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Leveraging Technology to Enhance Access to Wound Care

Gardner, Faye M., DNP, MSN, BSN, RN, CWCN

Advances in Skin & Wound Care: August 2018 - Volume 31 - Issue 8 - p 344
doi: 10.1097/01.ASW.0000540068.22287.5f
Departments: Commentary

Faye M. Gardner, DNP, MSN, BSN, RN, CWCN, is System Director of Nursing Education, Practice, and Research, University of Pittsburgh Medical Center Pinnacle, Harrisburg, Pennsylvania.

Employing telemedicine in wound care involves using interactive video, audio, and other means of telecommunication to provide healthcare at a distance.1 As the demand for specialized wound care services continues to rise, healthcare organizations must respond and create solutions to provide comprehensive care that are timely and cost-effective.1 Within the acute care setting, the demand for timely recognition of skin and wound issues is very real to the hospital’s bottom line. Our organization has invested in technology that can be used when the wound care teams are not available to tap into their expertise for those timely consults.

Within our 8-hospital system, the wound care teams work during the day to interface with patients and be part of the interdisciplinary care team process. However, that schedule, as well as the need for our trained staff to scale across all campuses, creates a gap in our provision of care. We were compelled to address the off-hours and distance constraints that put the patient at risk of missed or delayed care. To close that gap, new technology has been introduced that can support direct care nurses and their access to the wound care team.

As noted by Chittoria,2 wound care is a visual specialty, and having a high-quality image is the criterion standard for diagnosis and treatment. Several telemedicine machines were purchased across our system and strategically placed for easy access to the direct care nursing staff. These machines are equipped with video and audio features for a robust virtual patient encounter. Once the consult is established, the direct care nurse places the telemedicine machine at the bedside, allowing the wound care nurse to interact with both the patient and the patient’s wound. Once the wound care nurse remotely logs into the program with the portable device, his/her facial image is projected on the screen of the telemedicine machine in the patient’s room. He or she then discusses the concern with the patient, family, and other nursing staff as the direct care nurse adjusts the position of the machine as directed by the wound care nurse. A quality image is achieved using the machine’s features to zoom into the problem area for a closer and more detailed visual assessment of the wound. The mobile device used by the wound care nurse also provides a quality image that is stored and uploaded into the electronic medical record.

Our teams are focused on connecting with the patient from any location, and this interaction with the patient and the direct care staff is cost-effective in confirming skin and wound care issues that may be present on admission. All involved care providers are diligent to ensure patient privacy is maintained throughout the audio and visual interaction. The telemedicine machines are positioned within the patient room to comply with the Health Insurance Portability and Accountability Act standards for a secure and private patient interaction.

During staffed hours, efficiency is maximized through real-time or synchronous interactions with the clinical staff using telemedicine. After hours, the same wound care team shares the call responsibility equally. The wound care team can make its recommendations verbally to the nurse during the consult and finish the interaction by documenting those recommendations in the electronic medical record. Offering this expert opinion improves not only the quality of care provided to the patient, but also the knowledge base of the direct care nurse, which benefits the entire organization.3 Giving that direction at the point of care quickly puts the patient on a path toward healing. Our overall time to consult has improved, which supports documentation of any skin or wound issues found on admission.

Our experienced wound care team has readily embraced this technology and has rotated its call schedule to absorb this after-hours requirement without creating a work-life imbalance. To operationalize the after-hours coverage, each wound care nurse is on call for 1 week each month. The team did not find the adoption of this virtual interaction any more involved or disruptive to their call responsibilities.

The adoption of telemedicine can help to advance wound care in the digital age.2 By leveraging this available technology, the consult is addressed more quickly, the patient has an effective and timely interaction at the bedside, and the direct care staff can learn from the clinical expertise of the wound care team.

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References

1. Sood A, Granick MS, Trial C, Lano J, Teot SP. The role of telemedicine in wound care: a review and analysis of a database of 5,795 patients from a mobile wound-healing center in Languedoc-Roussillon, France. Plast Reconstr Surg 2016;138:248S–56S.
2. Chittoria RK. Telemedicine for wound management. Indian J Plast Surg 2012;45:4120417.
3. Zarchi K, Haugaard VB, Dufour DN, Jemec GB. Expert advice provided through telemedicine improves healing of chronic wounds: perspective cluster controlled study. J Invest Dermatol 2015;135:895–900.
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