Wound Nurse en West View Healthy Living

*WOUND NURSE NEEDED*

Mission Statement:

West View Healthy Living is a Christian based, non-profit, continuing care senior community. We provide high-quality care within a family atmosphere, guided by Christian values, moral integrity, and respect for the individual diversity of those we serve.

Key Responsibilities:

Staying Informed of ODH Wound Care Regulations:

· Regularly Review ODH Guidelines: Keep yourself updated on any changes to Ohio Department of Health regulations regarding wound care, pressure ulcer prevention, and infection control. This could involve regularly checking the ODH website or subscribing to newsletters or updates that the department may provide.

· Understand Legal and Ethical Considerations: Be aware of the legal standards for documentation, resident rights, and any regulations about wound care that pertain to treatment, prevention, and care planning. Ensure that care follows not only best practices but also complies with state-specific policies.

Training and Guiding Staff on Proper Wound Care Techniques:

· Hands-on Training: Regularly provide hands-on demonstrations and instruction on proper wound care techniques—such as how to clean wounds, apply dressings, and manage infection risks—so that nursing staff feel confident in performing these tasks.

· Prevention Strategies: Educate staff on preventing pressure ulcers and other common types of wounds through proactive measures like repositioning residents, proper skin care, maintaining hygiene, and managing incontinence.

· Identifying Complications Early: Teach staff how to recognize the early signs of complications, such as infection, delayed healing, or worsening pressure injuries. This can include looking for increased redness, unusual discharge, changes in pain levels, or abnormal swelling.

Maintaining Updated Facility Protocols:

· Review and Revise Protocols: Regularly review and, if necessary, update the facility’s wound care protocols to ensure they align with the most current ODH regulations and evidence-based practices. This includes policies on pressure injury prevention, wound treatment options, and infection control measures.

· Include Best Practices: Ensure that facility protocols reflect the most effective and current wound care strategies, such as the use of appropriate dressings, infection prevention techniques, and pressure-relieving devices.

· Review treatment progress notes, completion, and adherence to orders with the unit manager and DON every week during wound care review meetings.

Organizing Protocols in a Binder for Easy Reference:

· Create a Centralized Binder: Organize all relevant protocols, ODH guidelines, and facility-specific wound care procedures in a well-organized binder. This binder should be easily accessible to all staff and kept in a location where it can be referenced frequently. Sections might include:

§ Pressure injury prevention protocols.

§ Wound assessment and documentation procedures and visuals aids

§ Treatment protocols (for various types of wounds)

§ Infection control guidelines

Regulatory updates from ODH Documentation and Compliance:

· Ensure that all wound care documentation (progress notes, treatment records, wound assessments) complies with ODH requirements for thoroughness, accuracy, and timeliness. Regular audits of documentation can help maintain compliance and ensure that all necessary records are up to date.

Documentation and Communication:

· It is crucial that all documentation is up-to-date and complete, which not only helps with continuity of care but also ensures that interventions are tracked over time. If a resident’s wound care is not progressing as expected or if there are concerns about comfort or care, clear communication with other members of the healthcare team and the family is key.

· Documentation Best Practices: Provide detailed guidance on how to write clear and concise progress notes whenever a resident's skin integrity is altered. This should include:

o The date and time of the observation.

o A description of the wound, including its size, location, and any changes noted.

o Treatment provided and any changes to the care plan.

o Signs of infection or complications, if present, and actions taken to address them.

o Resident’s response to treatments and any comfort measures implemented.

Emphasize the importance of timely documentation to ensure a clear record of each wound’s progression and ensure legal and regulatory compliance. This is a collaborative effort between the wound nurse, unit manager, and staff nurses.

o Wound grid

o POC

o Progress notes

Creating a Culture of Collaboration:

· Foster an environment where staff feel comfortable asking questions and seeking advice about wound care. Encourage a team approach where everyone, from nurses to aids, feels responsible for monitoring residents' skin integrity and contributing to their care.

· Regularly hold in-services or refresher training to update staff on any changes in wound care protocols, new evidence-based practices, or regulatory updates

Collaboration with the Healthcare Team: The care plan should be reviewed and adjusted regularly based on the wound’s progress and the residents’ changing needs. Close collaboration with the rest of the healthcare team—including physicians, dietitians, and physical therapists—helps to address all factors contributing to the wound's healing process.

Assessing Wounds with CNP: The wound nurse collaborates with the Wound Nurse Practitioner (WNP) during weekly rounds to evaluate the condition of the wound types specified below, ensuring that any changes or concerns are addressed. This includes documenting and tracking wound measurements to assess healing progress over time. Brigitte (WCN) will collaborate with Barb (NP) to decide what wounds are appropriate for the WNP to see which will include any pressure wound staged two or greater, surgical wound requiring extra, and simple vascular wounds.

Skin Checks for New Admissions and occurrences of wounds: Within 24 hours of a new resident's admission or a new occurrence of a wound, the wound nurse and nurse manager are responsible for conducting a four-eye skin assessment to identify any potential wounds or areas at risk. Any skin alterations will be documented and followed by a progress note, ensuring that proper care is immediately initiated. The nurse manager and WCN will conduct a four-eye review and sign off on all wounds upon admission or new wounds. A wound grid will be initiated at that time and WCN and NP will determine if it will be managed by WCN and NP, the wound care CNP, or if there needs to be a referral made for the wound care clinic. The WCN will classify all wounds in house.

