One month and 17 sessions into his hyperbaric oxygen therapy regimen, Michael Albanese was gearing up for his next "dive" at New York Hospital Queens Center for Wound Healing at Silvercrest.
A patient with diabetes who lost all the toes on his right foot in two amputation procedures, he's grateful for the cutting-edge treatments to help avoid compromising his reconstructed skin flap. He's equally grateful for the team of advanced trained nurses and other professionals overseeing his outpatient care at the newly opened, state-of-the-art facility.
"They know how to do their job here," said Albanese, who was nearing age 50 when he talked to ADVANCE. "This is a good thing."
Officials cut the ribbon on the $500,000 center in Briarwood on July 10. Since, at least 100 patients in need of more aggressive therapies for hard-to-treat, chronic wounds like pressure ulcers, diabetic ulcers and radionecrosis have found help.
"It's an extremely exciting time," said Cari Dabak, BSN, BA, RN, WCC, the on-site program director who was among those at the grand opening.
For Setlidz Saint-Louis, MSN, FNP, CWON, the clinical director of wound/ostomy care for the 519-bed hospital who works closely with Dabak, it was the most special of days.
"It was something I had been waiting for," she told ADVANCE. The veteran nurse knows all too well the suffering associated with non-healing and chronic wounds, conditions that impact the lives of three million to five million U.S. residents.
For many patients at NYHQ Center for Wound Healing at Silvercrest, "It's the last resort," she said.
"There are a lot of success stories already," said Michaelle Williams, RN, senior vice president/CNO.
And that's just the beginning.
At first, wound center referrals came primarily from the hospital and Silvercrest. Now, referrals come from physician offices, as well as other hospitals and nursing homes. The host site for the new NYHQ program, Silvercrest is a 320-bed skilled nursing facility that serves adults who are chronically ill and make Silvercrest their home as well as individuals who need restorative therapy and rehabilitation before returning to an independent lifestyle.
"Anyone is welcome," Williams said. Initially, interest was slow. "Now, we're at capacity," Dabak said. "It's wonderful. It's what we were hoping for."
While a chronic wound is defined as one that has not healed in 6 months, others are more severe. "Some patients have been dealing with problems for years," she said, echoing Saint-Louis' compassion. "It certainly can affect one's quality of life."
At the new center, Dabak said they not only try to heal the wound, but try to figure out the underlying cause. There is always much discussion about what is best for the patient.
"I love treating wounds that other people have tried to heal, and we see them heal," Dabak said.
According to Williams, the wound center caters to a growing need among an aging population experiencing diabetes and vascular disease, among other ailments. According to 2011 hospital data, 49 percent of hospital admissions are patients ages 71 or over.
"If you compare our population across the country, we're well above average," Williams said. At the same time, she said wound care rules and regulations by Medicare and Medicaid have changed in the past 5 years.
Dabak joins Saint-Louis in conducting rounds at the hospital once or twice a week. Dabak is also working closely with Thomas Concert, MSN, RN-BC, manager of nursing informatics, to develop a streamlined referral process between NYHQ and the wound center to ensure continuity of care upon discharge, which is key to the patient's best outcome.
At Silvercrest, Dabak works closely with Loretta McManus, MS, BS, RN, LNHA, vice president of nursing services.
Though the idea for a wound center was introduced about 4 years ago, Williams said it took time to determine the perfect location. The center, which is wheelchair accessible, is built into a section on the first floor of Silvercrest. Construction and renovations took about a year to complete.
The décor is cheery. But first-time visitors are more likely to notice the two hyperbaric chambers, which Cynthia R. Bacon, NYHQ director of public affairs and marketing, described as "the most striking pieces of equipment in the center."
