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Now is not the time to be satisfied with the status quo, wound care specialists say. Increased specialization, larger numbers of elderly patients, the growing dominance of managed care, and technological advances are fueling dramatic changes in wound care. It is quickly becoming a distinct field of practice requiring specialized knowledge.
"Wound care is a high-tech field now. It requires expert knowledge, right down to the microcellular level," says Kristy Wright, RN, MBA, FAAN, ET, marketing specialist for the Wound, Ostomy, and Continence Nurses Society (WOCN) in Costa Mesa, CA. "This means there are more products on the market so many that it’s hard to know which is best without knowing why and how it works and who it will work on," she adds. "Plus, with the trend toward managed care, including managed Medicare, which has grown 30% in the last year, wound care is now done less in institutionalized acute care settings and more in subacute or home care settings."
Keeping pace with the changes requires continuing education. New organizations are forming to arm wound care specialists with the knowledge and credibility they need to adapt to the changes, improve outcomes for their patients, measure up to stricter quality standards, and at the same time, advance their careers.
"In addition to educating wound care specialists, the specialists need to be educating the actual caregivers," says Wright. "That could even include a daughter or wife of a patient or a visiting nurse doing home care."
In the past year, two organizations have formed to address these needs: the Wound Care Institute (WCI), a nonprofit educational organization based in Miami Beach, FL, and the American Academy of Wound Management (AAWM), with headquarters in North Bay Village, FL. The WCI is a nonprofit organization dedicated to disseminating information on wound healing and diabetic foot pathology to practitioners involved in wound care. It was founded in September 1995 by Tamara D. Fishman, DPM, as a result of her own frustration trying to gather up-to-date information on the overall management of wound care patients. Already, it offers a speakers’ bureau, a newsletter, consultations, a medical library, and an educational site on the organization’s Internet home page, says Fishman.
The AAWM was established to credential multidisciplinary practitioners involved in wound management. Though they provide different services, both organizations have a similar mission: to advance the science of wound healing and provide better quality care to patients suffering from acute or chronic wounds.
But with the emphasis on wound care changing from nurse-oriented to an interdisciplinary approach, the new programs offer educational opportunities for doctors, dietitians, home health providers, diabetic educators, physical therapists, and others. The WOCN Internet site located at http://medicaledu.com features both didactic information and a complete product index to rapidly and accurately provide information to any health care professional who renders wound care. (For more information on professional opportunities, see related story, p. 56.)
"We need to refocus the industry’s thinking about wound care to emphasize the interdisciplinary approach, where podiatrists should play an active role in lower-extremity wounds," says Fishman. "We also need to restructure our treatment protocols into management protocols, managing the patient’s underlying medical condition, such as diabetes, instead of just slapping on a wound care product to treat the diabetic’s foot wound."
"Health management," not just disease-based treatment, is a major focus of managed care. The philosophy goes hand in hand with disease prevention through the team approach, Fishman says. She believes medical caregivers from all disciplines should work together to understand the pathology and management of a disease and its causes and symptoms, so ultimately they can help patients avoid or deal with that disease.
For example, she points out that the nutritional status of patients usually is neglected in the cases she sees. But in a health management environment, a nutritionist would be a key caregiver. This multidisciplinary team approach in wound treatment is also emphasized by Mike Freedman, administrative manager at the AAWM, which offers board certification Certified Wound Specialist (CWS) status to a variety of practitioners.
"Within a wound care program, in addition to a doctor and a nurse, there might be an occupational therapist, a podiatrist, and a dermatologist," he says. "Since we started . . . we’ve received about a thousand certification applications. That’s more than we ever expected."
Now, through WOCN and AAWM, there are certification programs for specialists treating everything from diabetic, venous, ulterior, and pressure ulcers, to burns and fasciitis. To qualify for certification from WOCN, applicants must submit competency information based on how much experience they’ve had before sitting for the exam. Similarly, those seeking certification from the AAWM before December 1998 will pay $400 to apply and must either pass an examination or submit a portfolio documenting their previous wound care experience. After 1998, credentialing only can be achieved through examination.
Those who earn board certification through the AAWM will be listed in the National Registry of Board Certified Wound Specialists in the spring of 1997. They also will receive discounts on the Academy’s continuing medical education programs, plus a subscription to its quarterly publication. In addition, new certified wound specialists can participate in a research consortium, can serve on committees, and can help shape the future of wound care delivery.