Exploring the concept of a team approach to wound care: Managing wounds as a team

Abstract

Background - The growing prevalence and incidence of nonhealing acute and chronic wounds is a worrying concern. A major challenge is the lack of united services aimed at addressing the complex needs of individuals with wounds. However, the WHO argues that interprofessional collaboration in education and practice is key to providing the best patient care, enhancing clinical and health-related outcomes and strengthening the health system. It is based on this background that the team approach to wound care project was conceptualised. The project was jointly initiated and realised by the Association for the Advancement of Wound Care (AAWC-USA), the Australian Wound Management Association (AWMA) and the European Wound Management Association (EWMA). Aim - The aim of this project was to develop a universal model for the adoption of a team approach to wound care. Objective The overarching objective of this project was to provide recommendations for implementing a team approach to wound care within all clinical settings and through this to develop a model for advocating the team approach toward decision makers in national government levels. Method An integrative literature review was conducted. Using this knowledge, the authors arrived at a consensus on the most appropriate model to adopt and realise a team approach to wound care. Results - Eighty four articles met the inclusion criteria. Following data extraction, it was evident that none of the articles provided a definition for the terms multidisciplinary, interdisciplinary or transdisciplinary in the context of wound care. Given this lack of clarity within the wound care literature, the authors have here developed a Universal Model for the Team Approach to Wound Care to fill this gap in our current understanding. Conclusion - We advocate that the patient should be at the heart of all decision-making, as working with the Universal Model for the Team Approach to Wound Care begins with the needs of the patient. To facilitate this, we suggest use of a wound navigator who acts as an advocate for the patient. Overall, we feel that the guidance provided within this document serves to illuminate the importance of a team approach to wound care, in addition to providing a clear model on how to achieve such an approach to care. We look forward to gathering evidence of the impact of this model of care on clinical and financial outcomes and will continue to share updates over time.

Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives

“…In most cases, the health professional who conducts the initial assessment of a patient with a heel ulcer is the 'wound care navigator' (WCN). 91…”

“…Patients managed by an MDT have better outcomes than those not managed in this way. 91 Guidelines recommend that referral should take place promptly and within 24 hours of identification of a DFU. 28 Evidence suggests that this rapid referral does not happen in the majority Assessment, referral and the multidisciplinary team of cases.…”

“…Patients managed by an MDT tend to have better outcomes than those not managed by one. 91 The constitution of an MDT varies worldwide 91,106 and generally they are associated with the acute care setting rather than the community. Nevertheless, a patient in the community who meets the guidelines for management by an MDT, perhaps because of a change in status of the wound, should be referred to one.…”

Patient-centred care: a call to action for wound management

“…'the patient should be at the heart of all decisionmaking, as working towards the universal model for the team approach to wound care begins with the needs of the patient.' 4 Have your wound assessed and monitored by trained healthcare personnel Wound education should be incorporated into all health professions and certifications maintained. The wound care patient deserves the right to be treated with confidentiality and respect.…”

“…For example, the European Wound Management Association (EWMA) has put together two highly comprehensive position papers, 'Optimising wellbeing' (2012) and 'Managing wounds as a team' (2014). 3,4 In this latter document, the key factors necessary for a team-based approach that will resonate with patients are listed as: 4 • A patient focus using an advocate for the patient-a wound navigator • Referral mechanisms that are responsive • Aggregation of assessment data to form a single plan • Appropriate remuneration systems • A health-care system sensitive to team models. But perhaps we are in danger of preaching to the converted.…”