Teamwork and Collaboration for Transitioning Wound Care Patients From Acute Care To The Home Care Setting.

Team work and collaboration is such an important part of wound care. Patients with wounds need to receive the most comprehensive care to facilitate healing. This care includes patient and family education by the nursing staff and physicians, though there has been evidence that home care givers feel they have not received the tools to manage their family member’s health care at home. When we are tasked with wound care, there are many different avenues that can introduce issues. These issues can be resolved or improved upon with education, a sense of instilled confidence, and hands on practice made more readily available to home caregivers. Working together to bring about a fuller wound care experience can result in better healing and health for the patients involved.Nonprofessional caregivers attempting to clean and dress a wound at home can become overwhelmed. “In a recent study of the challenges faced by family caregivers, caregivers reported receiving some instruction prior to performing wound care, but 42% stated they learned on their own” (Kirkland-Kyhn, 2018). This study also showed that more than half the participants felt the care they had to provide was difficult. The feelings of the home caregiver include fear of causing harm or making a mistake, as well as the concern that the time it takes to provide wound care is an inconvenience. Wound care is not a linear process for all. Depending on the wound and patient involved, instructions should be individualized to the situation and made clear to all who must perform it. Inappropriate wound care can cause more harm than good. Further infection and worsening of the wound are all issues that arise with improper education. Underlying factors other than dressing a wound such as diet, lifestyle, and medication regimen all need to be addressed as well. To reiterate, it is so important to individualize care to each patient and family. Opening that conversation and getting a complete picture can give the nursing staff a better understanding of education required. Team work and collaboration stands at the forefront of the wound care process. Nursing, acute care clinicians, doctors, and case managers are responsible for providing accessible patient and family education. Utilizing different aspects of education such as verbal, written, and video can provide a fuller experience. Discussions about the patient’s care after discharge should start as early as possible to ensure that the home caregiver can mentally process their duties as well as ask questions and voice any concerns they may have. “Nurses should provide information in a clear manner, including instructions and details about how to obtain supplies, and strive to promote a discussion in which questions and mutual problem-solving are encouraged” (Kirkland-Kyhn, 2018). The greatest moment for patient and family/home caregiver education is while the nurse or medical staff provider is doing the actual wound care. If possible, engage in wound care when the family or caregiver is present. Provide verbal step by step instructions, as well as printable or video instructions, and illustrations on the process. The more content available the better. Making the patient and their family and caregivers active participants in the plan of care creates more opportunities for education. It is highly important to discuss the signs and symptoms of both local and systemic infection, and when to call the primary care physician. Something as simple as washing your hands before care can minimize readmittance to the hospital for infection. Nonhealthcare people may not fully grasp the importance of what medical professionals know to be evidenced based practice. Begin a conversation about the etiology of the wound such as diabetes, pressure, venous insufficiency, or surgical. This enables education to be given on all processes, and how to avoid further complications. Ideally this further information will open willing conversation on diet and lifestyle changes needed, as well as the possible need to reposition the patient to offload their pressure wounds. Engaging all involved and giving that education and information can lessen the reoccurrence or further disturbances to the patient’s present health. We want to be able to provide healing, maintenance, and comfort during the patient’s acute care stay and into the future at home. So overall, teamwork and collaboration between the nursing staff, case manager, physician, acute care clinician, medical insurance company, family, patients, and home caregivers needs to be elevated. Wound care should not be left up to chance. Infections, losing an extremity, deteriorating health, and possible death should not be due to fear of providing wound care or its perceived inconvenience. “Patient and family engagement and education, including their goals and concerns, are fundamental to a successful transition” (Earlam, 2018). Opening that line of communication, and providing the education needed in many forms for wound homecare suppliers could minimize complications. All involved in the plan of care for our wound patients should make it a priority that when these people are discharged, they are armed with the knowledge and resources needed to be taken care of. Providing support, education, and care is the goal for transitioning wound care patients from an acute care setting to the home care setting.  References: Earlam, A.S., DNP, MPA, BSN, RN, CWOCN, Woods, L., MSN, RN-BC, CWOCN, & Lind, K., BSN, RN. (2018). Transitioning wound care patients to post-acute care Setting goals and meeting needs. American Nurse Today, 13(1), 28-29.Kirkland-Kyhn, H., Generao, S. A., Teleten, O., & Young, H. M. (2018). Teaching Wound Care to Family Caregivers. AJN, American Journal of Nursing, 118(3), 63-67. doi:10.1097/01.naj.0000530941.11737.1c Johnson, C., RN, BSN, WCC, LLE, DAPWCA. (2018). Providing wound care in the home: An option to explore. 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