Scenario of Wound Care Scenario of Wound Care in Malaysiain Malaysia

DR.MOHAMMAD ANWAR HAU ABDULLAHDR.MOHAMMAD ANWAR HAU ABDULLAHHOSPITAL RAJA PEREMPUAN ZAINAB IIHOSPITAL RAJA PEREMPUAN ZAINAB II

1.10.20121.10.2012

WoundsWounds• Wound-care important aspect in Wound-care important aspect in

infection control infection control • Wound- potential source of cross Wound- potential source of cross

infection leads to hospital acquired infection leads to hospital acquired infection and outbreak (MRSA, infection and outbreak (MRSA, pseudomonas etc).pseudomonas etc).

• Cause of bad smell /odour in the wardCause of bad smell /odour in the ward• Social stigmaSocial stigma

Wound - World scenario:Wound - World scenario:• World Union of Wound Healing Societies • Wound-care society in our neighboring countries

(Singapore, Thailand, Indonesia)• Japan Society for Surgical Wound Care and

Japanese Society of Pressure Ulcers• World Alliance for Wound• Federation of Asian Wound Healing Society (we

are one of the member)• Australian Wound Management Association.

World scenario:World scenario:• Many countries (developed) – dedicated

wound-care team in the hospital.• Specialist in wound-care (in advanced

countries)• A lot of R&D and advances in the field of

wound-care• A lot of wound-care products- various

companies.

Trauma

WOUND CARE IN MALAYSIA WOUND CARE IN MALAYSIA • Not well covered/stressedNot well covered/stressed• Superficially touchedSuperficially touchedin the medical curriculum as in the medical curriculum as

well as the curriculums for the well as the curriculums for the paramedics (nurses and health paramedics (nurses and health assistant).assistant).

Malignant

Wound careWound care

Knowledge and practice:Knowledge and practice:• Learned from the seniors- Learned from the seniors-

observing and modelingobserving and modeling• Lack of scientific evidenceLack of scientific evidence• Cultural belief/mythCultural belief/myth

Wound careWound care• Not a glamorous fieldNot a glamorous field• Not a popular field Not a popular field ----> Not many are interested----> Not many are interested----> Not many are committed----> Not many are committed-----> take it lightly and easy-----> take it lightly and easy----> assignment- luck----> assignment- luck

Wound careWound carePatients with wound: Patients with wound: • Least priorityLeast priority• Placed --> end of the wardPlaced --> end of the ward• Senior doctors- not actively Senior doctors- not actively

involvedinvolved• Care by more junior doctorsCare by more junior doctors

Trauma

Wound careWound care• Lack of wound care guidelines Lack of wound care guidelines • SOP for wound dressingSOP for wound dressing• Courses- not manyCourses- not many• No standardised training No standardised training

modulemodule

Wound careWound care• Personal preferencePersonal preference• Different protocol – within Different protocol – within

same unit /departmentsame unit /department• Care: changes rapidlyCare: changes rapidly• Confusing: junior doctors, Confusing: junior doctors,

staffs and patientsstaffs and patients

Wound careWound careWound care products:Wound care products:• Personal preferencePersonal preference• Many different productsMany different products• Lack of knowledge Lack of knowledge (advances)(advances)

• Used inappropriately ---> Used inappropriately ---> wastage, not cost effectivewastage, not cost effective

Necrotising fascitis

Wound careWound careDifferent standard:Different standard:• Health clinic (primary care): Health clinic (primary care):

conventional wound careconventional wound care• Hospital: advanced wound careHospital: advanced wound care• Standard of care: different and Standard of care: different and

lack of continuationlack of continuation• (Issue of money )(Issue of money )

Wound careWound care• Not well organisedNot well organised• Lack of standardised policyLack of standardised policy• Very few hospital – wound Very few hospital – wound

care team care team • No professional organisation/ No professional organisation/

body to spearhead and drive body to spearhead and drive wound care activities wound care activities (no man’s land)(no man’s land)

Malignant

Mid-2009National wound care National wound care management committee in management committee in Ministry of HealthMinistry of Health

(members: doctors and paramedics (members: doctors and paramedics from various specialties and from various specialties and hospitals)hospitals)

National wound care National wound care management committeemanagement committee

• Policy and planning• Training- wound care module

and conduct training• Secretariat

Wound Data Collection• No of hospitals involved: 7• Duration: 2 months (August and September 2010)• Involved: surgery, medical, orthopaedic and

others (O&G, peadiatric and etc)

Objectives:– Work-load- number of patient and number of

wound– Time taken for various types of wound dressing– Amount of dressing solution and material used– Outcome

Findings1. Workload: 6.5% (11732) of total inpatients and

10% (16586) of total out-patients .

