Wound Care

Program Evaluation: Wound Care Center The Methodist Hospital offers a Wound Care & Hyperbaric Medicine Program which works closely with patients and specially trained physicians (2010). The program focuses on monitoring, management, and treatment of chronic and non-healing wounds (TMHS, 2010). Non healing wounds affect a large number of the populace and prevent people from leading an active life. Researchers report new technologies are altering the process in which chronic wounds are treated. More options for wound treatment are available today than previously available. Bio-engineered skin substitutes, specialized dressings and the latest compression wraps are a few of the more recent methods for wound treatment. The Methodist Hospital's Wound Care & Hyperbaric Medicine Program offers state-of-the-art technologies and advanced wound care techniques to effectively care for non-healing wounds. Evidence depicts that a wound that has not healed in over a month should not be overlooked (CDC, 2009). The TMHWC program uses a team approach to promote advanced wound healing. The first step of healing for patients enrolled in the wound care program is a methodical evaluation by a wound care physician. There is a huge need for quality wound centers. Non healing wounds and excessive management cost health care centers a substantial amount of money each year. According to Pompeo (2010) health care organizations want well-organized and precise figures to decide which cost effective wound care services to propose. The difficulty with chronic wounds is that it is very demanding on staff within a hospital’s organization (Shai & Halevy, 2005). The burden of chronic wound management is constant and an evaluation is necessary in an effort to prove the importance of maintaining The Methodist Hospital Wound Center. The purpose of this evaluation is to examine the wound care program at The Methodist Hospital in Houston Texas. This evaluation will provide the history and overview of the root source for chronic wounds and the effectiveness of treatment of those wounds. This evaluation will also comprise a review of the programs patient population, chronic wound diagnoses, primary diseases, treatment devices, as well as costs associated with the health care organization. The assessment will expand the findings of the previously submitted needs analysis for the healthcare organization expansion of services. The components of the proposal are consistent with the organizational mission, values and vision. Background The Methodist Hospital's wound care Treatment Center came to exist from a meeting between several surgeons at a wound care clinic in Southeast Texas. The physicians were discussing a patient who had suffered with wounds for a number of years. The physicians were interested in increasing improving the credentialing and recognition of wound care services. The Wound Care Center was founded and incorporated in 1990 as an extension of The Methodist Hospital. The Methodist Wound Care Center is dedicated to the multidisciplinary team approach in promoting the science of prevention, care, and treatment of acute and chronic wounds. Today the Methodist Wound Center continues to offer treatment and intervention for chronic wounds. The Methodist Wound Center is an independent center staffed and funded by The Methodist Hospital. A chronic wound has an appearance of one or more underlying conditions which become evident on the skin. Chronic wounds are reported to have the following etiologies (Krasner, 2001): pressure, venous, arterial, diabetic, ischemic, cancer, and end-of-life. A chronic wound entails intervention by numerous health care authorities to address the many conditions and co-morbidities that impact future prognosis and healing. Mission The mission of The Methodist Hospital's Wound Care Center is to provide a full range of the highest quality, outcome oriented physical therapy services for a variety of patients with wounds. The Methodist Hospital Wound Care Clinic team of specialists works together for improved healing rates and fewer amputations in chronic wound cases. In the course of treatment, the clinics aim is to prevent prolonged or permanent disability and reduce hospitalizations. Vision Statement Where people want to work, where physicians want to practice, and most important, where registered patients want to go when they need healthcare services. The vision statement sets specific goals in objective terms, and a time frame for the goals to be met (Pelland, 2009). Literature Review Webster's New Riverside University Dictionary (2010) defines an ulcer as an inflammatory, often suppurating lesion on the skin or an internal mucosal surface of the body, as in the duodenum, resulting in necrosis of the tissue. Dorland's Medical Dictionary (2010) describes an ulcer as a local defect or excavation on the surface of an organ or tissue which is produced by sloughing of inflammatory necrotic tissue. Wounds that do not respond within the expected time frame are defined as chronic wounds or ulcers (Wollina, Hansel, Kronert, & Heinig, 2010). Chronic wounds are contributed to primary diagnoses which slow down the healing process and may sometimes result in death (CDC, 2007). The first step in conducting a needs analysis for the Wound Care Center is to identify the services most in need of support. A review of the number of referrals for different services could direct an initial effort. Networking with practices that have already implemented similar services may be of assistance. Performance measures must be in place for monitoring program success. Performance measures should assess for method reimbursement and sustainability, patient and provider satisfaction, treatment outcomes, and areas for improvement (Lockamy & Smith, 2009). Development of standards makes ease of operation with other systems a reality and are necessary for efficient operations (Spivack, 2005). Principles to be considered in selection, implementation, and evaluation are patient satisfaction, strategic alignments, process management, performance measurement, and project management (Lockamy & Smith). Developing community and governing commission liaisons will strengthen the chance of program implementation success (Dick, Manson, Hansen, Huggins, & Trullinger, 2007). The CDC (2009) reported that over 25 billion dollars is spent annually to govern the management of non-healing wounds. Each year seven million Americans are diagnosed with at least one type of chronic wound. The incidence rate of chronic wounds ranges about ten percent annually and is contributed to the current increase in age of the populace. Stages of Wound Healing There are three phases of wound healing (Fishman, 