Debra Johnston, MN, RN, WOCC(C)1, Marg McKenzie, RN, CCRP2, Dr. James Mahoney, MD, FRCS(C)3, Dr. Mantaj Brar, M.D., F.R.C.S.C4, Leslie Heath, MCLlSc-WH, RN, WOCC(C)5, Nicole McGrath, RN, BScN, MScN6, Estrella Mercurio, RN, BSN, MA, GNC(c), WOCC(C)7, Dr. Giuseppe Papia, MD, MSc, FRCSC8, Emily Pearsall, MSc9 and Dr. Robyn McLeod, M.D., F.R.C.S.C9, (1)Wound and Ostomy, Toronto General Hospital, Toronto, ON, Canada, (2)Zane Cohen Centre for Digestive Diseases, Best Practice in Surgery, University of Toronto, Toronto,, ON, Canada, (3)Chief Division of Plastic and Reconstructive Surgery, St. Michael's Hospital; Medical Director Wound Healing Program, St. Michael's Hospital; Medical Director, Perioperative Services, St. Michael's Hospital, St. Michael's Hospital, Toronto, ON, Canada, (4)General Surgery, Mount Sinai Hospital, Toronto, ON, Canada, (5)Toronto General Hospital, Toronto, ON, Canada, (6)Toronto Central LHIN, Toronto, ON, Canada, (7)ParaMed Home Health Care, Toronto, ON, Canada, (8)Department of surgery: Division of cardiac and vascular surgery; Department of critical care medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, (9)Best Practice in Surgery, University of Toronto, Toronto, ON, Canada
Background: Transitioning a patient with closed or open surgical incisions from acute care into the community is often complicated due to the lack of wound care expertise by prescribing surgical teams, lack of available of WOCN/ WOCC nurses for wound consultation, strained communication between key stakeholders, and the differing wound care product formularies in various health care sectors. In an effort to promote best practice in surgical wound care, a collaborative project was sought
by the quality initiative committee at the local university and the Local Health Integrated Network (LHIN) Home and Community care.
Objective: To develop an evidence-based clinical practice guideline for the management of patients with closed and open surgical wounds from their surgical procedure through to their transition back to the community. This guideline is intended for use by surgeons, fellows, residents, hospital and community nurses and other health care professionals involved in the management of closed and open surgical wounds.
Methods: Over the course of two years, an interprofessional group of advanced practice nurses specializing in wound care, surgeons, patient partners, members of an Ontario LHIN, and knowledge translations specialists developed an in-depth guideline based on evidence and expert consensus where evidence was lacking. A consensus meeting was held with 40 representatives from all hospitals and LHINS where the guideline will be implemented. The guideline provides recommendations on preoperative risk assessment, topical wound care management of closed surgical incisions, infected and non-infected dehisced surgical incisions healing by secondary intention, and discharge planning and care.
Outcomes: The guideline will now be implemented across several academic sites. The implementation plan includes changes to the local LHIN referral, development of an app with a built in algorithm to determine appropriate wound care management, educational slide decks, and other educational resources.
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