Categorizing Wounds: To streamline wound care, keep a list categorizing different types of wounds (e.g., pressure ulcers, surgical wounds, diabetic ulcers) for better tracking. This helps ensure that each wound is treated according to its specific needs.

WCN and NP will determine on any new admissions or during the review of skin sheets of a new skin concerns whether that wound is manageable with onsite staff.

Determining on site management:

· Deterioration of a current skin concern or wound requires the provider to assess that wound alongside the wound care nurse.

· Stage 1-3 superficial pressure wounds will be managed by the community staff nurse, WCN, and NP in house collaboratively.

· Skin irritations, rashes, abrasions, skin tears, and superficial ulcers will be managed by the community staff nurse, WCN and NP in house collaboratively.

· Simple surgical wounds with or without wound vac, wet to dry packing, or not requiring immediate debridement or cultures will be managed by the community staff nurse, WCN, and NP in house collaboratively.

Determining wounds to defer to consulting Wound Care NP

· Wound care requiring a wound care consult by the wound care NP will be determined jointly by WCN and NP based on complexity and comorbidities of each case.

· Orders made by the wound care NP will be reviewed and approved by our in-house NP with input of the WCN.

· Each resident referred to a consultation will have that wound tracked for progression in healing, by the WCN. The WCN will evaluate the continued necessity of consultation by the wound care NP.

· WCN along with house NP will determine if deterioration of any consulted wounds need further evaluation by and outside wound care clinic.

Criteria for Wound Care Clinic referrals

· Wounds exposing bone, tendon, or muscle.

· Post surgical wounds with signs or symptoms of complex deterioration, dehiscence, or acute infection.

· Fresh amputations, complex vascular/arterial wounds to include extensive diabetic wounds.

Immediate Notification: Encourage staff to notify you promptly when a new wound is identified by a resident, ensuring that it is assessed, categorized, and a treatment plan is developed as soon as possible. This may include formal documentation of the wound and updating the care plan.

Clear Communication: Reinforce the importance of clear communication with both the wound care team and the rest of the clinical staff when a new wound arises. This ensures everyone is on the same page and can provide consistent care.

Monitoring Shower Sheets & Skin Assessments: Ensure that weekly skin assessments are completed and that any missed or refused showers are rescheduled. The Unit manager will be responsible for ensuring shower sheets are completed and any missed showers are not only rescheduled but documented to support staff efforts for maintaining the hygiene needs of that resident. Brigitte and the unit manager will conduct weekly skin assessments on each unit.

Additional shared responsibilities of staff nurse, nurse manager, wound nurse, and director of nursing include:

Monitoring Wound Treatments:

· Each unit manager will monitor all wound treatments on their unit to ensure they are being done correctly and consistently. This includes:

o Checking that the correct treatments (dressings, medications, etc.) are applied according to each resident’s care plan.

o Ensuring treatments are applied timely and effectively, reducing the risk of infection or delayed healing.

o Making sure that all wound care treatments are initialed and dated by the responsible nursing staff, which ensures accountability and proper documentation. This also provides a clear record of when care was provided in case of any future concerns or audits.

o Weekly checks on treatment implementation: You should review the wound care being provided during your rounds, ensuring staff follow the prescribed care plan, and intervene if necessary to correct any discrepancies.

o Follow up on wound care reports made in matrix to determine the next steps.

Nutritional Monitoring:

· Attend weekly dietary/nutrition meetings to stay informed about residents who may be.

· experiencing weight loss or gain, as these changes can impact wound healing and overall health.

· If significant weight changes are noted, make sure to notify the Primary Care Physician (PCP) and family and document it in a progress note to ensure all parties involved are informed and can intervene if needed.

Developing Individualized Care Plans: Each care plan should be tailored based on the specific type of wound, its severity, and the resident’s overall health status. The care plan must consider underlying conditions or risk factors that could impact wound healing. These may include:

o Immobility (limits blood flow and increases pressure)

o Poor nutrition (can delay healing)

o Incontinence (can cause skin breakdown)

o Decreased sensation (increases risk of unnoticed injury)

o Diabetes (impairs circulation and immune function)

o Anemia (reduces oxygen supply to the tissues)

o Low albumin levels (a protein marker that impacts tissue repair)

Detailed Records for Pressure Injuries: For all in-house pressure injuries, it is essential to maintain detailed records that track the following:

o Wound assessments: Regular documentation of the size, appearance, and progress of the wound.

o Treatment: A record of all treatments applied (e.g., dressings, medications).

o Progress: Ongoing monitoring of the wound’s healing or lack thereof.

o Complications: Any issues that arise (e.g., infection, delayed healing).

o Interventions: Measures taken to promote healing (e.g., turning schedules, repositioning, nutritional adjustments).

o Unavoidable pressure forms need completed and signed by the physician.

Supporting Comfort During the Healing Process: Beyond the technical aspects of wound care, resident comfort is a critical part of healing. Advocate for pain management, positioning, and emotional support for residents undergoing wound treatments. This may involve:

o Ensuring that treatments do not cause undue pain or discomfort.

o Regularly assessing residents as signs of discomfort or distress and addressing those concerns with appropriate interventions.

o Collaborating with other staff members to create a holistic care plan that includes pain management and mental health support as part of wound healing.

West View appreciates all our employees by offering them the following: