Implementing and sustaining evidence-based practices in long-term care.

Our Journey to Excellence in Wound Care

By: Liliane Boire, RPN, Associate Director of Care, Southbridge Lakehead and Heather Woodbeck, RN, LTC Best Practice Coordinator

Southbridge Lakehead, Thunder Bay

In 2012, the staff at Lakehead Manor (now known as Southbridge Lakehead) was struggling with skin and wound issues. We had a Wound Care Champion whose workload was overwhelming. She did not have time for wound education. She could neither stay current with best practices nor support our staff. There was no team collaboration, no wound care monitoring and little charting on wound care.

We had a case of flesh-eating disease and many pressure injuries. Our lowest point came when the local radio station and newspaper did stories about maggots found in one resident’s wounds. The Ministry of Health and Long-Term Care followed up with a compliance order.

The Director of Care offered support and encouragement. Our new Wound Care Champion met with our Long-Term Care Best Practice Coordinator from the Registered Nurses’ Association of Ontario (RNAO). Working with a few team members, we did the gap analysis for Assessment and Management of Pressure Injuries. We reviewed the practice recommendations. We found the ones that we were meeting, partially meeting, or not meeting. We started our quality improvement work by working on the partially met and not met recommendations.

Our Wound Care Champion took an in-depth education course from Wounds Canada. Other registered staff members, interested in improving wound care, were recruited to our wound care team. Several registered staff and personal support workers (PSW) took a two-day 3M Wound Care course. We built a team of Wound Care Champions with current wound care knowledge and skills. Together we developed a plan to improve wound care at Lakehead Manor.

We began by identifying all the residents with wounds in our home on each unit. Initially, we did not understand how critical evaluating these outcomes would be to our success. We were able to see patterns in the incidence and types of wounds by unit. Some units had much lower rates of pressure injuries than others had.

Providing wound care education for staff became the highest priority. Wound Care Champions did most of the education one-on-one. They focused on the specific wounds on each unit found on the previous month’s wound review. Topics discussed included use of heel booties, prevention and healing of skin tears, and treatment options for wounds.

We soon realized that the best way to care for wounds is to prevent them before they happen. Wound Care Champions reminded PSWs to tell registered staff about any skin changes as soon as they saw them. Registered staff then assessed the wound immediately. They reported findings to the Wound Care Champion. Together they determined the cause of the wound. Strategies were implemented to prevent the wound from getting worse. We introduced pressure reducing mattresses, elbow pads, and sleeves. Heel booties were one of the most successful prevention tools. Recognizing the benefits, our home started providing booties to each resident at risk of heel breakdown.

Our Wound Care Champions also audited wound care. We wanted to know that dressing changes were done on time, as ordered, using the correct product and charted weekly. Staff received direct feedback on their wound care and documentation.

There have been challenges with some staff, who are not Wound Care Champions. A few times, staff required disciplinary action for not reporting early signs of pressure injuries or not taking steps to prevent wounds. Some staff members continue to need mentoring about the appropriate dressing. We realized that ongoing education and mentoring have helped to sustain the use of best practices for wound care.

Our RAI-MDS data and wound outcomes have greatly improved. We are now below the provincial benchmarks. We have progressed from catching pressure injuries at stage 2, to finding them at stage 1. Our new computer system flags reddened areas. Now we do timely assessments, followed by implementing wound prevention plans. We are now preventing most pressure injuries from moving past stage 1. We have few internally acquired pressure injuries. The keys to our success have been early reporting, rapid assessment, and continual monitoring of wounds and wound care.

Residents and families are much happier with our approach to wounds. Our home has now developed a reputation for excellence in wound care.

Our Skin and Wound Committee continues to meet monthly to review wound patterns by unit. Meetings have become shorter because there are fewer wounds to discuss. There have been occasional increases in heel ulcers, skin tears, and other wounds. When this happens, we quickly address the underlying causes. With leadership support, dedicated Wound Care Champions, knowledgeable and skilled staff, and much perseverance, we have achieved our goal of improved wound management at Southbridge Lakehead.

When your heart is in it, and you love what you are doing, anything is possible!

-About Southbridge Lakehead-

Southbridge Lakehead is a 131-bed for-profit long-term care home located in Thunder Bay, North West Ontario in LHIN 14.