Medical teams using a cutting-edge communication and tracking tool in treating wound patients at NYU Langone Medical Center in New York City, now can put clinical data behind their success.
With the help of the National Institutes of Health, Harold Brem, MD, chief of the Division of Wound Healing & Regenerative Medicine in the Helen & Martin Kimmel Wound Center, found that what he developed as a smart card was able to prevent 93% of Stage II pressure ulcers, or bed sores, from progressing to Stages III and IV, even in the most critically ill, bed-bound hospitalized patients, and decreased limb amputation rates by 75%.
Bed sores result in more than 80,000 limb amputations a year and more than 12 million emergency visits per year, Brem says.
The smart card is an electronic medical record (EMR) that organizes volumes of information on the patient and type of wound. The card mechanically pulls information from all of the patients records and organizes it on one computer screen. The screen of information prints compactly onto one sheet of paper. Without this summarized patient-specific version, Brem says, you would need to look at 20 computer screens to get all the information pertinent to each patient.
Theres no way you could remember all of the radiographic studies, their labs, their medical history, their current medications without having it on one sheet of paper, says nurse practitioner Diane Stella, RN, who works with Brem. This saves time because you dont have to constantly search for more information. You get more time to make plans for the patient based on results.
Access Anytime, AnywhereIrene Jankowski, RN
The system was developed in 1998 before the term EMR was popular, Brem says, as a tool to organize volumes of information doctors and nurses had to have to provide care. It can be shared among unlimited clinicians through computer access.
Considering the average patient sees up to 30 clinicians each week, its extremely practical for doctors, nurses, occupational therapists, nutritionists, etc., to all have the same information and photos in real time, Brem says. We have created a solution for getting all the clinicians together. We do all of this at the bedside. Its no longer just in the chart. Now that there are computers in the patients rooms we can go over the pictures and the information with them.
It was important the system be developed for nurses, Brem says. He said his team discovered there were 137 variables for care for each patient and keying in data was not something on which nurses should be spending their time. This had to be a computer system that standardized information depending on the type of wound, he says.
The smart card also features a picture of the wound that is updated regularly to see how it has changed size, shape, or characteristics. It also relates whether a nurse can turn the patient on all sides or whether there are mobility issues that prevent turning. Wound team members or medical assistants typically take photos of the wounds, Brem says.
Streamlined CareBarbara Delmore, RN
Wound care specialist Barbara Delmore, RN, PhD, CWCN, is hoping to build on the wound services success. All units use the smart card at NYU Langone, however, a pilot program to test the smart card as a prevention tool has begun in the ICU, where patients can be at high risk for pressure ulcers. Medical leaders hope to incorporate the information from the pilot into the permanent EMR throughout the center and achieve a paperless system.
The smart card works for assessment, prevention, and treatment because it raises clinicians awareness and offers reminders, Delmore says, adding the digital photos, updated daily or weekly, make all the difference. Before using photography, healthcare providers relied on verbal descriptions of the wound and clinicians describe wounds in different ways.
Now, if a physician or physical therapist or a nurse wants to see a wound and its not time for the dressing to be changed, they will have access to it, Delmore says. The smart card also gives clinicians a way to better track patients and assess how the institution is doing in its wound care and prevention and how it compares with other institutions in real time every week, Brem says. Having this tool is particularly important in the care of wounds because there are so many different ways to treat them and the smart card guides them objectively instead of just by opinion, he says.
The NIH has invested more than $2 million in grants for the research of this project, with many nurses as part of the investigative team, Brem says. The database, developed over 10 years, now includes more than 100,000 cases. In a decade, treatment options have increased and patients may be more rapidly transported to more units of the hospital so the necessity of being able to track a patient from the ICU to a regular floor to a sub-acute facility is much greater, Brem says.
Irene Jankowski, APRN-BC, MSN, CWOCN, the first Joint Commission Resources Inc. and Hill-Rom Nurse Safety Scholar-in-Residence at Beth Israel Medical Center in New York City, has worked for many years in institutions that focus on preventing pressure ulcers.
I congratulate Dr. Brem and NYU for paving the way to providing integrated electronic wound care records that will be visible to all healthcare team members, she says. Using an EMR form that captures all relevant information in one place and that allows a visual assessment of the condition of the wound is valuable in any setting that cares for patients with wounds.
There are various wound documentation systems available, but most require resources time and technicians to populate the system with the information time and resources frequently lacking in most hospitals today, Jankowski says.