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Getting the SKINny
Current events and issues of relevance to WOC Nurse practice, updates on new website features and links to external sources of interest to WOC nurses.
Sunday, October 05, 2014
A Group Purchasing Organization (GPO) is an entity that is created to leverage the purchasing power of a group of businesses in order to gain discounts from vendors based on the collective buying power of the GPO members.  Group purchasing is a strategy that has been used for years in many differnt industries from groceries to manufacturing. 
 
The first healthcare GPO was established in 1910 by the Hospital Bureau of New York. The Medicare Prospective Payment System, more commonly known to hospitals as the Diagnosis Related Group (DRG) payment structure instituted in 1983, caused all hospitals to focus their attentions on cost containment fostering rapid expansion in GPOs.  By 2007, it was estimated that 97 percent of all not-for-profit, non-governmental hospitals participated in some form of group purchasing.

Despite the growth of these entities, they are not without controversy.  The controversies lie in how the GPOs are funded, typically by a membership or administartive fee paid by the vendors. GPO members are typically rewarded with top tier pricing for goods and services in addition to rebates for compliance with buying contracts.  GPOs have historically been exempted from all anti-kickback legislation and regulations.

Most wound, ostomy and continence nurses have, at one point, run head-on into the reality of a GPO, particularly when a certain product is needed to serve a particular patient's needs. While most buying contracts allow a certain allowance for going off-contract to purchase certain unique products to meet individual patient needs, local purcahsing departments are generally charged with buying contract compliance.  Depending on your internal politics, it can be very challenging to convince a purchasing agent as to the medical necessity of going off-contract to achieve a certain patient outcome.

As hospitals, home care agencies, outpatient clinics and long term care facilities continue to face huge financial pressures, they will continue to seek new ways to manage their costs.  WOC nurse must not only accept the GPO as a way of life, but we must embrace them.  I think it is best to influence product formularies from the inside.  Product formularies must be based on clinical outcomes, and who better than clinicians can articulate this?  But the days of getting every product that we want to have on the shelf are long over.  We can no longer just look at clinical outcomes, but we must also look at institutional outcomes and the costs of doing business.  If we don't step up, others will do it for us.

 


Monday, September 01, 2014
THE UNITED OSTOMY ASSOCIATIONS OF AMERICA (UOAA) is declaring that October 4, 2014 be recognized as Ostomy Awareness Day 2014-Live, Learn, Share. By celebrating this special day, their mission is to help patients LIVE a normal life following surgery, to help the medical community LEARN about the needs of ostomy patients, and to SHARE stories to raise awareness about ostomies throughout the United States.
 
I am certified in the full scope of WOC nursing practice.  Even so, the lion's share of my practice involves management of complex wounds.  That being said, my ostomy patients hold a very special place in my heart.  And I would be a very sad nurse if I couldn't care for ostomy patients.  They often face so many physicial, emotional and social hurdles.  And I feel the tremendous satisfaction of knowing that I made an impact in helping them to cope and fully rehabilitate.
 
So it is with gladness that I plan to celebrate with the UUOA and WOCN Society in recognizing Ostomy Awareness Day on October 4, 2014.  On this day, we commemorate individuals who have had this life saving surgery, and recognize the families and caregivers who function, often in silence, to offer their love, support, and physicial care.  We also need to think about all of health professionals who went before us in creating the various life enhancing surgical interventions, and the forerunners of enterostomal therapy, a specialty group focused on patient advocacy and improved quality of life for this patient population.  And lastly, we cannot forget to acknowledge our industry partners, who invest research and devlopment efforts to constantly improve the appliances and supplies that foster independence and security.
 
On this day, we are charged to spread the word about ostomy surgery and how this surgery can make a positive difference in the lives of our patients. Building AWARENESS begins with us, and together we make a difference in the ostomy community.

Thursday, August 07, 2014
I read an interesting article in my local newspaper the other day.  The author was writing about her experience leading a group reading and discussing a series of books on contemplative living.  She asked her audience to think of a time in which they were aware of God's presence in their lives.  It is interesting to note that hospitalization and illness was listed as a common time when God's presence was felt.
 
The intent of this blog is not to preach about religion.  Whether you practice religious beliefs, and whether you believe in a higher power is not the point. We are all on a journey through life.  For some, that is a spiritual journey.  For others, it is a humanistic journey.  What is significant for me is the fact that we are the people present at this most intimate time in our patients' lives.  We are there when others uniquely touch that brush with their higher power.
 
Our society uses cellphones, emails, tweets, texts, FAXes, and lots of digital technologies to communicate with others.  But it is through silence and touch that we are often able to relate to our patients in this spiritual way.  In a world filled with noise, multi-tasking and distractions, we need to respect the silence in order to better connect with others.  By living in a contemplative manner, we deepen our awareness of the impact of our everyday experiences.  We are directed to examine the important issues of living, helping us to not be caught up in sweating the small stuff that so easily consumes us. 

