Cathy Thomas Hess, BSN, RN, CWOCN, is President and Director of Clinical Operations, Wound Care Strategies, Inc (WCS), Harrisburg, Pennsylvania. WCS focuses on clinical operational, regulatory, and compliance/auditing aspects of skin and wound care in all healthcare settings. Please address correspondence to Cathy Thomas Hess, BSN, RN, CWOCN, 4080 Deer Run Court, Suite 1114, Harrisburg, PA 17112; e-mail: email@example.com
Competency is the common thread found in the art and science of skin and wound care that directly impacts the overall care of the patient. The Joint Commission defines competency as a determination of an individual's capability to perform per expectations. The Joint Commission further recommends
* developing a competencies program in your facility,
* choosing your annual competencies for validation,
* scheduling and assigning annual competencies assessments,
* using preceptors and peer review for competency validation, and
* complying with Joint Commission standards.
Competency affects all healthcare professionals across the continuum. Providers need to be competent in delivering care, and payers need to be competent in understanding the clinical practices for which they are paying on behalf of the patient.
Skin and wound care competency is mandatory for all professionals delivering care in this disease management approach. These programs need to be monitored, evaluated, and modified as the facility deems appropriate.
One way to improve skin and wound care competency is to structure ongoing education and training that will maintain and improve the clinician's knowledge level. Then, the facility has the responsibility to perform ongoing competency assessment through a defined, continuous process. This ongoing monitoring will identify those professionals who are experts in the art and science of wound care. All facilities benefit greatly from competency testing. It increases patient satisfaction.
The art and science of skin and wound care management directly impacts the patient's clinical and financial outcomes. An outcome is the overall condition of a patient that results from all healthcare processes performed on or for that patient. It refers not only to the patient's medical condition but also to the resulting quality of life the patient experiences. To achieve the best possible wound care outcomes while controlling costs, a comprehensive wound management system, based on published evidence, validated protocols, and competency programs for staff members, should be established.
An effective tool for managing outcomes is the clinical pathway. Such a pathway can serve as a guideline for the healthcare team to follow for a specific diagnosis. A wound-healing pathway designed for a specific diagnosis should include accurate assessment, documentation, intervention processes, and the expected outcome:
* Assessment, both initial and ongoing, describes the overall condition of the patient, including wound status.
* Documentation, both written and photographic, lays the foundation for management decisions, evaluation of the wound-healing process, and reimbursement decisions. It also serves as a defense in litigation.
* Interventions, guided by the multidisciplinary wound care team, include topical treatments, use of support surfaces, adjunctive therapies and products, and nutritional supplements.
* Expected outcome describes the overall condition of the patient that should result from all the processes performed on or for that patient.
* Monitoring the competency of staff members and patients, evaluating the clinical research for each product used, and assessing outcomes through utilization management tools can help ensure positive outcomes, despite the many variables that can affect wound care outcomes.
Skin and wound care competency is mandatory for all professionals delivering care in your facility. These programs need to be monitored, evaluated, and modified as the facility deems appropriate. Structured ongoing education and training will maintain and improve the clinician's knowledge level, benefiting the clinician, facility, and patient. Some wound competency validation tools that may be appropriate to introduce in your facility are wound assessment and measurement, dressing change, and photographic assessment.
As a review, consider using the following competency checklist to improve your clinical outcome:
* Incorporate accurate assessment, documentation, and intervention processes based on validated guidelines.
* Review all relevant guidelines at least annually and update your policies, procedures, and facility practices. Provide competency validation testing for your staff at least annually to ensure that proper practices support your policies.
At the end of the day, no matter how clinically competent we are, integrating checklists into our practice will improve our clinical and operational outcomes. If you have a checklist to share with our readership, please e-mail firstname.lastname@example.org. Good luck!
Source: Hess CT. Clinical Guide to Skin and Wound Care. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008.