Seamless Negative Pressure Wound Therapy from OR to Discharge

Purpose: The purpose of the study was to examine the effectiveness of a multi- disciplinary clinical pathway on implementation of negative pressure wound therapy (NPWT) in the operating room(OR) environment.

Subjects and Setting: The study sample comprised of one hundred and forty three consecutive surgical cases where negative pressure wound therapy was intiated in the peri operative setting. The research environment is in a 350 bed acute care hospital in the Southeastern United States.

Methods:Data collection and analysis were guided by a quasi-experimental pass/fail design. A collaborative approach between the OR, wound ostmy continence nurse (WOCN), surgeon, and the case coordinators was created. All departments worked together to contribute to the pathway. The OR staff was educated on the NPWT process and the surgeons were instructed on the initiation of the NPWT orders prior to the patient advancing to the post-operative setting. The WOCN created a formal notebook with written instructions and machine sign out sheets.  A data sheet, discharge planning tool was created and utilized to calculate and reflect the process compliance. A monthly data report is provided to the OR clinical supervisor. The results are discussed in the staff meetings. The frequent communication of the data reminds the staff of the process.

Results: Initiation of the NPWT clinical pathway was associated with increased NPWT physician order intitation, alternative dressing instructions, WOCN consultations, and collaboration between the surgery department, WOCN, surgeons, and case coordination services. The clinical pathway reached a total compliance rate of 86% from February to August.

Conclusion: Communication tools are essential for health care systems to provide quality care and positive outcomes. The new NPWT Clinical Pathway is a successful communication tool that provides the staff with a  process to prevent variation in patient care with in the surgical environment.