Continuity of Care in Complex Wound, Ostomy and Continence in a Pediatric Hospital: A Picture is Worth a Thousand Words

Continuity of Care in Complex Wound, Ostomy and Continence in a Pediatric Hospital: A Picture is Worth a Thousand Words

Purpose:  Continuity of care is important in preventing skin breakdown and impediments in wound healing.   Patients with complex wound, ostomy and continence needs require a specific plan of care for caregivers to follow.  In our pediatric hospital, nurses have different skills and knowledge of wound and ostomies that provide routine care of these patients throughout their hospital stay.  Regardless of nursing experience, staff nurses need confidence and assistance with providing care for these complex patients. Verbal handoff of a complex plan of care may be difficult to interpret, follow and understand leaving the patient with inconsistent care.

In our hospital, appliance and dressing changes provided by the staff nurse led to multiple changes throughout their shift. Different techniques and inappropriate supplies were used. Skin breakdown and compromise to wound healing was noted. The WOCN and the Wound Care RN (WCC) provided the appropriate dressing and ostomy changes in order to achieve longer ostomy wear-time and less skin breakdown. 

Objective:  A step-by–step instruction notebook was created to educate and assist staff nurses and care givers with How To or DIY in taking care of the patient’s needs. This included pictures, supplies required and helpful hints on how to best position the patient, comfort or distract them while doing their care. Nurses gave handoff and families were also instructed on the care of the patient by using the instruction notebook.

Outcomes:  Appliances lasted for the desired wear-time for patient needs.  At discharge, the WOCN/WCC gave handoff to home health nurses by utilizing the instruction notebook.  Patients discharged by using this teaching tool were not readmitted for issues due to skin breakdown or complications to the stoma site.