HEALING PLACE:Those helping the wound center get a successful start include, from left, program director Cari Dabak, BS, BSN, RN, WCC, chief nursing officer Michaelle Williams, MS, RN, NEA-BC, and clinical director of wound/ostomy care Setlidz Saint-Louis, MSN, FNP, CWON. On the opposite page, Elaine Sessa, RN, CNM, WCC, with patient Alfred Engresser. Photos by John Ciuppa
Arriving patients are greeted by Tiana Caraballo, the front desk coordinator. Rounding out the staff are Elaine Sessa, RN, WCC, clinical nurse manager; Psalmuelle DeLeone, RN, wound nurse; and HBO technicians Melissa Walls, RN, and Jenny Espinosa, RN.
Saint-Louis said the hospital/center follows all evidence-based practices, including negative pressure wound therapy. They also used products with silver to decrease bacterial burden on the wounds.
"They are all amazing," Dabak said of the staff. "I honestly do not believe we would have come out of the gates as strong as we did if we did not have them."
Dabak, who worked in healthcare administration before becoming a nurse 8 years ago, had a say in the hiring process. She was looking for team players, individuals who could multitask and cross cover, who also had a strong knowledge of wound care. "And they had to be very caring. Many of our patients are elderly," she added. Patients at the Wound Center range in age from 49 to 85.
The center is the second of its type to open in Queens, a borough of 2.5 million people. Saint-Louis especially likes the idea that patients can receive the care they need near where they live and work.
A nurse for 32 years, Saint-Louis discovered her passion for the profession as a young girl. Even as a child when a friend would suffer an injury, especially a cut, she wanted to take care of them. It wasn't until 12 years ago that she found her true niche in wound care.
"It's the love of my life," she said of wound care. "And, I am very persistent." It's not unusual for Saint-Louis to come to work on a weekend, or her day off, to oversee a difficult case. She welcomes the challenge. "I'm interested," she said.
Williams, a nurse for nearly 30 years, often reminds Saint-Louis how special she is to both patients and colleagues. "This is my family," Saint-Louis said of the hospital.
Interest is a characteristic she believes is common among nurses who choose wound care. Compassion is another quality. While all 700 nurses employed at NYHQ are trained in wound care, only 100 claim the title "Wound Care Champion," according to Saint-Louis. Those nurses volunteered to undergo additional 14 hours of training, taught by Saint-Louis.
About 11 percent of all wound care patients assessed qualify for hyperbaric oxygen treatment, Dabak said. Patients receiving hyperbaric oxygen treatment spend 1 hour and 30 minutes at pressure in the monoplace chamber, Monday through Friday for 6-8 weeks. At 8 feet long and 34 inches wide, "it's a tight fit," Dabak said.
"When they come in, they strip down to their birthday suit and put on 100 percent cotton gowns and covers," she said. During treatments, patients can watch television, listen to music or take a nap. Except for a slight pressure on the eardrum as the air is compressed, they feel no pain.
"They feel like they are traveling down a mountain, or flying in an airplane or scuba diving," Dabak said.
Compression lasts 7-10 minutes. At any moment during treatment, a patient can signal if they want to discontinue treatment. It takes another 9-10 minutes to decompress the patient.
"In the atmosphere, we breathe 20 percent oxygen and 80 percent nitrogen. During hyperbaric oxygen therapy, pressure is increased to two to three times normal and you breathe 100 percent oxygen," she said. Oxygen improves blood supply that, in turn, generates healthy tissue - which allows for faster healing.
Hyperbaric treatment, which has been used in acute settings for decades, has an average healing rate of 92.3 percent in an average of 9.3 weeks of treatment for hard-to-treat wound patients, Dabak said.
Time Well Spent
Albanese, a widowed father of five, was diagnosed with diabetes about 20 years ago. In addition to receiving treatments at NYHQ Center for Wound Healing at Silvercrest, he undergoes dialysis for his failing kidneys at another facility three times a week. An electrician by trade, he retired on disability about six years ago. But he still likes to help out family and friends, like installing a ceiling fan when he can.
For him, time in the hyperbaric chamber goes by quickly. Afterward, "I feel rested and a little more energetic," he said. "I would recommend it to anybody. I can see a difference from a month ago until now. It is worth coming here every day."
Rose Quinn is a frequent contributor to ADVANCE.