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Hospitalists' Needs Assessment and Perceived Barriers in Wound Care Management

A Quality Improvement Project

Walker, Cynthia A.; Rahman, Alphonsa; Gipson-Jones, Trina L.; Harris, Ché Matthew

Journal of Wound Ostomy & Continence Nursing: March/April 2019 - Volume 46 - Issue 2 - p 98–105
doi: 10.1097/WON.0000000000000512
Wound Care
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The purpose of this quality improvement project was to determine hospitalists' knowledge, practices, and perspectives related to management of pressure injuries and neuropathic/diabetic foot complications (having a foot ulcer or subsequent development of a foot infection because of a foot ulcer). We also sought to identify resources for and knowledge-based barriers to management of these wounds. This quality improvement effort targeted an interdisciplinary group of 55 hospitalists in internal medicine that consisted of 8 nurse practitioners, 10 physician assistants, and 38 physicians. The site of this initiative was the Johns Hopkins Bayview Medical Center, a 342-bed academic hospital located in the mid-Atlantic United States (Baltimore Maryland). The first phase of our quality improvement project comprised an online survey to identify hospitalists' knowledge, practices, and opinions on inpatient management of pressure injuries and diabetic foot complications. The second phase involved semistructured focus groups attended by hospitalists to identify resource gaps and barriers inferred by survey results. Twenty-nine of 55 (52%) hospitalists responded to the survey; 72% indicated no formal training in wound care. Over 90% had little to no confidence in management of pressure injuries and diabetic foot complications. In a separate ranking section of the survey, respondents selected lack of knowledge/confidence 12 of 29 (41.3%) and resources 9 of 29 (31.0%) as number 1 barriers to wound care. Managing patients with obesity was identified as a second major barrier from 10 of 29 selected options (34.5%). Eighteen of 55 (33%) hospitalists attended focus group sessions acknowledging barriers to wound care that included provider education, information technology, system factors, and interprofessional engagement. Attendees welcomed additional educational and ancillary resource support.

Cynthia A. Walker, MSN, RN, APRN-CNS, CWON, Interprofessional Practice & Patient Safety, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.

Alphonsa Rahman, DNP, APRN-CNS, CCRN, Interprofessional Practice & Patient Safety, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.

Trina L. Gipson-Jones, PhD, Hampton University, School of Nursing, Hampton, Virginia.

Ché Matthew Harris, MD, MS, FACP, Department of General Internal Medicine, Johns Hopkins School of Medicine, Joint Appointment Johns Hopkins School of Nursing, Division of Hospital Medicine, Collaborative Inpatient Medicine Service, Baltimore, Maryland.

Correspondence: Ché Matthew Harris, MD, MS, FACP, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, Baltimore, MD 21224 (charri21@jhmi.edu).

This QI project was supported by an internal grant—The Rajiv Thakkar Scholarship fund—Johns Hopkins Bayview Medical Center. This work was also supported under a grant from the National Heart, Lung, and Blood Institute to The University of Mississippi Medical Center (1R25HL126145-01—MPIs Beech and Norris).

The authors report no conflicts of interest.

© 2019 by the Wound, Ostomy and Continence Nurses Society.