2008). First, there's phase one-the inflammatory phase, which immediately begins and is active for the first five days of injury. The inflammatory phase generates coagulate from vaso-constriction, platelet aggregation, and thromboplastin formation. The proliferative phase is the second stage of wound healing. This phase transpires up to three weeks after injury. Granulation, contraction and epithelialization draw the ulcerated edges together in an effort to reduce the deficiency (Fishman, 2008). Stage three of wound healing is sometimes defined as the remodeling phase. The modification stage last up to two years. Collagen is formed, which increases the overall vigor of the wound (Fishman, 2008). There are three types of cost analyses. They are cost-effective analysis, cost-benefit analysis, cost-utility analysis and cost-utility analysis. They are aimed at reducing the wastage of resources in invalid methods by getting the advantages of use of a particular activity with the value in terms of cost. People with diabetes are more prone to developing ulcers on their feet. Decreased sensation and a lack of circulation lead to this problem. The best way to prevent ulcers from forming is by performing a daily foot inspection. The three are not mutually exclusive in their use and can be used in any one particular situation though in different stages of the pyramid. An example is the use of exercise as a cost-effective means of tackling diabetes. In one of its many advantages, the exercise does not only help manage the diabetes but other conditions are catered for in the primary stage. This includes, stress reduction and hypertension which may be additions to the disease. There are many benefits of using exercise to various diseases like the cardiovascular types. The use of exercise is implemented in the third stage, tertiary stage that will include the treatment or management of the disease. It helps in burning down the excess calories in the body. (Hatziandreu, E. , 2003) Wound Center Protocol Patients undergo an inclusive physical upon admission to the wound care center. The work up plan for wound care consists of physical evaluations, blood work, Xrays and wound assessments. Medical staff meets daily to discuss the best plan of care for the patients. The treatment protocol Centers which practice systematic ways to develop wound treatment provide excellent care, including evidence based treatment protocols which lead to superior clinical outcomes (Fishman, 2008). The Methodist Hospital's Wound Care Center treats and takes care of the wounds at any part of the body including sacral, abdominal and even in the lower extremities. The center treats all types of wounds caused by burns and pressure, diabetes, radiation and vascular diseases. The centers protocol is to treat all chronic wounds until they heal as well as prevents recurrence and preserve limbs. The center’s staff does not only treat but also monitors wounds teaches prevention ways such as eating proper nutrition among other specialties. Program Objectives The American Physiological Society (2010) website indicated the evaluation provides formative feedback that helps guide a program as it is being implemented. It also provides summative data that clearly demonstrates that the program is accomplishing its stated goals and objectives. Without an efficient evaluation, the program personnel may be unsuccessful with regard to documentation of impactful program issues. The Wound Care Center employs five full time registered nurses, certified in wound care. The center also employs three administrative personnel, including the clinic administrator. The wound care center employees several medical staff physicians, including a podiatrist, 2 general surgeons and one plastic and internal medicine. The treatment of chronic wounds and research on the pathogen has been going on for many years now. Despite the effort, a large number of people still face the problem when it comes to wound care. A number of people have named lack of integrative perspective in research methodology as a critical issue facing wound care centers (Singhal, Reis, and Kerstein, 2001). Researchers do not view treatment of wounds holistically but have focused on efficacy and safety of specific therapies. The Methodist Hospital's Wound Care Center objectives are to continue with single treatment investigation in addition to pursuing an integrated approach to the mechanisms of wound healing. Integrated approach deals with the physiological activities that make a wound heal or not heal based on the fundamental activities. Study design This study design is pertinent to an evaluation of the wound care center and the subsequent hospital visits from patients subsequent to discharge. The study design for this research is quantitative and the population will be those patients who required treatment at the Wound Center within the last 24 months. The study will use data from Method admissions data base to calculate the number of patients. The system will also track the number of patients returned to the center. Quantitative designs require a prearranged selection of variables. Quantitative designs clarify the result of an experiment, a correlation testing, and often involve the acceptance or the failure to rejection the null hypothesis (Sproull, 2004) using statistical formulas and hypothesis testing with a significant randomly selected sample that represents the population (Creswell, 2004). Sample Patients who are currently admitted in the wound care center and scheduled for discharge within the next 30 days will be the population for this study. The population will be reviewed and counted from the Method’s computer system. We will aggregate the data of all patients admitted and discharged from the last 24 months. The selection process can be described as systematic sampling. The specificity of the items in the database is controlled by change. The series of items is compiled from the medical record number and is tracked over the last 24 months. The advantage of systematic sampling is that, unlike simple random sampling, a designated number does not need to be assigned to every item. Most patients have been discharged from the program because the wounds have healed or they have transferred to other wound care facilities. Recruitment of Participants. This evaluation will not require an excessive amount of contact with participants. There will be no questions or surveys provided to the participants. An option for this evaluation is to review the data in Method and analyze the discharge and monitoring of each wound care patient. MethoD is the computer admitting database which reports on all admitted patients to any program within the institution. Methods The research