for wound care.
Feb 7, '12
Since the OP did mention the state in her post, I thought I would share this. Go to www.cms.gov
and look up pressure ulcers, or F314, I believe. That should fill you in on what the state is looking at and why.
Feb 8, '12
THanks for the input and for the links. Sounds like it's done differently everywhere. I wonder what system works best.