Development of a Wound Team in a Home Health Agency

Wound and Ostomy Certified (WOC) nurses improve patient outcomes in the home health care (HHC) setting (Westra, Bliss, Savik, Hou, & Borchert, 2013). Wounds account for one-third of all HHC patients (Ellenbecker, Samia, Cushman, et al). Wound care teams are prevalent in acute care settings yet are virtually non-existent in HHC. With a census of 1000 patients and one WOC nurse, a wound care team comprised of HHC nurses was piloted to, 1) further develop wound care skills and, 2) provide field clinicians with greater access to wound care experts.  Seven HHC nurses were selected based on interest in wound and ostomy care and by geographical area to ensure equal access. The team met quarterly for structured education taught by the WOC nurse, to receive updates on advanced wound care and ostomy products, and to interactively discuss complex cases.  WOC team members completed self-assessments at baseline, 6 and 12 months using a Likert-type scale to rate their confidence level in selecting advanced wound care products, applying compression wraps, working with negative pressure wound therapies, performing ostomy care, making alternate wound care recommendations, and instructing other HHC nurses on wound care. Upon completion of year one, confidence increased incrementally in all measured areas except one.  Ostomy care declined at 6 months and was felt to be in response to the education provided as team members became more aware of deficits in this area. At month 12, confidence in ostomy care rebounded. WOC nurses remain an important asset to HHC agencies. By sharing their knowledge and developing the skills of HHC nurses, they are more confident and provide a vital resource to fellow HHC nurses in the field. Future efforts will focus on linking patient outcomes to WOC team nurses and exploring relationships between nurse characteristics and level of confidence.