Wound healing process captured online

This article originally appeared in Aged Care Insight magazine, February 2012.

A computerised wound care system is significantly reducing costs for nursing staff in Victoria, writes Beverley Head.

More than a quarter of a million older Australians are treated each year for chronic wounds. Besides the obvious health implications, treating wounds can be a costly business.

According to the Wound Management Innovation CRC a total of 433,000 Australians are treated each year for chronic wounds, at a cost to the health system of $2.6 billion a year.

Information technology is now promising to both reduce the time taken to heal wounds and tackle the associated costs by ensuring carers follow best practice protocols.

The award-winning Mobile Wound Care system now being used across Victoria’s Gippsland region is providing carers with online access to evidence-based best practice protocols and also allowing a single regional wound consultant to effectively be on-call to each of the hundreds of patients treated in the region each year.

Each nurse has a laptop or netbook computer which they can use to capture data about the patient, and also a camera to take a photo of the wound which they upload to the computer.

Basic information is collected about each new patient. Using an on-screen diagram of a man or woman the nurse marks where wounds are located, and describes and photographs the wound.

On subsequent visits the carer can be stepped through the most appropriate treatment plan, and collect a record of the visit. This can also include more digital photographs of the wound that are attached to the record and which can be viewed remotely by the regional wound consultant.

While still a pilot, the service has already won the 2011 Victorian Healthcare Association Award. Implemented by the Latrobe Community Health Service, using software developed by Auckland based company HSA Global, the system has not at this stage been extended to nursing homes in the region, but it is being used by community nurses visiting older people still in their own homes.

In the future, however, Nicole Steers, the Latrobe Community Health Service executive director of ambulatory care, who has oversight of the pilot project, believes it would have significant benefits in residential aged care settings.

The wound care management system is one module in HSA Global’s collaborative care management system. Latrobe Community Health is the first Australian user of the system.

Over time the application allows carers and the wound consultant to monitor wound-healing and track the outcome of a treatment plan over multiple visits. Baseline data collected through this process can be used as an evidence base for best practice wound treatment protocols to be developed and implemented.

Steers explained that the system had allowed the health service first to collect data about the types of wounds, the treatment, the healing rates and the number of visits to clients.

In the first year of operation 12,775 assessments were performed on 824 clients with 1227 wounds, which translates to roughly 150 wounds a week being managed by 15-20 nurses backed by one specialist wound consultant who can access all the data and see all the wound photos.

“The technology means that we can make better use of the regional wound consultant. Now if the nurse is using the right wound care, but the wound isn’t healing they can refer to the wound consultant,” said Steers.

“The consultant can monitor that from her office. She can make the trip when it’s really necessary. But because she’s not up and down the road all the time she can provide that level of service to more clients.”

Although older people have been treated using the system in their own homes, Steers said it had not been extended to any local nursing homes. It wasn’t that nursing homes didn’t want to be involved, on the contrary, but because the pilot system is being analysed by Monash University’s department of rural and indigenous health, it was necessary to be very strict in how it was used so that apples could be compared to apples.

Given the pilot timeframes and the need for carer training Steers said that at this stage it had not been taken to nursing homes. However, she believed that the technology could have enormous benefits in terms of improved healing rates, reduced costs and also ensuring that staff followed best practice protocols regardless of their level of training and expertise.

“The software is quite easy to use and the Mobile Wound Care product interfaces with most systems – so there’s no duplication of data re the demographic information.”

More importantly the system allowed appropriate care pathways to be established and followed by nursing staff.

“At the moment we are looking at skin tears and putting in place care pathways that are evidence based,” she said. The system also provides guidelines regarding acceptable healing rates, tracks the costs of providing care and details the products to be used.

“This is quality management for nursing homes,” said Steers. The system also prompts nurses to look at co-morbidities, such as diabetes, when deciding on the best treatment protocol.

In the La Trobe system if the healing rate moves outside the expected range, or a nurse isn’t happy with the way a wound is responding to treatment, the specialist wound consultant can review the data and photos and either provide additional advice or visit the patient.

Steers is convinced that freeing up the specialist wound care consultant to remotely provide advice, limiting visits to just the most challenging cases has already led to significant benefits and is also delivering economic benefits.

“If you don’t get it right, the time factor can be so delayed – you add visits and the cost of products – it can all escalate. If you are delivering evidence based care with consultant support then you are providing the best care in the least amount of time.

“In my service with 150 wounds if you are taking twice the amount of time [to achieve healing] then the costs blow out to astronomic levels.”

For aged care providers the benefits of such a system are clear, said Steers: “There are real operational issues regarding time and cost from using evidence based care pathways. This should help nursing homes’ less qualified staff because it’s so simple and intuitive.”