Purpose: Consistent, competent wound care was identified as an unmet need in the LTAC setting. The two primary diagnoses that provide the greatest potential for positive reimbursement in the LTAC setting are ventilator weaning and wound care. Therefore, the need for expert wound care to deliver the best outcomes was recognized.

Objective: Prior to the wound care team (WCT), skin/wound assessment and care was staff nurses' responsibility. Despite multiple educational opportunities and one-to-one interaction with nursing staff by the clinical nurse specialist (CNS), the wound care delivered was highly variable. This was reflected in inadequate or incorrect documentation, patient status when seen on wound rounds, and varying unit-based practices. The goals for initiating a wound care team included: consistent assessment of current skin state and pressure ulcer risk, consistent wound care according to established protocols, consistent documentation via a web-based documentation system*, decreased waste in supply utilization, itemization of actual wound care cost, decreased pressure ulcer incidence rate, documentation of wound outcomes (e.g. healing rate), improved communication, and enhanced patient satisfaction.

Outcomes: Since the implementation of the wound care team in February 2005, the following outcomes have been recognized: improved reliability of Braden Risk Assessment scoring, improved skin & wound-related documentation, consistent wound care rendered by specially-educated nursing staff, enhanced communication regarding skin & wound issues due to presence of wound care team RN in interdisciplinary rounds, real time availability of reliable data re: wound healing and wound type, wound prevalence & incidence, effective utilization of products, no patient complaints regarding skin and wound care, positive feedback from third-party payors regarding improvements in wound status and improvement in transition from inpatient to outpatient wound care.

*WoundExpert (Net Health Systems, Inc.)