Patients often come into our acute care facilities with complex wound and fistula management problems. They have extended lengths of stay and transfers to sub-acute facilities and/or discharges home are difficult because the care givers in the sub-acute facilities or the family are daunted by the shear difficulty of caring for the wound and fistula.

            A 67 year old woman with a very large mid-line abdominal wound is a case in point. Due to dehiscence and fistula formation within the wound, this patient's length of stay was 7 months. During the course of the patient's stay a great deal of critical thinking and trial and error were needed to find a way to manage the wound, protect the surrounding skin and contain the high output drainage from the fistula.  Then a need for clear and simple instructions for management of the wound by the sub-acute facility or the family became evident. A booklet with simple step-by-step instructions and large images was developed for discharge.

            Each patient is an individual and the wound care needs are very specific to that patient, so mass producing a discharge booklet is not feasible. Each discharge instruction booklet must be individualized to meet the patient's and family's needs. In this particular  case, more than 25 images were taken to illustrate from beginning to end how to approach and accomplish pouching this wound and fistula. Each image was placed on a separate sheet with only one or two lines of instructions. The patient's husband was involved as the photographer and the finished project made everyone, including the acute care staff feel that the process was simple and not as complicated as they thought. The positive psychological effect on everyone involved actually helped to keep the acute care length of stay from being extended even further.