How Community-Based Health Care Providers Can Manage Hard-to-Heal Wounds

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I'm Cathy Milne. I am an adult nurse practitioner and certified wound ostomy continence nurse, advanced practice nurse, and I practice in Connecticut for Connecticut Clinical Nursing Associates.
 
I was thrilled to have the opportunity to get together with several of my colleagues to come up with these Hard-to-Heal Wound Guidelines for Community Health Practitioners.
 
What are the biggest challenges faced by community-based healthcare providers in addressing hard-to-heal wounds?
 
Community health practitioners have a number of challenges. They have to see anything from asthma to stroke to chest pain. They have very complex patients and they don't have any time to see them. So that's number one, that's a big challenge.
 
Number two is that the education of a community health practitioner is minimal in terms of wound care. We know that surgeons get less than three hours in their entire training. So a community health practitioner's primary care, urgent care, they get very little. Urgent care gets some in acute wounds. Home health, we don't know what they get because it varies. So that's another challenge. And they take care of over 80% of the wounds that are out there in the world. And their patients come to them first.
 
And then the third barrier and challenge is that they don't know what they don't know. And so they don't refer to us fast enough. And so what that does is increase costs, increase utilization, and the patient suffers because of that.
 
What were the panel’s recommendations for identifying and treating these wounds?
 
So we've recognized that there's a triage system that needs to be in place and the community health provider is the first stop, whether it be a home health nurse, whether it be a long-term care nurse, whether it be urgent care, primary care, and so we've separated these guidelines into what can a community health care provider do for these patients and when can they refer, what's the that red flag so they get into see us the specialist sooner? So that's number one.
 
And number two, we've come up with a toolkit because a lot of times you don't have the things in the office that you need. Maybe you know what you need but you don't have it. So now we've said this is what you should have available to you at all times. So at least you can start some very good wound care.
 
What practical adjustments can CHPs make based on your poster’s findings?
 
Well, first of all, they can take that toolkit and go to their manager or somehow their purchasing department and say, "This is what I really need because I see X amount of patients with wounds in my setting." And then standardize that toolkit and then also get education about those red flags and teach their other colleagues about what those red flags are, which is a poor healing rate, or people that are at high risk that you know all of a sudden just because they look OK, they have some type of underlying disease state that's going to make their wound hard to heal right off the bat, so they know who to refer early on in the process.