WOC Nursing In The Correctional Health Care Setting: Results From Two Wound Healing CQI Projects

Correctional medicine, inside the prison, is an untapped area for the WOC nurse.  Jails and prisons vary in population numbers, security level (work release to maximum) and availability of medical care.  This northeastern USA prison system has a daily census of 7,000 to 10,000, yearly intake of 30,000, 6 major housing areas and 5 satellite sites.  Twenty years ago they decided to contract for WOC nurse services in order to better manage complex wounds on site which subsequently accelerated transfers into prison, decrease hospital length of stay, decreased transfers to the ED and referrals to outside wound specialists.   Hospitalization is also a burden to security.  It is typical protocol for one inmate to be shackled in their hospital room and guarded by two correctional officers continuously while hospitalized.  In our 30 bed Infirmary four correctional officers guard all individual rooms and common areas where most inmates can move about freely.      

From 9/1/12 through 12/31/12 a CQI project was conducted in the prison’s Infirmary.  28 patients with a total of 71 wounds were considered for evaluation while 17 patients with 55 wounds meet the criteria of at least one follow-up WOC nurse evaluation.  24 wounds (43.65%) healed, 26 (47.35%) improved and 5 (9%) were unchanged. From 9/1/13 through 1/28/14 a CQI project was conducted in one building’s population wound clinic.  24 patients with 68 wounds were included.  Of these, 44 (64.7%) healed, 9 (13.2%) improved and 15 (22.1%) were unchanged of which all required surgical referral which will be discussed in this presentation.  No wounds deteriorated in either project. 

These CQI projects demonstrate the value of the WOC nurse in conducting regular wound rounds in a prison’s Infirmary and evaluating patients routinely in the wound clinics.  Wound etiologies, therapeutic interventions and implication of wound bioburden will also be discussed as these issues impacted outcomes.