Utilizing Evidence Based Wound Care in the Home Care Setting

A large home health care agency in Southern Indiana comprised of registered nurses and licensed practical nurses often performed complex wound care with little to no formal wound care education. Antiquated practices, inclusive of multiple dressing changes per day, resulted in increased product and nursing care raising costs for the agency.  Collaborative efforts between the home health care agency and CWOCN enabled the development of a formal wound care curriculum and a standardized dressing decision guide for field nurses. The practice in wound management was redesigned to correlate with current evidence by reducing dressing changes from daily changes to once every 3-5 days. Monthly in-services captured key concepts pertinent to wound care management. Participating nurses were administered pre and post surveys. The 4-point Likert scale measured nurse comfort level in performing wound assessment, documentation, intervention, and patient education.  Nurse comfort level in these areas improved significantly with in-servicing. After education was provided, 61% (n=10) of surveyed nursing staff demonstrated “comfort most of the time” when discussing the need to change wound care for patients in the home care setting. Additional outcomes reflected post education, 85% (n=27) of nurses felt “comfort at all times” when managing needs of patients with lower extremity venous disease compared to 37% (n=12) prior to education. The wound care product inventory was analyzed to identify duplication and unnecessary usage.  Cost analysis resulted in an immediate cost savings of greater than $3000. Development and implementation of an evidence-based wound home health care core curriculum aids in saving the organization expenses through unnecessary costs of wound care supplies. Additionally, a standardized dressing selection grid guides staff in decreasing the number of visits needed to perform wound care. Opportunities exist for CWOCNs in the acute care setting to lead collaborative efforts in successful evidence based home care delivery practices.