Please Don't Disturb Me, I'm Healing

Introduction

Wound care in the hospital can become costly if dressings are replaced too frequently. Wounds that worsen can have financial implications due to penalties and the cost of care, reimbursement and quality ratings. Injuries can be painful and costly for patients and can affect quality of life.

Problem

Hospitalized patients typically have more tubes and lines that can make ambulation more difficult. Patients are often moved by care givers causing friction and shearing. Typical use of gauze and tape often shears off from boosting and turning patients. Tape can cause trauma to the skin and sheared off dressings disrupt wound healing. Dressings that would typically be changed each shift often need to be changed more frequently.

Method

We moved to a foam border dressing to prevent the frequency of replacing gauze dressing and promote an undisturbed wound healing process.  Nurses were instructed not to replace the dressing unless it was soiled or came off. The WOC monitored the wounds and pressure injuries to assure they remained undisturbed and then photographed the outcomes.

Results

We found that the border dressing stayed on the wound, absorbed exudate pulling it away from the wound and promoted an undisturbed wound bed with no evidence of friction and shearing. All wounds and pressure injuries decreased in size or resolved prior to discharge.

Discussion

Changing the practice or culture of dressing changes every shift is difficult for nursing to adapt to and understand. Buy in was trying at first. We provided education at the bedside with rationale for undisturbed wound healing. Evidence was the key to getting the nurses to visually see the progress a wound can make with this type of dressing.