Strategies for survival: development of a skin/wound assessment and treatment protocol for a WOCN service

Introduction to the problem:   Many advanced products are available for the management of wounds and pressure ulcers. However, grey areas exist for WOCN practitioners regarding which dressings require a physicians order. While WOCN specialists are experts in topical management of wounds, to stay within an RN’s scope of practice, many times a physicians order is required.  In our institution physician providers rely on the WOCN service to develop the plan of care for skin/wound management.   After assessment the physicians are contacted via phone to obtain verbal orders for the developed plan of care.

Strategy and its purpose: With the medical director, the WOCN service developed a skin/wound assessment and treatment protocol. The purpose of this protocol is twofold: to manage grey areas involving our scope of practice in assessment and treatment of patients, and to streamline the process of assessment, implementation of orders and communication between the WOCN service and the attending providers.  The provider orders skin/wound care per protocol. The orders are placed electronically by the WOCN service and sent to the provider for a co sign and review. The protocol also benefits our WOCN advanced practice nurses; in our institution a collegial contract with a physician is required to write orders under that provider.

Strategy Discussion: The protocol contains requirements for assessment, documentation and therapy goals for a patient with a pressure ulcer or soft tissue wound. A topical therapy algorithm outlines topical management according to the stage or type of soft tissue injury. The plan of care and products used are based on the WOCN practitioner’s assessment in accordance with the protocol.

Outcome monitoring:  Quality will be monitored by a random review of charts by the Medical director to evaluate the practice of the WOCN Service providers.