O'Brien ML, Lawton JE, Conn CR, Ganley HE, et al.
International wound journal. Date of publication 2011 Apr 1;volume 8(2):145-54.
1. Int Wound J. 2011 Apr;8(2):145-54. doi: 10.1111/j.1742-481X.2010.00761.x. Epub
2011 Jan 28.
Best practice wound care.
O'Brien ML(1), Lawton JE, Conn CR, Ganley HE.
Author information:
(1)Quality & Risk Management Unit, St Vincent's Hospital, Sydney, New South
Wales, Australia.
This article describes the barriers, changes and achievements related to
implementing one element of a wound care programme being best practice care. With
the absence of a coordinated approach to wound care, clinical practice within our
Area Health Service (AHS) was diverse, inconsistent and sometimes outdated. This
was costly and harmful, leading to overuse of unhelpful care, underuse of
effective care and errors in execution. The major aim was to improve the outcomes
and quality of life for patients with wound care problems within our community. A
collaborative across ten sites/services developed, implemented and evaluated
policies and guidelines based on evidence-based bundles of care. Key barriers
were local resistance and lack of experience in implementing structural and
cultural changes. This was addressed by appointing a wound care programme
manager, commissioning of a strategic oversight committee and local wound care
committees. The techniques of spread and adoption were used, with early adopters
making changes observable and allowing local adaption of guidelines, where
appropriate. Deployment and improvement results varied across the sites, ranging
from activity but no changes in practice to modest improvement in practice.
Evaluating implementation of the leg ulcer guideline as an exemplar, it was
demonstrated that there was a statistically significant improvement in overall
compliance from 26% to 84%. However, only 7·7% of patients received all
interventions to which they were entitled. Compliance with the eight individual
interventions of the bundle ranged from 26% to 84%. Generic performance was
evaluated against the wound assessment, treatment and evaluation plan with an
average compliance of 70%. Early results identified that 20% of wounds were
healed within the target of 10 days. As more standardised process are
implemented, clinical outcomes should continue to improve and costs decrease.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
DOI: 10.1111/j.1742-481X.2010.00761.x
PMID: 21272244 [Indexed for MEDLINE]
