Streamlining Wound Care Management and Revolutionizing Resident Care
Caregiving isn’t a profession; it’s a calling. Like everyone else in the field, we use our skills to improve the quality of people’s lives. But it’s never a solo show. From frontline nurses to top-level executives, caregivers work together to make impactful and meaningful changes when it comes to helping adults in their golden years. Continuing care centres have evolved to meet the ever-changing needs of residents. We provide around-the-clock care and monitoring for those who need it.
At Bethany Care Society, we provide communities, affordable housing, supportive living, and long-term care for residents with varying degrees of health and ability. No matter their situation, we strive to give them the best environment and person-centred quality care so they can flourish and have their unique needs met.
Apart from looking at data, listening to residents’ stories is also a big part of what we do. We have quality indicators and other metrics that identify the impact of our activities, but to truly understand the situations behind the metrics, we go to the source and pay attention to what residents are telling us. After all, our numbers reflect their reality, and making improvements has a tangible impact on their lives.
We also connect with our employees, our Care Service Managers (CSMs), and residents’ families to find ways to improve quality of care. It’s a collaborative effort, and the more input we receive, the better we can enhance resident care.
Cumbersome Wound Care Management
Bethany is a forward-thinking organization. A major pillar of our strategic plan is using innovation and technology to drive and manage change, thus transforming our workflow and processes. Frontline employees often spend a lot of time on documentation. As a result, we try to continually find ways to help reduce the time spent on these tasks so they can focus on delivering care.
One area we reviewed for improvement was the management of skin and wound care. The body’s ability to heal declines as we age, and older people take longer to recover from skin tears, abrasions, and other wounds. We had a process in place for these situations, but it was paper-based and time-consuming—particularly in terms of documentation.
When one of our residents requires treatment for a skin tear, abrasion, or other wound, we start a wound evaluation and keep them in a treatment binder. The treatment binder involved handwritten documentation and the printing of photographs to assist with communication. The processes did not set employees up for success. The workflow was cumbersome and didn’t support communication for ongoing assessment. For example, as treatment progressed, subsequent evaluations weren’t always as detailed as the first evaluation, and it was difficult to update the information in a timely way or include new photographs of the affected area.
As a result, we couldn’t track wound progress as effectively as we would like. Another concern was accessibility. Whenever there was a shift change, our frontline team had to consult a physical binder to ensure that a resident was receiving care according to their plan, but accessing that binder wasn’t always possible. We needed an easier solution to advance our skin and wound care program while integrating into existing workflows.
Finding an Ideal Solution with Our Existing EHR Provider
We’ve been using PointClickCare as our electronic health record (EHR) platform since 2006. As we were narrowing down the qualified product list for a wound care solution, we discovered that PointClickCare had recently released a Skin & Wound app that integrated with their main product and therefore tied into residents’ existing profiles. That in itself represented a huge leap forward in workflow efficiency, but the app offered so much more.
As is the case everywhere, clipboards are a thing of the past. Our blood pressure monitors are connected to PointClickCare and upload vital signs into the resident chart. Caregivers use iPods and iPads to collect, share, and transfer information. The Skin & Wound app feeds into this same ecosystem.
With Skin & Wound, staff can photograph wounds with their iOS devices and upload them to a resident’s file. They can enter their observations and a structured progress note is created automatically. These features make it easy to perform continuous and regular evaluation that lead to better care.
Another crucial issue we considered was app fatigue. It is laborious and time-consuming to switch from one app to another, even on a mobile device. Because Skin & Wound is part of the larger PointClickCare app, users don’t have to go back and forth between the two. Believe it or not, this functionality makes a huge difference in change management, as every extra step is an obstacle to adoption.
Managing Change While Rolling Out Skin & Wound
When we settled on our solution, we didn’t go all in right away. Bethany operates eight sites serving 1,200 residents. We needed to understand the complexities and unique challenges facing each of the sites before rolling out Skin & Wound everywhere.