2. Actual dressing time (hidden time):– Diabetic foot ulcer (10cm x 8cm): 8 to 25

minutes– Pressure sore (15cm in diameter): 20 to 60

minutes– Traumatic wound: 15 to 25 minutes

3. Dressing solutions and materials used: RM 1.5 million.

DG DirectiveOct 2011:

By 1.7.2012- specialist hospitals- must set up wound care team (KPI for hospital director).

Other hospitals: by 1.1.2013

Implementation Phase I:

Formation of wound care team and hospital wound care committee in all state hospitals- July 2012

Phase IIFormation of wound care team and hospital wound

care committee in all specialist hospitals, to train nurses in health clinic- July 2012

Phase IIIWound-care team in non-specialist hospitals, post-

basic in wound-care, wound-care nurses in health centers, home-care- January 2013

AIM:AIM:

• To establish a dedicated wound care team/unit in Ministry of Health hospitals with a vision to develop a wound care unit in future.

• To provide systematic, standard and quality wound care.• To facilitates patient-centered care through holistic

approach.• To provide training for medical staffs involved in the

management of wounds• To optimize financial and human resources• To improve functional outcome by reducing morbidities

and mortalities hence improve patient’s satisfaction

HOSPITAL WOUND CARE COMMITTEEHOSPITAL WOUND CARE COMMITTEE

DEPUTY HOSPITAL DIRECTOR

DEPUTY HOSPITAL DIRECTOR

INFECTION CONTROL UNIT

INFECTION CONTROL UNITDIETICIANDIETICIAN

MICROBIOLOGISTMICROBIOLOGISTWOUND CARE TECHNICAL MEMBERS

-VARIOUS DEPARTMENTS

WOUND CARE TECHNICAL MEMBERS

-VARIOUS DEPARTMENTS

WOUND CARE TEAM

WOUND CARE TEAM

PHARMACISTPHARMACIST

Secretariat

HOSPITAL WOUND-CARE TEAMHOSPITAL WOUND-CARE TEAM• HEAD – clinical

specialist nominated by Hospital,

• COORDINATOR – senior medical officer UD48 , coordinator,

• Sister• 2 staff nurses• 2 assistant medical

officers

TEAM COORDINATOR

TEAM COORDINATOR

HEAD

(NOMINATED BY DIRECTOR)

HEAD

(NOMINATED BY DIRECTOR)

STAFF NURSESTAFF NURSE ASSISTANT MEDICAL OFFICERS

ASSISTANT MEDICAL OFFICERS

SISTERSISTER

WOUND CARE TEAM:WOUND CARE TEAM:

• The wound care team/unit shall consist of: • Chairman – Deputy Director of Hospital (Administrative)• Committee members – representative from various

clinical departments• Coordinator – specialist/senior medical officer UD48• Medical officers – from various clinical department• Wound care paramedics – sister, staff nurses and

assistant medical officers from various disciplines• Pharmacist • Microbiologist• Dietician• Infection Control member – representative of infection

control unit.

Trauma

Wound care committee/team

• Standardised practice (not Standardised practice (not regulatory)- SOPregulatory)- SOP

• Improved standard Improved standard • Cost effectiveCost effective• Improved satisfactionImproved satisfaction

Wound care guideline:Wound care guideline:• Training moduleTraining module• Used by health care Used by health care

providers in the health providers in the health centers /clinics/hospitalscenters /clinics/hospitals

Wound care algorithm• Simplified Simplified • Simple, practical and Simple, practical and

easily understoodeasily understood• Used by any health care Used by any health care

providersproviders

Wound care chart

Wound care training- in various hospitals and

regions(standardised module)

- participants from private colleges/ universities

- Identify Local champions

> 20 MOH hospitals- form wound care team, others in progress!

(ENT surgeon as coordinator!)

future:future:

FUTURE• Staffs in health clinic –

wound care trained• Effectiveness of wound

care team in various hospitals

Professional body on Professional body on wound carewound care

--------------------------------------------------------------------Malaysian Society of Malaysian Society of

Wound Care ProfessionalsWound Care Professionals

• Collaboration with Non-MOH (ministry of health) hospitals- university and private hospitals.

• Experts from non-MOH – in the team/committee

Future:Future:• Specialists in wound care

(post-basic, degree, fellowship in wound-care)

• Wound care- recognised as a specialty and specialised field.

• Stand alone- own staffs and budgets

Road ahead Road ahead • Long, winding and bumpy

and full with obstacles• Work together• Best care to our patients

and our self.

Thank you very much for your kind

attention