Coordinating Care in the Wound Clinic & Home Setting: A Patient Case Study

The establishment of trust between the wound care patient, the wound clinic, and the home health nurse is crucial when it comes to collaboration within the continuum of care. This article presents a successful case study from a New England-based facility. 

Chronic wounds affect 6.5 million people in the United States each year, according to the U.S. National Library of Medicine. It is more likely that successful outcomes will occur when care plans are devised that allow patients to feel involved in their care and empowered to be the ones driving that care. That said, education can be the best tool that outpatient wound care providers and home healthcare nurses can and should employ. By collaborating to develop and implement personalized treatment plans for their patients, wound clinic and home healthcare staffs can put into place a solid support system that gives their patients the best possible chance for healing. This article will discuss how wound clinic staff can effectively collaborate with nurses in the home setting to produce optimal outcomes by evidence of a recent patient experience. 

Establishing Relationships in the Home

When treating a patient who lives with a chronic wound, who is also likely to be living with at least one other chronic comorbid disease or condition, one of the most crucial components of the treatment plan is establishing a strong, trusting relationship between the provider and the patient. This is especially true for those wound care patients who also live with a diagnosed mental illness such as depression, addiction, or schizophrenia. Without a strong bond that includes effective two-way communication, patients may fear that their wounds will never heal. However, the establishment of a relationship in the home care setting can serve as a bridge for those providers in the wound clinic who will rely on the care that’s rendered in the home to help impact on the patient’s day-to-day progress.

In an effort to determine the best care plan and ultimately a program of lasting success for the patients between clinic visits, it’s critical for wound clinic staff and home-based wound care specialists to collaborate closely. Wound care nurses in the home are generally heavily involved in overseeing the care of these patients and can therefore provide important insight into the patient’s recovery process for those providers in the wound clinic. This can include insight into the patients’ routines and physical surroundings and being able to monitor how patients are coping psychologically on a near full-time basis. With this information, home-health nurses are able to provide a better overall picture of the patient’s well-being and make appropriate recommendations to wound clinic staff.

Most home care agencies will employ a primary care nurse to work directly with the wound clinic staff. These nurses should be knowledgeable about the products and modalities being utilized in the clinic, as well as the physiology behind the healing of specific wounds. Depending on how the patient’s wound is responding to clinic-based and home care treatment, home care nurses should also be empowered to make recommendations to the clinic’s physician, and two-way communication should occur as needed. By promoting close collaboration and open communication, expectations should remain consistent among the wound care clinician, at-home nurse, and patient.

_____________________________
RELATED CONTENT
Avoiding Legal Pitfalls for Home Health Services in Wound Care
The Importance of the Home in the Healing Process
_____________________________

A Lesson In Building Trust

To showcase how important the establishment of trust is for patients and their providers as it relates to wound healing, let’s consider a home care case from 2013 involving a 58-year-old male living with diabetes, multiple vascular leg wounds, and comorbid kidney failure. He had refused dialysis, had a clinical diagnosis of paranoid schizophrenic disorder, and was extremely suspicious and mistrustful of his healthcare providers due to past experiences that included “painful dressing changes.” The patient had six open wounds on his left leg and had undergone a right leg amputation. Not wanting to risk losing the left leg, a viable, lasting solution was needed. A non-painful, silver polymeric membrane dressing was utilized and education was provided so that expectations could be established and tracked. The result was a bonding relationship between the providers and the patient, who saw his persistent pain significantly reduced upon the dressing’s application, which led to long-term compliance (Figures 1 and 2; see PDF version of this article for the images). The patient no longer feared a painful dressing change and his six previously persistent wounds healed in approximately three months. 

This patient example illustrates how providers can successfully integrate education into the patient’s overall care plan and how pivotal this is to successful treatment. It also emphasizes how important collaboration can be when the at-home nurse and the wound clinic staff collaborate to discuss essential “behind-the-scenes” information about a patient’s background and recovery process — something that may have not been established in the clinical setting alone.

Donna Morrow is a registered nurse and wound and ostomy nurse manager at Nizhoni Health, Somerville, MA, a full-service home health provider.