WEST ORANGE, N.J. — At Kessler Institute for Rehabilitation, RNs have created and implemented a nurse champion model to promote evidence-based practices in wound care management.
Its primary goals are to prevent pressure ulcers and manage associated factors that may impede the healing process.
Established two years ago, the wound care program is led by Conchita Rader, RN, MA, CFCN, CWCN, wound care coordinator, along with approximately 200 RNs from the West Orange, Saddle Brook and Chester campuses.
Called “wound care extenders,” these nurses serve as mentors on their units, offering a second set of eyes to validate wound and skin assessments as well as providing unit-based inservices and initiating wound protocols, according to Rader.
“Because of our wound care program, nurses have become more accurate and consistent in the skin assessment process as well as in the staging and documentation of any skin changes,” said Jay H. Rosenberg, RN, MSN, CCRN, CNML, director of nursing and ancillary services, West Orange campus. “Skin integrity is one of the cornerstones of rehabilitation nursing, and the educational initiatives offered by the wound care team have given our nurses the opportunity to learn and grow in this area.”
The team has established specific hospital-wide protocols for prevention of pressure ulcers from stages 1-4, unstageable pressure ulcers and suspected deep tissue injury, which nurses use as guidelines in assessment and treatment recommendations.
Using a non-pharmaceutical formulary of wound and skin care products that the parent company, Select Medical, has endorsed, Rader and nurse colleagues conduct trials and are involved in the selection of wound and skin care products and make specific recommendations to physicians about treatment options.
“For example, based on our trial and selection process, we now use a dimethicone barrier cloth, which has resulted in a decrease of incontinence-associated dermatitis to zero, and a mepilex foam dressing that handles wound drainage more effectively and requires less dressing changes,” Rader said.
This year, Rader said, she plans to initiate an educational program and establish protocols for lower extremity wounds.
To become a wound care extender, nurses participate in an educational program designed by Rader, which includes completion of classroom and hands-on skills lab components. Participants must demonstrate competence in assessing pressure ulcers, measuring wounds, proper use of photo documentation, selecting dressings for specific wound types and application of negative pressure wound therapy. They also focus on prevention strategies and general wound care skills and techniques, and they continue to receive ongoing training by participating in wound care rounds and National Database of Nursing Quality Indicators prevalence surveys.
“All of our nurses are engaged, share their knowledge with one another, upgrade their nursing practice, and as a result we have better patient outcomes,” Rader said.
Rader and her team also have offered seminars, print and online educational opportunities for nursing staff and physicians and formalized wound care policies and procedures.