study objectives is to identify chronic wound services that need most support, to review the number of referrals and to determine the favorable ways of treating, preventing and controlling chronic wounds. The study uses quantitative data from The Methodist Hospital's Wound Care Center computer records. The study will use a systematic sampling of all the patients that have been treated for wound in the last 24 months. The study will record all the patients who have visited the hospital with wounds, it will determine their age, sex and the type of wound they were treated on. The study will also record how many times the patient has been treated and when the wound healed and if it did not heal the preventive advice given to the patient. The methods of data collection will be observation and investigations of medical records. The prearranged selection of variables includes age, sex, type of the wound and the duration it takes for the wound to heal. The correlation testing will be used to find out if there is a relationship between persons age and time the wound takes to heal or the type of the wound and the sex of a person. The study will apply statistical model of wound healing rates because it predicts the actual healing of the wound. The statistical model does not impose a fixed methodological structure on the healing structure such as time but monitors the progress and actual behavior of the wound (Kumar, 2007). Data Analysis The results obtained from the centers medical records and analyzed by Method’s computer system showed that the center had received quite a number of wounded patients. The computer software showed that 3-4 people out of a hundred people who visited the hospital were wounded. An estimate of 20-30% of the hospital beds were occupied by patients with wounds a big percentage being patients whom had acquired wounds during hospitalization. Pressure ulcers obtained during the period of medication is the major cause of chronic wound affecting an estimate of five inpatients. The results also showed that 5% of patients died after contracting surgical wound infection during the period. The result statistics indicated through tables and graphs drawn using method computer programs showed that chronic wound were caused by a number of factors such as immobility which usually affected patients on hospital bed causing bed sores and pressure ulcers. The other factors included diabetes, trauma, poor circulation and vascular disease (Stillman, 2010). Diabetes was the major cause of developing a chronic would as statistics showed as 20-50% of people with diabetes had the risk of contracting . Wounds can also be caused by other causes namely unhealthy nutrition, ill-fitting shoes, hygiene and lack of exercises. A big number of people obtained wounds after falling. The research study used a new statistical model that combines both the wound’s size wand the time of closure. This was because it was not easy to determine the actual time that most patients would heal after they were released from the hospital. Methodist Wound Care Center just like other hospital and clinical centers released their patients after their wounds closed after giving them advice on proper preventive measures. The model analyzed the wound size against time. A graph drawn should exhibit negative correlation, that is, as time goes the size of the wound reduces in order to indicate healing. Implications Meta-analytic review of wound healing processes showed that the duration a wound took to heal depended on the type of treatment given and the size of the wound. A large number of wounds do not heal completely but only undergo a process called closure. It is therefore not easy to calculate the correlation between the size of the wound and the duration it takes to heal completely. The statistical approach therefore calculated the time of closure as the healing of the wound. Studies have shown that there are four major stages of healing. A normal would heal even before stage IV but a chronic wound that progresses to stage IV may have serious implication that may lead to amputation (Columbia University Medical Center, 2007). Stage IV is usual the wound closure as it involves formation of a new skin and scarring but it does not mean the wound is completely healed. The data analyzed showed there was a negative correlation between the time of closure and the size of the wound. The size of the wound decreased as time the patient undertook treatment increased. This was a measure that healing process was taking place. While 45% of the patients admitted in the hospital for the given period showed a healing trend, some patient’s wounds did not heal regardless of the time frame. In fact some small wounds grew in size as time progressed. The study results did not indicate a linear relationship since some wounds grew in size as time progressed while others became smaller as time increased. The study results showed a non-exponential Gompertz-type model that shows specific differences and variations in individual wound behavior. Monitoring The modified Gompertz-type model was the best for monitoring and evaluating the healing process of the wound as it applied to all types of wound (both the ones that healed and the ones that did not heal). The model has advantage over other models as it could predict the rate of healing based on the treatment and similarity of wound type. Healing involves tissue healing and wound closure. The study model monitored all the patients that had visited the hospital in the last 30 days to determine which stage of healing process they were in. Generally the healing process involved four phases namely inflammatory phase, proliferative phase, remodeling phase and epithelialization(Hess, 2005). All the wounded patients for the last 30 days were monitored and the phase they were in recorded. The wounded patients that had already visited the hospital in last 24 months were expected to be at various phases depending on the size and type of the wound. A table was thereafter recorded and graphs drawn to analyze the data in order to gain conclusive results of the study. A normal wound requires 3-4 days to be at the epithelialization phase where another layer of skin form leading to scarring (Sussman and Bates-Jensen, 2007). Some wounds take more than that depending on the size of the wound. The research study was given 30 days period in which to monitor the phases of patients wound in order to get conclusive results. A table was set up for all the wounded patients, the time they were admitted and the time they underwent all the four phases. At the end of the one month period a time table was prepared that showed the time period and the number of patients at a particular phase.