Wound Care in Complex Rehab Patients: A Quality Improvement Intervention

Patients admitted to Craig H. Neilsen Rehab Hospital (NRH) have complex medical histories and often have complex wounds requiring extensive and expert wound care with very specific wound care instructions provided by physicians. These patients often do not have timely or accurate wound care orders, which if they are not rectified can increase the risk of infection, prevent appropriate and timely healing, and can increase the burden of patient care on nurses. Our goal was to improve the process for ordering wound care, with the specific aims of 1) Reducing the number of wound care orders placed more than 24 hours after admission from 39% to 20% during the 3 months after the intervention, and 2) Reduce the number of admission wound care orders identified by the wound care team as needing to be changed from an average of 2 per week to no more than 1 per week. A wound care order set was created in conjunction with the wound care team to provide a more streamlined and accurate process for ordering wound care recommendations. In addition, an order constraint was created to promote entering appropriate wound care orders at the time of admission. Post-intervention data collection is planned after implementing the order set for April-June.

Wound Care in Complex Rehab Patients: A Quality Improvement Intervention Arafat A, Dickenson B, Mascoe J, McGuire F, Nabi A, Tang W, Wijetunge H, Whitlock J, Ehn M Craig H. Neilsen Rehabilitation Hospital (NRH), Department of PM&R, Salt Lake City, UT Introduction/Problem: Process Map Patients admitted to NRH often do not have timely or accurate wound care orders, which can lead to: • Increased risk of infection • Inappropriate and untimely healing • Increased burden of patient care on nurses Results: Results: • 633 total wound orders were placed during a 4-month (17-week) period • 253 (60.0%) of patients had orders placed within 24 hours of admission • 68 (10.7%) total wound care orders were placed incorrectly, requiring changes later with notification from the wound team The process of identifying and rectifying inaccurate or late wound care orders has created a significant administrative burden on the wound care team and the resident physicians working at NRH Objective: • Reduce the number of wound care orders placed outside of the 24-hour admission window from 40% to 20% • Reduce the number of admission wound care orders identified by the wound care team as needing to be changed from 10.7% to 5.3% Total orders Orders after 24 hours Discussion: Wound care requires a multi-disciplinary, team-based approach to perform successfully. Based on our process map, it was clear that multiple avenues of change could be explored. Rather than implementing change to the ancillary staff process, we elected to focus on changes that could be made at the resident physician level. Study Design: • Single center study • Data collection period: 9/2/24 – 12/31/24 • Collaboration with EPIC IT on quantitative measure collection via wound care coding Conclusions: • Beginning April 2025, an embedded admission LDA order set was launched with the help of our EPIC team. • We will be collecting data for another three months (through June 2025) ©UNIVERS ITY OF UTAH HEALTH