Introduction: The Burden of Pressure Injuries

Chronic wound conditions are prevalent across health care systems globally and often result in economic and humanistic burdens on clinicians and patients.¹ Moreover, pressure injuries, among of the more common types of chronic wounds, affect an estimated 2.5 million people in the United States annually, resulting in a staggering 60,000 preventable deaths.² In addition, the Centers for Medicare & Medicaid Service reported that the United States spends about $9.1 to $11.6 billion annually as payment for the burden imposed by pressure injuries.²

The Need for Wound Care Specialists in an Interdisciplinary Team

As the world tries to recover from the pandemic’s damages, the ongoing health care workforce shortage has put a strain on multidisciplinary team members right when an at-risk patient populations need them the most. In a survey conducted by Today’s Wound Clinic, 56% of wound care professionals reported that “wound severity has either increased or significantly increased since the start of the pandemic.”

Around 50% of respondents reported an increase in amputations, and several clinicians noted a surge of inpatient load.³ A solid knowledge base of wound care is essential for these needs. Current research has identified possible gaps that general health care providers may have with regard to current evidence-based care, management, and treatment of chronic wounds.^4,5, Hence, the burden of chronic wound care calls for the use of multidisciplinary teams. The impact of board-certified nurse specialists in particular should be explored to mitigate facility obstacles with wound care.

Certified Wound Care Nurses and Their Impact on Reducing Pressure Injury Rates

In a study by Padula et al,⁶ the work of Certified Wound Care Nurses (CWCN®) was reported to improve nursing care quality significantly. These investigators found that the addition of 1 CWCN® per 1000 hospital beds resulted in a 17.7% reduction in pressure injury rates.⁶ In the same study, the services of the CWCN® were recognized to go beyond traditional bedside nursing work, with a greater emphasis on activities. These activities related to specialized and evidence-based wound care, as well as involvement in nursing leadership and nursing quality roles.⁶

Multidisciplinary Involvement in Wound Care to Improve Outcomes

Through the use of a multidisciplinary and collaborative approach to wound care, high-performing facilities rely on structural nursing empowerment. This approach focuses on engaging and educating the primary care team of providers and caregivers to equip them with the necessary knowledge, skills, and autonomy related to evidence-based wound care. Usually, this engagement and education are the result of a wound care program led and developed by wound care specialists.^6-10 The use of a multidisciplinary team is a departure from the earlier models that relied solely on the wound care nurse to perform all activities related to wound care. As a progressive development, this newer approach has resulted in expanded and comprehensive wound care improvements.^9,10

Conclusion

Comprehensive and multidisciplinary wound care programs can significantly improve chronic wound care outcomes while increasing patient quality of life and care. Moreover, health care facilities should continue to recognize the value of board-certified wound care specialists by providing autonomy to exercise their specialties beyond traditional bedside work and realizing that they are equipped and trained to be leaders, educators, and innovators who may successfully enhance healing beyond the bedside.^1,6-8

References

1. Järbrink K, Ni G, Sönnergren H, et al. The humanistic and economic burden of chronic wounds: a protocol for a systematic review. Syst Rev. 2017;6(1):15. doi:10.1186/s13643-016-0400-8
2. Englebright J, Westcott R, McManus K, et al. A comprehensive program to reduce rates of hospital-acquired pressure ulcers in a system of community hospitals. J Patient Saf. 2018;14(1):54-59. doi:10.1097/PTS.0000000000000167
3. Cole W. A look at the impact of the COVID-19 pandemic on wound care practices one year later. Today’s Wound Clinic. 2021. Accessed July 20, 2022. https://www.hmpgloballearningnetwork.com/site/twc/articles/look-impact-…
4. Dalvand S, Ebadi A, Ghanei Gheshlagh R. Nurses’ knowledge on pressure injury prevention: a systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Clin Cosmet Investig Dermatol. 2018;(11):613-620. doi:10.2147/CCID.S186381
5. Tan JJM, Cheng MTM, Hassan NB, He H, Wang W. Nurses’ perception and experiences towards medical device‐related pressure injuries: a qualitative study. J Clin Nurs. 2020;29(13-14):2455-2465. doi:10.1111/jocn.15262
6. Padula WV, Nagarajan M, Davidson PM, Pronovost PJ. Investing in skilled specialists to grow hospital infrastructure for quality improvement. J Patient Saf. 2021;17(1):51-55. doi:10.1097/PTS.0000000000000623
7. Gu YH, Wang X, Sun SS. Benefits of multidisciplinary collaborative care team-based nursing services in treating pressure injury wounds in cerebral infarction patients. World J Clin Cases. 2022;10(1):43-50. doi:10.12998/wjcc.v10.i1.43
8. Monaco D, Iovino P, Lommi M, et al. Outcomes of wound care nurses' practice in patients with pressure ulcers: an integrative review. J Clin Nurs. 2021;30(3-4):372-384. doi:10.1111/jocn.15583
9. Parker CN, Shuter P, Maresco‐Pennisi D, et al. Implementation of the Champions for Skin Integrity model to improve leg and foot ulcer care in the primary healthcare setting. J Clin Nurs. 2019;28(13-14):2517-2525. doi:10.1111/jocn.14826
10. Edwards HE, Chang AM, Gibb M, et al. Reduced prevalence and severity of wounds following implementation of the Champions for Skin Integrity model to facilitate uptake of evidence-based practice in aged care. J Clin Nurs. 2017;26(23-24):4276-4285. doi:10.1111/jocn.13752

About the Author

Alex M. Aningalan, MSN, RN, CWON, WCC, is a board-certified wound and ostomy nurse clinician and specialist. He has varied experiences in both acute and long-term care. In addition to wound healing, he is passionate about nursing education, nursing mentorship, and nursing scholarship. He loves to share the value of the wound and ostomy care specialty, especially among new-to-practice nurses, while encouraging and promoting it to fellow and emerging clinicians who share his passion for wound and ostomy care. In addition, he values the importance of leadership, evidence-based practice, and interprofessional collaboration among clinicians and patient populations.