NGAN Hau Lan APN (Wound Care) United Christian Hospital 7th May 2012
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1 An outcome evaluation for the provision of three-tier collaboration model in Nurse and Allied Health Clinic - Wound Care Programme: A way forward to promote effective wound management in the community NGAN Hau Lan APN (Wound Care) United Christian Hospital 7th May 2012
2 Introduction Nurse and Allied Health Clinic (NAHC) - Wound Care Programme has been providing service in KEC since September clinics site Kwun Tong Jockey Club Health Centre GOPC Ngau Tau Kok Jockey Club GOPC Tseung Kwan O Po Ning Road GOPC Tseung Kwan O Jockey Club GOPC Provide wound care consultation by experienced nurses specialized in wound care (Enterostomal therapy nursing)
3 Objectives Provide advanced wound care management Enhance wound care knowledge among nurses Identify patients who need advanced level intervention Develop a fast track referral system for patients required advanced level of wound care Provide continuity of wound care at basic, intermediate and advanced level
4 Three-tier collaboration model in wound care 1st tier: Basic level of wound care at General Out-Patient Clinic (GOPC) by general nurse in GOPC 2nd tier: Intermediate level of NAHC Wound Care Programme by nurse specialized in wound care in GOPC 3rd tier: Advanced level of wound care at hospital level of Specialist Out-Patient Clinic (SOPC) by Wound Care Nurse
5 Three-tier collaboration model 1 st tier Basic Level Wound dressing in GOPC Wound improved Back to Basic Level Prolonged healing wound, wounds with complications 2 nd tier Intermediate Level NAHC Wound Care Programme Wound static or worsen Medical Officer consultation if indicated 3 rd tier Wound improved Back to intermediate Level Advanced Level at SOPC Wound Nurse Clinic Surgeons/ Physician/ DM nurse/ MSW in indicated
6 Collaboration Attend regular interdepartmental meetings Collect feedback from staff in GOPCs Provide education on wound management to nurses Hold regular wound team meetings for intermediate and advanced level
7 Collaboration Design and use the same teaching material for patient education Develop a fast track referral system for patient required advanced level intervention Wound care nurse in SOPC Other health care professionals Surgeons / Physicians / DM nurse / CNS / MSW etc
8 Outcome measures for NAHC Wound programme
9 NAHC Wound Programme Source of Referral (Sep 09- Mar 11) GOPC (94%) GOPC nurse / GOPC doctor Hospital (6%) SOPC Wound Nurse Clinic Discharged from hospital 6% N =663 GOPC Hospital 94%
10 NAHC Wound Programme Wound type (Sep 09- Mar 11) 9% 10% N = % 21% 44% Burn Leg ulcer Pressure ulcer Surgical wound Traumatic Others 2%
11 Wound condition at discharge (Sep 09- Mar 11) 2% 6% N =600 20% Wound healed Wound improved Wound static or worsen Others 72%
12 Cases refer for advanced level 12 cases Venous ulcer (7) PVD ulcer (2) Pressure ulcer (3) 5 cases refer to Dr for further investigation / medication or surgical intervention 2 cases refer for wound biopsy 1 case was diagnosed to have skin cancer
13 Pain level at discharge 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 85% 14% 1% Decrease Unchange Increase
14 Fair Patients Satisfactory Levels 85% 90% 80% 70% 60% 50% 40% 30% 15% 20% 10% 0% 0% 0% 0% Very satisfactory Satisfactory Dissatisfactory Very dissatisfactory
15 15 Impact of Wound Care Programme on Dressing Frequency (7 clusters) 618 out of 4,078 patients with wound managed at GOPCs for at least 4 weeks before enrolment of wound program and discharged from the program Frequency of wound dressings was decreased 87.9% * Enrolled during Aug 2009 Sep 2010 Source: The evaluation of Quality of Care NAHC-WCP - Interim Results, by Department of Family Medicine and Primary Care, The University of Hong Kong, 14 June 2011
16 Conclusion Three-tier collaboration model of NAHC- Wound Care Programme could provide an effective approach to promote wound healing maintain continuity of wound care address patients complicated problems promptly in community setting
17 Way Forward Nurse training on wound care Patient empowerment for prevention of venous leg ulcer recurrence
18 Acknowledge Ms. Yuet Kwai CHAN, CGM(N) KEC/ GM(N) UCH Dr. David CHAO, CCOS(FM&PHC) KEC Ms. Amelia CHANG, DOM (Ambulatory/AED) TKOH Mr. Wing Sang TAM, DOM(SOPD/GOPC/EDU) UCH Ms. Hoi Yan WAN, APN (Wound) UCH Ms. Lai Chu FUNG, RN (Wound) UCH
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