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Chronic wounds get healing care at O'Connor Hospital's wound clinic.

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THE WHOLE PATIENT: O'Conner nurses are called on to treat the body, mind and spirit. Lexa Most, RN, sits with a patient after treatment.

Skin is pretty remarkable. The average adult is covered with about 20 square feet of it, most between 2-3 mm thick. Every square inch is filled with more than a dozen blood vessels, hundreds of sweat glands and more than a thousand nerve endings. It is the largest organ of the body and its best defense against pathogens. Any breach, or wound, in that defense is potentially dangerous to the body as a whole. Add in a host of comorbidities, and wound management becomes crucial.

Wounds 101

Not all wounds are created equal, noted Ashraf Gulzar, MSN, RN, clinical nurse manager at O'Connor Hospital's Wound Care Clinic in San Jose.

HEALING CARE: Sheila Bannan, RN (left), and Lee Ann Kientzy, RN, examine a wound.

"Healthy skin has a supply of protein and growth factors that encourage the body to regenerate new skin when it's wounded," she explained. "But patients with diabetes or vascular insufficiency may not have enough of these factors, leading to a non-healing wound."

A former med/surg manager, Gulzar said she used to take skin for granted. Wound care meant patients came in, got their dressings changed and went home.

"I had no idea of the depth of our practice," she said. "Patients see their primary care provider, who may not have advanced wound care experience. After a few months, if the wound hasn't healed, they refer the patient to us. This accounts for nearly 80 percent of our patients. We see a lot of non-healing wounds."

Wound care transcends all levels of nursing, noted Judy Watland, MSN, RN, O'Connor's chief nursing officer and vice president for patient care services.

"There isn't an area of medicine where wounds aren't an issue," Watland said. "That makes them a universal issue for nurses as well."

Gulzar said the clinic follows clinical pathways for best practices; diabetic and neuropathic ulcers, arterial ulcers, pressure ulcers and venous ulcers. Patients may come with complications from comorbidities, others from compliance issues. She noted smokers tend to have a more difficult time with healing and are encouraged to quit smoking to help their treatment.

TREATMENT SUCCESS: Joanne Bischoff, RN (left), and Ashraf Gulzar, MSN, RN, clinical nurse manager, congratulate a patient on his "graduation" from the clinic. photos courtesy O'Connor Hospital

Coordinated Care

The clinic is staffed by a variety of specialists including vascular surgeons, general surgeons, podiatrists, internists, a plastic surgeon, an orthopedic surgeon and an infectious disease physician. Patients are assigned to a particular physician based on the location or type of wound.

"For example, a patient with a heel wound will be seen in the podiatric clinic," Gulzar said. "A vascular wound would be evaluated and treated by the vascular surgeon."

With 18 treatment rooms, Gulzar schedules two clinics at the same, for example, vascular and podiatry. In cases where the patient has overlapping wound care needs, appointments are made so the patient can see both physicians on the same visit.

"They come as long as it takes to resolve the wound," she said. "We see 35-50 patients a day, 550 a month on average. When a patient is discharged, we say they've graduated."

Dorothy Reggiardo, RN, WOCN, works with ostomy and stoma patients, helping clinic physicians assess wounds and develop care plans. She also consults on inpatients and helps with those developing hospital-acquired pressure ulcers.

Staff nurses from the clinic take their skill and knowledge on the road to area skilled nursing facilities several times a year, Watland said.

"Our wound care nurses work with the nurses at the SNFs to look for pressure ulcers and do skin assessments," she said. "With bed-bound patients, this is a constant problem."

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