Best Practices in Wound Care: Spinal Cord Injury Service leads the way

March 25, 2013

The Spinal Cord Injury Rehabilitation Service at Helen Hayes Hospital is a wonderful and amazing place and I am proud to serve there as the Nurse Manager. Our team of rehabilitation specialists provide the most up to date medical care and we are experts in treating patients with complex needs related to their spinal cord injury. From ventilator weaning to highly advanced technologies for seating, communication and enhanced control of the environment, to the most current physical and occupational therapy technologies, the Spinal Cord Injury Service gives every patient the opportunity to reach their maximal degree of independence and function. But we don’t just do the sexy stuff. There are many, many things that patients with spinal cord injuries must learn to manage and cope with and we address those needs, too. As the Nurse Manager, every patients’ well being is important to me, but I do have a few areas of special interest and I want to share one of those interests today.

Patients with spinal cord injuries are particularly prone to developing trauma to their skin and underlying tissue because of pressure. They are impaired in their ability to move themselves and often have impaired sensation and can’t feel when a wound might be developing. Pressure ulcers are dangerous for a number of reasons, most notably as a source for infections that can cause serious illness and even death. Wounds can take months or longer to heal, interfere with doing therapy and limit seating time. Their treatment can extend the length of hospital stays, often require expensive, long-term antibiotic use, surgical debridements, or cleaning of the wound and a relatively new negative pressure therapy that uses suction to bring blood to the wound to promote healing.

If you are reading this blog, it is likely that you are aware that hospital acquired pressure ulcers were one of several medical complications deemed unacceptable by the Centers for Medicare and Medicaid Services (CMS). Because wounds were felt to be avoidable, had a high degree of morbidity (caused additional medical problems) and greatly added to costs, CMS put in place financial penalties for the institution where the wound developed. While wounds are awful for the patient, hospitals would now also suffer for having allowed a wound to develop.

In anticipation of these new CMS regulations, we proactively undertook a review of our wound care processes hee at HHH. This was a multidisciplinary and multilevel project with activities ranging from a review of policies and procedures to examination of bedside transfers by nursing aides to a review of documentation and classification of wounds in the electronic medical record.

This hospital-wide review led to a sharing of current best practices and opportunities to standardize prevention and treatment practices throughout the organization. All nursing and therapy staff was required to pass computer-assisted competencies in wound care. To fully entrench the organization’s commitment to wound management, all patients admitted to HHH with a pressure ulcer were seen at the bedside by the patient’s nurse, nurse’s aid, nurse manager, the attending physician, myself and the Spinal Cord Injuryattending physician, who also has a special interest in wound management. Finally, we solidified our relationship with a wound care clinic operated by a plastic surgeon and an advancedp R.N. at a local, acute care hospital.

While I am always excited to be a part of something as special as the Spinal Cord Injury Rehabilitation Service, it is even more gratifying to know that we provide our patients the very best care possible, and that when it comes to the prevention and healing of wounds and pressure ulcers, there is no place better than Helen Hayes Hospital.

Yvonne Evans, RN, CRRN
Nurse Mnager, Spinal Cord Injury Rehabilitation Service