We embarked on a phased approach to implementation. For our starting point, we chose a site with a CSM that had a lot of experience and passion for moving the health record into PointClickCare. This CSM is well versed in the intricacies of PointClickCare and understands how to use technology to improve resident care. Upon the successful completion of the pilot at this site, we progressively deployed the Skin & Wound app at all our sites.
Deployment followed a structured plan that centred on creating local teams at each site. Two Quality Practice Leaders—one focused on the EHR and another focused on skin and wound care—introduced the new app and then assembled a team consisting of the CSM, Site Administrator, Clinical Educator, and Wound Care Champions.
The team then determined the different processes and technologies that were likely to change during the transition at their site. We aligned these with our overall Skin & Wound rollout strategy, so nothing fell through the cracks. Next, we personalized the local implementation based on these findings and applied change management strategies that were adapted to specific needs of the site.
From there, we communicated the changes brought on by the adoption of the Skin & Wound app. We had a series of templates that we could customize and deploy at every site, and we used multiple methods to communicate the changes, which included: email, screensavers on big screen TVs that served as electronic billboards announcing the initiative, and staff meetings. After letting employees know about the change, we then provided education to the Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) and any other Allied health staff with advanced wound care training. We used the Skin & Wound app provided by PointClickCare and delivered an hour hands-on session that gave employees practice with the app.
Our approach was adaptive. It was important to have a plan, but also be ready to adapt it to any specific needs of the site. We tweaked the implementation as we went along and then watched the process unfold, intervening as necessary. By the time we got to the seventh location, we had developed a well-established process.
Apprehension and Excitement
Once Skin & Wound was implemented, we knew we had a hit on our hands. Our caregivers crave technology: They want digital alternatives to clipboards, binders, and filing cabinets, and they saw the app’s advantages right away.
They were especially excited about the ability to photograph a wound with their devices and upload it directly to the resident’s file. However, some were also apprehensive. Knowing that Skin & Wound was integrated with the main PointClickCare app helped ease their fears, but we also let them know we were there to support them and to assure them that anything they do will not break the app.
We also took a supportive approach to providing feedback. We have seen how negative feedback can impact employees from external reviews. Thus, our approach was to look for and provide feedback on what they were doing right. Focusing on their successes helped to encourage the employees to use the app during their day-to-day practice.
It took a year, but our slow and steady approach was worth it. The Skin & Wound app has now been rolled out to all Bethany sites.
Individual wound care data is always accessible because caregivers can now access it on their mobile devices. Charts are easier to compile and consult. Because all data is available remotely, employees no longer have to go to a nursing station or a resident’s room to get the necessary information to prepare the next step in their wound care.
The quality of documentation has improved as well. So far, 81% of employees indicated that it was easier to look up an individual treatment plan. Evaluations are performed on a more regular basis as compared to before implementing the Skin & Wound app. By comparing pre- and post-wound evaluations, we identified significantly more wound evaluations by almost 2X after implementing Skin & Wound.
An unexpected outcome of adopting the app was improved communication. In the past, our nurses had to personally communicate with occupational and physical therapists (OTs and PTs) and registered dietitians (RD) regarding individual residents’ wounds. Given all their other responsibilities, this was sometimes difficult to do in a timely manner. The Skin & Wound app helps facilitate this communication by integrating the information into the primary PointClickCare resident record. OTs, PTs, and RDs now have a fuller picture of a resident’s health and can adjust their interventions accordingly. All of this data improves our holistic approach to care.
There’s also the potential to use the Skin & Wound app to communicate with residents’ families. We can track progression and show relatives how the wound is trending over time, educate them about wound care, and give them the information they need should a medical intervention be necessary.
The Little Things Count
At any given time, frontline caregivers are dealing with an onslaught of information and overwhelming responsibility. They are constantly juggling priorities and balancing the needs of the residents under their care. Technology makes it easier for them to evaluate information and schedule activities in a way that provides the most efficient and personal care.
Bethany’s dedicated healthcare practitioners are transforming the lives of our residents. PointClickCare and the Skin & Wound app give them the tools they need to efficiently handle data so that they can excel at their calling.