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Provide Organizational Support


a. Multi-disciplinary Team Intervention Referral Criteria checklist

 
iFUN Criteria guidelines for referral to an advanced wound specialist
i Intervention If an intervention is required (i.e. ABPI, toe pressures, debridement)
F Frequency If the frequency of dressing changes is not less than 3 x a week within 4 weeks of treatment
U Unknown If the cause of the wound or the cause of the failure to heal is unknown
N Number If the size of the wound has not decreased by 20-30% in 3-4 weeks of treatment
 


Table 3: Professional Referral Suggestion Chart

 
Criteria Suggestions for Referral
Patient requiring assistance to quit using tobacco or nicotine products Refer patient to smoking cessation program, pharmacist, social worker, physician, nurse practitioner and/or counsellor
 

Level A: RNAO's Integrating Smoking Cessation into Daily Practice Evidence Level1

Medical management may include appropriate systemic antibiotic therapy for patients with bacteremia, sepsis, advancing cellulitis or osteomyelitis. Refer to most responsible physician, nurse practitioner or Infectious Diseases Specialist for antibiotic treatment.
 

Level C: RNAO's Assessment and Management of Venous Leg Ulcers2

Prevent or manage pain Refer to most responsible physician, nurse practitioner, physiotherapy, pain and symptom management team or pharmacist as needed
 

Level C: RNAO Assessment and Management of Venous Leg Ulcers3

Mini Nutritional Assessment (MNA) < 24
Unable to afford or have access to nutritional food
Refer to Registered Dietitian
Refer to Social Work
 

Level B: RNAO Assessment and Management of Venous Leg Ulcers4

Mobility Issues Refer to physiotherapy or occupational therapist for mobility or gait aids
 

Level B: RNAO Assessment and Management of Venous Leg Ulcers5

Unable to complete lower leg assessment and/or ABPI Refer to wound care specialist, trained nurse or vascular lab
 

Level B: RNAO Assessment and Management of Venous Leg Ulcers6

Home Safety Assessment Refer to physiotherapy or occupational therapist
 

Level B: RNAO Assessment and Management of Venous Leg Ulcers7

 

b. Patient, Caregiver and Healthcare Provider Teaching and Learning Resources

‘Teach-back’ method is a way of ascertaining patients understanding about what they need to know or do regarding their health. Patients are asked to state in their own words what they understand to be important. It is a way to confirm that things have been explained in a manner that the patient understands
 
Lifestyle
  • Tobacco and nicotime cessation with goal to be nicotine-free
  • Pain management
Rest/Activity/Mobility
  • Turning and sitting schedule for repositioning
  • Pillow between knees
  • Activity level according to post-operative instructions
Safety
  • Prevention of injury - friction, shearing
Wound
  • Self-care of wound/tube(s) if appropriate
  • Handwashing/hygiene
  • Aseptic technique
Reprocessing of instruments
  • Appropriate storage of equipment and supplies
  • When to call primary caregiver (e.g. signs and symptoms of infection, dehiscence, deep vein thrombosis, cellulitis, impaired blood flow, and difficulties with compression)
Dietary
  • Dietary requirements as per dietitian
Diagnostic Tests
  • Results understood by patient
Skin Tear
  • Comprehensive self-care of skin
  • Incontinence and prevention/treatment of Moisture Associated Skin Damage (MASD)
Family and caregiver support
  • Family/caregiver actively and willing and able to participate in treatment plan
  • Assess family fears and concerns
  • Repositioning, nutrition, continence if needed
  • Access need for caregiver respite/relief
  • Conflict with caregivers
Community/Social Supports
  • Community support groups  (eg. Diabetic education and self- management sessions, walking groups, Southern Ontario Aboriginal Diabetes Initiative - SOADI)
  • Check for availability for financial compensation (e.g. private insurance, veterans medical benefits, Ontario Disability Support Program –ODSP/Ontario Works, Non-Insured Health Benefits -NIHB and Southern Ontario Aboriginal Diabetes Initiative – SOADI for First Nations people and Inuit)
  • Long or short term placement (e.g. convalescent, respite, rehabilitation)
  • Confirm that ongoing medication coverage is arranged

c. Discharge or Transfer Planning and Communications

Regardless of the method of providing the information (e.g. Care Connect, photocopy or Discharge Summary), it is agreed that the following information is critical in providing seamless care when individuals who have surgical wounds are being discharged or transferred to a different care setting:
  • Diagnostic results
  • Relevant consultation notes
  • Post and current treatment and education plan
  • List of appropriate contact information for ongoing needs
  • If wound is on lower leg or foot:
    • Identify need to reassess ABPI/TBPI in 6 months
    • Lower leg assessment results

If wound closed or eschar is stable (in arterial disease) send discharge summary outlining outstanding issues and teaching completed to:
  • Referral source
  • Most responsible physician (MRP)/nurse practitioner
Appropriate documents shared between the following:
  • Acute care
  • Complex Continuing Care/Rehab
  • Long-term care
  • Community care
  • Primary care physician/Nurse Practioner
  • Professionals referred to
  • Other ___________________________

d. Waterloo Wellington Integrated Wound Care Program Evidence-Based Wound Care Surgical Wound Clinical Pathway

  1. Ontario, Registered Nurses Association of. Nursing Best Practice Guideline: Integrating Smoking Cessation into Daily Nursing Practice. 2007.
  2. M, Eagle. Understanding cellutlitis of the lower limb. s.l. : Wound Essentials, 2007.
  3. M, Eagle. Understanding cellutlitis of the lower limb. s.l. : Wound Essentials, 2007.
  4. Ontario, Registered Nurses Association of. Assessment and Management of Venous Leg Ulcers. Toronto : s.n., 2004.
  5. Ontario, Registered Nurses Association of. Assessment and Management of Venous Leg Ulcers. Toronto : s.n., 2004.
  6. Ontario, Registered Nurses Association of. Assessment and Management of Venous Leg Ulcers. Toronto : s.n., 2004.
  7. Ontario, Registered Nurses Association of. Assessment and Management of Venous Leg Ulcers. Toronto : s.n., 2004.

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