Swab Cultures in Chronic Wounds and the Impact of NERDS and STONEES

Purpose: The purpose of this project was to evaluate nursing obtainment of swab cultures of chronic wounds that displayed signs and symptoms of infection when utilizing the NERDS and STONEES assessment mnemonic during the standard nursing wound assessment process. Participants and Setting: Nurses providing wound care to patients with chronic wounds of mixed etiology in an outpatient setting.Approach: The NERDS and STONEES mnemonic has been validated and shown to be an effective assessment tool among wound specialist. Pain is an indicator of infection and critical colonization of bacteria. The tool was adapted to help capture the assessment of pain as a symptom of infection/critical colonization in both the NERDS and STONEES mnemonic. The adjusted assessment tool was then integrated into the nursing workflow using the Plan Do Study Act (PDSA) model. Nurses used the adapted NERDS and STONEES assessment tool for every visit. During an 8 month period of time, chart audits were used to measure the number of wound swab cultures that were obtained with documentation of the presence of greater than or equal to 3 signs and symptoms of infection and those obtained with less than 3 signs and symptoms of infection. Outcomes: Evidence demonstrated an increase from 47% to 76% of swab cultures obtained had greater than or equal to 3 signs and symptoms of infection. Nursing staff reported increased confidence while assessing chronic wounds and reporting their concerns to providers.Implications: The NERDS and STONEES tool has been shown to improve collection of swab cultures supported by clinical assessment that indicates an increased level of infection in chronic wounds there by, providing improved clinical evidence of infection and the ability to determine subsequent interventions.