An Evaluation of a Wound Provider Program

Timothy Larsen, DNP, RN, APRN, CWOCN, Connected Care, Cleveland Clinic Medical Care at Home, Independence, OH and Mary Beth Zeni, ScD, RN, Gradulate Nursing, Ursuline College, Pepper Pike, OH
An evaluation of a Mobile Wound Provider Program

In a large medical center in Northeast Ohio, the Medical Care at Home division has a Mobile Wound Provider program since 2013. Program providers include a Medical Director, 2 Advanced Practice Registered Nurses (APRNs) Certified Wound Ostomy Continence Nurses (CWOCNs) and a home care team of Wound Ostomy Continence (WOC) nurses.  The purpose of this study was to evaluate the effectiveness of interventions provided by the APRNs CWOCNs within the home care setting on patient outcomes.   APRN interventions included evaluating and assessing wounds; prescribing treatments, therapies and medications; ordering home care and other services; performing conservative sharp wound debridement of wounds and ordering supplies and other medical equipment.  Dependent variable was changes in wound measurements.  

Methodology- A retrospective study was conducted with 25 patients over a 90 day period who received at least 2 home visits by the APRN.   Descriptive data included wound locations, type of wounds, co-morbidities, prescribed medications, debridements and total number of APRN visits.  Per and post-intervention wound measurements were compared.   

Results:  Visits per patient ranged between 2-7 with a total of 79 visits.  Wounds ranged from 1-5 per patient.  Significant changes were found in pre and post-intervention wound measurements with X2(2)= 8.0, p < .05.  56% wound improved, 24 % remained the same and 20% declined.   

Conclusion:  The Mobile Wound Provider Program practices a comprehensive care model.  The use of APRN CWOCNs was justified. 

APRNs worked closely with home care colleagues to ensure consistent patient care.  Patients are seen in the outpatient setting (nursing homes, long term care facilities, assisted living facilities, private homes and hospice) and ARRNs provide a consultative service for other home care agencies.   APRNs can bill independently.   The program continues to grow and flourish.