Wound Ostomy Continence (WOC) Nursing
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Transcript Wound Ostomy Continence (WOC) Nursing
WOC Nursing and Pressure
Ulcer Prevention
History and Current Status
Heath Brown RN, WOCN
Wellstar Kennestone
History
1958: Dr. Turnbull
created role of “ET”
(Enterostomal
Therapist)
◦ Purpose: Provide
rehabilitative care to
new ostomy patients
◦ First ETs: individuals
who had an ostomy or
a family member with
an ostomy
Milestones in Role Development
1960s: Formal training
programs developed
1976: RN established as
“entry into practice”
1983: Baccalaureate
degree required for entry
into practice
Scope of practice
expanded to include
wound care and
continence care
WOC Nursing in 2011: Statistics
Approximately 5000
WOC nurses in US
60–70% prepared at
baccalaureate level –
30 – 40% at master’s
level or higher
Practice settings:
acute care (majority);
HH; outpatient
Certification in WOC Nursing
Pathways:
◦ Completion WOCNaccredited program (10
weeks full time: theory
+ clinical)
◦ Experiential pathway:
1500 practice hours +
50 CE hours for each
area for which
certifying
WOC Nurse Role in 2011
Wound Care primary
focus for most WOC
nurses
◦ Diabetic foot care
◦ Fistula management
◦ Consultation/mgmt
regarding wound mgmt
◦ Pressure ulcer
prevention (agency
wide programs)
WOC Nurse Role in 2011
Ostomy Care
◦ Preop counseling/
stoma site marking
◦ Postop: pouch selection/instruction in self
care
◦ Rehabilitative care and
counseling (sexual
counseling)
WOC Nurse Role in 2011
Continence Care
(Setting Dependent)
Acute Care
◦ Staff education re: CAUTI
prevention
◦ Staff education re: correct
use indwelling bowel dng
systems
◦ Skin care and
containment
Changes and Challenges
Increasing focus on role of consultant vs role of
caregiver/educator
Increasing responsibility for development
agency-wide programs for pressure ulcer
prevention and evidence-based WOC care
Increasingly complex wound and fistula
care (e.g., negative pressure wound
therapy) and more challenging stomas
Advanced Practice WOC Nurses
increasingly common in outpatient care
Pressure Ulcer Prevention
Most PUP Programs are essentially the same:
Catch ‘em at the front door
(Assessment)
Prevent ‘em while they’re here
(Prevention)
Components of a
PUP Program
*
*
*
*
Initial skin assessment on admit
Daily Risk Assessment for all patients
Reassess skin daily or more often
Manage moisture – keep dry and
moisturize skin
* Optimize nutrition & hydration
* Minimize pressure
1 Initial Skin Assessments
Every Admitted Patient
Required by CMS to show what was POA
Good Nursing Practice
Braden Scale
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Sensory perception
Moisture
Activity
Nutrition
Mobility
Friction/shear
2 Risk Assessment for PUs
Daily or more often for all patients
Different scores should reflect different
preventive strategies
3. Reassess Skin Daily
Q Day or Q Shift
4 Prevention: Manage Moisture
Keep the patient dry
Moisturize the skin
5 Optimize Nutrition & Hydration
Attend to the microclimate of the skin –
calories, hydration, protein
Registered Dietician Consults
6 Minimize Pressure
Turn Every 2 hours or more often based
on clinical condition
Use Pillows to redistribute weight
Offload heels
Use Pressure redistribution Surfaces to
maximize the time/pressure ratio
On a Programmatic Level
Monitor, Monitor, Monitor
Continuously
Re-evaluate your processes
Monitoring our programs by conducting
quarterly prevalence surveys
Monitoring and conducting RCAs of HAPUs
Participating in almost every aspect of
nursing with an eye towards protecting
patients skin from pressure and reevaluating
processes
Device related pressure ulcers
Questions