Challenges of different wound practice settings

Jan Cuzzell, RN, MA, CNS, vice president of THA services, a home care management company in Savannah, GA, has written extensively about wound care. In a chapter included in a recently published anthology, Cuzzell describes the opportunities and challenges of wound care when undertaken in various practice settings. (Cuzzell J. "Wound care in alternative settings." In: Krasner D, Kane D. Chronic Wound Care. 2nd ed. Wayne, PA: Health Management Publications; 1997, pp. 303-308.) Here are a few excerpts from her book chapter:

Hospitals: "With decreased inpatient utilization, progressive downsizing of hospital administrative and professional staff and redesign of work processes are also likely to occur. Nonprofessional staff will be trained to perform tasks such as simple dressing changes, and professional nurses will assume a less hands-on’ role."

Subacute and transitional care facilities: ". . . wound care specialization is in its infancy in this setting. The patient population in general is at high risk for skin breakdown and delayed healing. In the future, optimal and cost-effective patient outcomes may depend largely on the availability of expert’ resources to assist with care planning, as well as educational preparation of the staff in wound prevention and treatment."

Rehabilitation facilities: "An increased focus on education and the availability of highly specialized wound consultants to serve as a resource for protocol development and care management would greatly enhance the quality of service provided in most rehabilitation settings."

Long-term care facilities: "Nursing homes have long been plagued with wound care problems. Either patients are admitted from the acute or home care setting with open wounds, or a lack of emphasis on prevention results in a high incidence of skin breakdown and pressure ulcers."

Home care: "Home care remains one of the fastest-growing and most economical settings in which to render wound care. . . . [Studies] suggest that wound care expertise is also lacking in home care, and that increased emphasis needs to be placed on standardization of treatment protocols and problem-specific patient outcomes."