Community WOC Nurse Role in Caring for Complex Pediatric Patients

Background: Skin breakdown is more common in pediatric patients than in adults. This is particularly true in complex care pediatric patients with developmental delays, Spina Bifida, and Cerebral Palsy.  Wound care issues facing this population include gastrostomy tube leakage, device related pressure injuries, and non-healing surgical wounds. Ostomy issues include poor pouch adhesion due to spasticity and frequent movement and challenges with abdominal topography. Practice Problem:   Complex patients may have limited access to care in medical center facilities secondary to transportation and logistics. Aim: Increase access to wound, ostomy, and continence nursing care for pediatric patients in the community. Methodology:  A WOC nurse was hired by a large pediatric quaternary hospital system to serve its 2 community hospitals and facilitate WOC nurse care across the hospital system. Programs were developed that focused on continuity of care for the inpatient population transitioning to outpatient care with the emphasis on training and support for parents, caregivers and school nurses.  Results: Expansion of the WOC nurse practice into the community setting has resulted in: 1) increased patient access to a WOC nurse consultant through a nurse led clinic 2) increased care coordination through WOC nurse involvement in the Complex Care Clinic; 3) increased knowledge via workshops and education for school nurses, caregivers and community groups in order to support this complex population on a daily basis. Conclusion:  These practices have served to increase collaboration with physicians, multiple disciplines and the care team and to incorporate complex care patients into the school setting.  In addition, needed supplies are now arranged and proper wound and ostomy care techniques are carried out in the home setting resulting in decreased ER visits, expedited wound healing, and extended pouch wear time.