NY hospital achieves TJC wound care certification

20 hospitals so far have been certified

Just four months after deciding to apply, South Nassau Communities Hospital underwent and passed a survey by The Joint Commission for certification in wound care, making it the first hospital in New York to achieve that status, and just the 20th in the country.

Wound care isn’t glamorous, but it is important to the overall well-being of patients and the bottom line of hospitals. And it’s not just diabetic patients who need this kind of care. South Nassau wound care patients include those with pressure ulcers, venous or arterial insufficiencies, traumatic wounds, and radiation burns.

Laura Righter, RN, administrative director of the 15-year-old wound care center at the hospital, says that achieving the certification took a team effort, including nurses, physicians, and support personnel from nutrition, pharmacy, and physical therapy, among others. The journey began a year ago, when the organization received a scholarship for some of its nurses to become certified in wound care. By last summer, executives were impressed enough with the wound care rates — about 95%, which is above the national average — and patient satisfaction that they decided to go for the Joint Commission certification.

The site visit was in December, Righter says, so they had four months to go through the certification standards, page by page, and see what needed tweaking or improving. “We have just six providers, and a medical director who is really on board,” she says. “He’s very into standardization, and although physicians have the freedom to deviate from standards with good reason, they have to justify it. And if after a month it’s not working, it’s back to the pathways we have established.”

That standardization probably made the certification process easier for South Nassau, she says. In addition, there is an existing collegial mentality strengthened by a decade of regular monthly team meetings where they talk about quality improvement opportunities and brainstorm ways to deal with difficult cases.

Given the maturity of the program, what is it that certification brought? Righter says it was a new focus on digging deeper into the data. “We looked at the broad brush data like healing rates, but after the survey they told us we should delve more into them.” For example, they knew their healing rates, but what is it for each physician? For each wound type? And what is the cause of any deviations?

The surveyors also had suggestions for improving data collection, she says. “For instance, if we were monitoring the blood sugar of diabetic patients by having them self-report, and their A1C data didn’t jibe with what they reported, we should look at why.” They now accept those self-reported blood sugar rates, same as before, but the wound care staff also do their own blood tests to see if there are any discrepancies that aren’t the result of an intervening meal. “We picked up two people in the last month who were non-compliant and were not really doing their blood sugar readings. We sent them for endocrinology consults.”

Another example was doing monthly weight and BMI monitoring. That’s fine, but you often miss the beginnings of nutrition problems with underweight and low-normal weight patients. Righter says they took on board a suggestion to look at that metric weekly so they can see potential problems earlier. Already one patient who was losing weight has been counseled and provided with protein supplements to keep her weight up and healing on track.

Righter says getting the certification shows the community that they have a commitment to providing the highest standard of evidence-based care. It also gave the staff of the center a sense of validation that what they were doing is great, as well as the impetus to keep reaching higher.

Another benefit of disease-specific certification is that it can galvanize other departments or units to seek their own certification and thus improve patient care, says Jean E. Range, MS, RN, CPHQ, executive director of disease-specific care certification at The Joint Commission. “Other departments take notice when you have a successful certification.” You might notice a sense of competition between units or departments as they vie to improve their own care processes. “Organizations tell us this over and over: When one group gets a certification, other service lines want to do it so they can get that acknowledgement.” That a certified service line may get more resources to help them with the increased data gathering and reporting requirements only increases that competitive desire.

Within the unit itself, Range says, it creates camaraderie and enthusiasm across the team as they work toward a common goal. “That can translate to teams working better together for other projects.”

While wound care certification allows facilities to set their own goals for performance measures — versus a certification for something like stroke centers where there are standardized measures based on national norms that every applicant has to meet — Range says a facility that engages in certification will have little variation in care, and that alone will improve outcomes for patients. “This gives a facility the opportunity to really monitor the care you provide and align it with evidence-based guidelines related to it.”

The biggest hurdles for organizations seeking wound care certification seem to be getting all the stakeholders on board, from senior management down, Range says. “Physicians often have their own way of doing things and may interpret best practices differently. You have to get to some place of agreement, so that you are all implementing evidence-based practice the same way, and that it is baked into the process,” she says. “You all need to understand why you are doing what you are doing, and that it is implemented systematically across the entire patient population.”

Even if you don’t want to go through the entire certification process, Range says any organization can learn from the program. “Over and over we hear that facilities who think they have a great program obtain the manual and go through it line by line. When they do a gap analysis, they can see the things they are missing. You can learn to improve care.”

If you do decide to go for certification, don’t think that once you get it, your work is done. Although site visits are done every two years, Range says that in the off year they have extended conference calls during which a program must demonstrate that it is continually looking at its measures, discuss its data collection, and show its quality improvement activities. “We expect very active continuous involvement,” she says.

As the population ages, there will be more and more patients with the kinds of conditions that lead to intractable wounds, Range concludes. “This is a program where everyone can learn something.”

For more information, contact:

  • Laura Righter, RN, administrative director, Wound Care Center, South Nassau Communities Hospital, Oceanside, NY. Telephone: (516) 255-8504.
  • Jean E. Range, MS, RN, CPHQ, Executive Director, Disease-Specific Care Certification, The Joint Commission, Oakbrook Terrace, IL. Telephone: (630) 792-5800.