Tuesday, July 01, 2014
The 46th Annual Wound, Ostomy and Continence Nurses Society Conference in Nashville is now a memory.  For all of you who were fortunate to attend, you are no doubt still sorting through your workshop materials.  And your head is likely still swirling with ideas you can incorporate into your daily practice. 
 
As a member of the JWOCN Editorial Board, one of my favorite experiences is watching the annual award recipients.  The Journal is proud to recognize outstanding manuscripts.  There are two manuscript awards, one for outstanding clinical innovation and the second is for the outstanding research study.
 
I hope you will take the time to revisit the 'Best of the Best' manuscripts for 2013.
 
Kudos to authors Virginia Sun, Marcia Grant, Carmit McMullen, Andrea Altschuler, Jane Mohler, Mark Hornbrooke, Lisa Herrinton, Carol Baldwin and Robert Krouse as recipients of the Clinical Manuscript Award for their study examining ostomy-specific concerns in persons with colorectal cancer who have lived with an ostomy for more than 5 years.  This article is recognized because it documents the need for ongoing contact with an ostomy nurse.
 
Another kudos to authors Elizabeth Jesada, Joan Warren, Dorothy Goodman, Ruth Lliuta, Gail Thurkauf, Maureen McLaughlin, Joyce Johnson, and Larry Strassner as recipients of the Research Award for their multisite study comparing digital photography to bedside assessment for pressure ulcer staging and wound characteristics included in the Bates-Jensen Wound Assessment Tool.  This cutting edge study reports the limitations and strengths associated with digital photography as a tool for chronic wound assessment.
 
Congrats to these authors!

Monday, June 02, 2014
Nearly 25 years ago, I was sitting in a classroom, a student at the Abbott Northwestern Enterostomal Nursing Education class. (A shout-out to all Abbott alumni!)  We had a guest lecturer that left a lasting impression on me.  A vascular surgeon was invited to our class to speak on revascularization interventions.  And he did meet the defined objectives.  Unfortunately, his lectured was peppered with a number of inflammatory comments about WOC nurses.  He defined the WOC nurse as someone who waltzes in to the rescue with a backpack full of bandage samples, when in fact, the issue was not one that a bandage could fix.  He chided us for being too focused on the topical treatment and not looking at the big picture, for inadvertently giving patients false hope and information by implying that all that was needed to heal the wound was a fancy bandage.
 
While his comments were not the most politically savvy considering the audience of soon-to-be WOC nurses, everyone in the room agreed with his points.  We had just spent weeks being lectured by the faculty on the importance of managing the wound systemically.  Chronic wounds are skin manifestations of chronic disease.  The role of adequate perfusion in supporting wound healing had already been drilled into us.  Our shock was the fact that he didn't recognize this. 
 
For me, his points brought a different clarity.  We all function in settings where 'clinical tasks' are often valued more than 'critical thinking'.  A dressing change is something that can be quantified.  And after you do 20 dressing changes a day, it is a skill that is easily mastered.  Not a day goes by when I am asked to recommend a topical treatment, when it is clear that the bandage won't fix the problem. 
 
While we are all experts at doing dressing changes, our clear value as WOC nurse clinicians comes from seeing the big picture, from seeing the topical treatment as a part of a larger plan of care.  Since the settings where we work value the 'dressing change' skill, it is easy to get pigeon-holed into that role. 
 
That is not to diminish the ability to accurately assess a wound and select a topical treatment that maintains wound bed moisture, contains the exudate, protects the wound from trauma and environmental contamination and supports autolytic debridement are not critical thinking and decision making skills worth touting.   But our value to the healthcare system comes from our ability to see the wound as part of a patient, and to critically analyze the wound history and characteristics as they fit into the patient's history and presentation.  I believe that it is this ability that distinguishes WOC nurse clinicians from others with less vigorous wound training focused exclusively on topical therapies.  Yes, many can be taught how to select and apply topical therapies.  But the future of healthcare reform will demand more. 
 
25 years ago, this guest lecturer obviously didn't have a clue to the critical thinking and problem solving skills the WOC nurse should bring to the team.  If he is still in practice, let's hope his opinion has changed and it is savvy WOC nurses who have changed his mind.
About the Author

Lee Ann Krapfl
Wound, Ostomy and Continence Nurse (1991 – present) at Mercy Medical Center in Dubuque, IA. Practices the full scope of wound, ostomy and continence care for adult and pediatric patients. Provides WOC nursing services in acute care, long term care, home care and outpatient settings. Has been an active member of the WOCN Society, most recently serving on the Council as the Chair of the Public Policy Committee.