Introduction to/History of the South West Regional Wound Care Program

Image of three Wound Care Champions.

In a prevalence study conducted by the South West Community Care Access Centre (CCAC) in December 2007, considerable opportunities were identified for improving client outcomes and resource utilization regarding evidence-informed wound care delivery.  Discussions with other health care system partners in acute care and the South West Local Health Integration Network (LHIN) identified that similar opportunities existed across the South West health care system.

The South West CCAC determined that the unique opportunity that presented would encompass not only an internal South West CCAC wound management program to realize excellence in wound care, but also provide an opportunity to collaborate with their partners to achieve a shared 'Vision'. While each sector (hospitals, long-term care, community and primary care) supports the wound types of the populations they serve, alignment of wound care practices across the continuum will achieve continuity, efficiencies and productivity within the health care system.  This would mean that no matter where an individual with a skin or wound issue would be receiving care in the South West LHIN, that they would receive a similar level of excellent evidence-informed skin and wound care, and that this plan of care would be continued if they were to move to a different health care sector or geographic area within the region.

The goal was to not only standardize a level of excellence in skin and wound care based on evidence-informed best-practice guidelines and current literature, but to involve health care providers from many disciplines and sectors in the development of the Program. This was an innovative and inspired model of collaboration in order to improve the care and use of human and fiscal resources for skin and wound care in the South West LHIN.

With the support of the South West LHIN, the South West CCAC hired a project lead (Connie Harris), and a Strategic Steering Committee for the Program was struck (May 2009), who collectively developed and implemented:

  • Clinical protocols for system-wide application of evidence-informed wound care;
  • A sustainable system-wide wound care education model and processes for quality evaluation;
  • A model for effective wound management product selection across all sectors, and;
  • A sustainable and effective business model for the procurement of wound management supplies across all sectors.

The Strategic Steering Committee struck three subcommittees to address the specific areas related to clinical evaluation, education and implementation, and product evaluation and product procurement, with sub-committee representation from acute care, community, long-term care (LTC), and primary care across the geographic region.

Multidisciplinary environmental scans conducted via focus groups and clinical practice surveys in 2009-2010 identified that there was a wide variation in the wound care practices of health care partners in the region.  LTC Home facilities had prioritized pressure injury prevention and management, and some acute care and community organizations had implemented a few of the Registered Nurses Association of Ontario’s Best Practice Guidelines about chronic wound care, but there was no standardized application across the sectors. There was no agreement as to the method of wound assessment, wound cleansing, or recognition of signs and symptoms of infection and appropriate interventions. Wound care product availability differed from sector to sector so that difficulty and expense occurred when individuals with wounds transferred from sector to sector.

Based on the results of the environmental and clinical scans, and their own observations in their work environments, the Program’s sub-committee members decided to start with the foundational basics of wound care, that of ‘Wound Bed Preparation’ (figure 1).

   Figure 1: Paradigm for Preparing the Wound Bed1   

Figure 1 - Paradigm for Preparing the Wound Bed

Together, the sub-committees endeavored to create a practical, adaptable collection of resources, accompanied by educational components, with the intent of improving the levels of competency and skills in the planning and delivery of skin and wound care in the region, known as the ‘Toolkit’.  Provided in a toolkit format at swrwoundcareprogram.ca, the Program’s website contains:

  • Assessment and documentation tools based on the best available evidence, along with instructions for use and literature resources for additional reading/learning;
  • Teaching and learning resources to help health care professionals increase their knowledge about the processes of teaching and learning;
  • Resources for Personal Support Workers and their managers;
  • Information on determining healability, debridement types and indicators, and management of localized infection;
  • Algorithms to direct appropriate wound cleansing, choice/application of adjunctive therapies and interdisciplinary referrals;
  • Information about various wound and ostomy etiologies, expected goals, teaching handouts, and relevant published articles, and;
  • Wound dressing selection aides.

In May 2013, upon the resignation of Connie Harris, new Program (Samantha Colwell-Castles, MSc) and Clinical Leads (Crystal McCallum, RN MClSc) were hired to revitalize the Program, with the initial focus being to engage the LTC Home sector, which has been achieved.  In addition, the governance structure of the Program was reviewed and modified to ensure equal regional representation from acute care, LTC, and community care, and with interprofessional membership as well.  The Program’s "Mission and Vision" statements were updated, as was the Program's "Strategic Direction" and goals.  A ''Code of Ethics'' and Program ''Values'' were developed, and further work was done on the existing 'Toolkit', updating historically posted information, and creating new resources. 

Copyright
With the exception of those portions of this 'Toolkit' for which a specific prohibition or limitation against copying appears, the balance of the 'Toolkit' may be produced, reproduced and published in its entirety, without modification, in any form, including in electronic form, for educational or non-commercial purposes.  This information, based on current research, will be updated as new information arises and can be used to develop wound management protocol, policy, documentation or educational materials within a unit, program or region.  

Appropriate credit or citation must appear on all South West Regional Wound Care Program copied materials as follows:  South West Regional Wound Care Program: Toolkit. London ON. 2011. www.swrwoundcareprogram.ca

Reference
1.  Sibbald RG, Orsted HL, Coutts PM, et al.  Best Practice Recommendations for Preparing the Wound Bed: Update 2006. Wound Care Canada. 2006;4(1):15-29.

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