Most Proposed Topic :
Committed and Happy Staff (staff wellness / OSH / retention)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors: (including presenting author): :
Ho CK, Wu WSF, Chow PFK, Yip YKL, Chan BY, Leung KH, Lai FSP, Leung SH, Li YC
Affiliation: :
Department of Family Medicine & General Out-patient Clinics
Introduction: :
Patients attending wound care in community based General out-patient clinics (GOPCs) require different levels wound care, ranging from simple to relatively complicated condition. This varies in attending frequency based on individual wound condition. Simple intermittent wound care by patient or relative could be possible with proper coaching by GOPC nurses. Implementation of WPEP in KCC FM&GOPC promotes self-management of wound dressing and improves patient convenience and quality of life by saving time and minimizing wound care attendance. Nurse-patient collaboration in GOPC wound care also improve clinical efficiency in primary health care.
Objectives: :
To empower patient’s self-management in wound care at home setting
To promote quality of life
To enhance communication and collaboration between nurses and patients and care givers
To promote clinic effectiveness of GOPC wound care service
Methodology: :
With support and coordination by KCC GOPC Wound clinic members, staff training session was arranged for all community based GOPC nurses in KCC on Wound care PEP. Training contents include criteria for case selection, patient education on wound care techniques, home care tips and clinical case follow up and evaluation. Regular staff training and sharing meetings were held to ensure regular review and care quality.
A list of wound types is suggested by KCC GOPC Wound team as simple and stable wound condition which is safe and suitable for patient to manage at home setting. They include simple traumatic wound and burn or scald wound, incision and drainage wound without pocketing, perianal and perineum wound, chronic leg ulcer, wound without complication (e.g. gangrene, wound bed necrosis, slough, undermining, wound infection), and no packing needed. Additionally, patients or caregivers who are willing, confident and capable to perform wound dressing at home, would be invited to join the Wound PEP. Besides, patient or relative with good visibility & dexterity, wound location reachable and visualized, and wound pain which is tolerable, are also considered. Patient who participate in WPEP would receive wound care education leaflet with on dressing demonstration in GOPC by nurses. Dressing materials would be selected to facilitate patient self-care at home. Follow up booking would be arranged for case review after one to three episode of home wound dressing as suggested by case nurse. At each follow-up attendance, nurses reviewed patient’s wound and skin condition and patient were actively discussed their experience or possible issue encountered during wound care at home. A survey of satisfaction from patient provide precious feedback and enhancement of the program.
Result & Outcome: :
From 4/2023 to 11/2023, 1102 patients participated and 94% (n=1034) completed the satisfaction survey. Among those who replied, 95% complied with frequency of dressing change and 97% satisfied. 95.9% agreed wound care instruction was helpful and 98.6% agreed dressing material was easy to manage. Narrative comments include time saving and minimize travelling to clinic, which is welcomed by patients and carers. Care convenience is considerable especially during extreme weather conditions. Comments also include appreciation to nurses on providing clear instruction. Few patients expressed lack of confidence but reassurance was given by nurses during follow-up visits. Some patients need caregivers assistance on less reachable wound location by himself. Video demonstration of wound care procedure was also suggested. To make PEP successful, all of above comments are important, service review with frontline nurse was discussed and continuous improvement include selection of dressing material and staff training were provided. After WPEP implementation, total KCC GOPC dressing attendance (79471) decreased 15% in the period from April to November 2023 as compared to the total dressing attendance (93929) before COVID period in April 2019 to November 2019.
