Nurse-led Wound Clinic in NTWC of Hospital Authority 1

Nurse-led (Wound) Clinic in General Out-Patient

Clinics (GOPCs)

CHIANG Sau-chingAPN / CCD / NTWC

May, 2006

Nurse-led Wound Clinic in NTWC of Hospital Authority 2

Nurse-led Wound Clinic in NTWC of Hospital Authority 3

Background

Daily attendance of wound dressings in all GOPC of HK : 713358 ( Statistical report of Department of Health, 2000 - 2001)

6/2004 data: daily dressing(NTWC) Total ~ 320 case> ½ yr 40 cases > 1 yr 20 cases

Nurse-led Wound Clinic in NTWC of Hospital Authority 4

ProblemsChronic wound patients suffer from time-consuming wound dressing, complications as well as affecting quality of life.

The cost spent on chronic wound patients will also cause sumptuous expenditure on health care system.

The management of chronic wounds are different from the acute wound in that chronic wounds involve holistic care and integrated approach management.

Nurse-led Wound Clinic in NTWC of Hospital Authority 5

Nurse-led ( Wound ) Clinic

Target group :

Chronic wounds: venous / arterial / diabetic ulcer etc……

wound > 4 weeks with poor healing progress.

Nurse-led Wound Clinic in NTWC of Hospital Authority 6

Nurse-led ( Wound ) Clinic

Nurse-led Wound Clinic in NTWC of Hospital Authority 7

Aims☺ To increase the healing rate of the chronic

wound cases.

☺ To reduce the complications of wounds, e.g.. Wound infection, amputation etc……

☺ To improve the quality of life of the chronic wound pt.

☺ To promote health education on wound care and preventive measure of wound.

☺ To utilize the resource effectively on wound management.

Nurse-led Wound Clinic in NTWC of Hospital Authority 8

Role of APNTo provide comprehensive assessment for accurate wound diagnose & to find out the factors of delay healing

To set up the short term & long term goal with the pt. & carers

To provide consistent & skillful wound care

Nurse-led Wound Clinic in NTWC of Hospital Authority 9

Role of APNTo empower the patient: chronic disease control, life style modification, wound care etc……

To continuous monitoring the the effectiveness & the pt. compliance of the treatment

To collaborate with other health care professionals in wound management

Nurse-led Wound Clinic in NTWC of Hospital Authority 10

ObjectiveTo evaluate the effectiveness of the Nurse-led (Wound) Clinic by comparing with conventional wound care in GOPC.

Study

Nurse-led Wound Clinic in NTWC of Hospital Authority 11

Study Design:A case control study is carried out on July of 2004 Sample size Study group : 50 cases

(GOPCs with Nurse-led Clinic)Control group:50 cases

(GOPCs without Nurse-led Clinic)

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Inclusion Criteria:Cases of wound care last for > 4 weeks with poor healing progress are under studied.Any ageMale and femaleAny racial groupSmoker or Non-smoker Drug addicts or non-drug addicts

Exclusion Criteria:Patient cannot attend nurse-led wound clinic.

Nurse-led Wound Clinic in NTWC of Hospital Authority 13

Data Analysis :SPSS (version 11.0)

Two tailed paired t test or Chi square to test:

1. baseline parameters

2. no. of weeks for wound healed

3. no. of visits for wound healed

4. no. of wound healed cases after 4 months intervention between control group and intervention group.

The significant level will be p < 0.05

Nurse-led Wound Clinic in NTWC of Hospital Authority 14

Baseline Comparison

Nurse-led Wound Clinic in NTWC of Hospital Authority 15

Surface size ( cm2 ) of wound before recruit

Surface size

425

400

375

350

325

300

275

250

225

200

175

150

125

100

75

50

25

0

Control group

50

40

30

20

10

0

Intervention group

Surface size

425

400

375

350

325

300

275

250

225

200

175

150

125

100

75

50

25

0

50

40

30

20

10

0

Test Statistics a

533.5001061.500

-.333.739

Mann-Whitney UWilcoxon WZAsymp. Sig. (2-tailed)

SA

Grouping Variable: GPa.

P>0.05No significant difference between two groups

Nurse-led Wound Clinic in NTWC of Hospital Authority 16

Wound bed tissue of different wound type

01020304050

Control Group. 28 26 2

Study Group. 9 39 2

Granulation wd. Sloughy wd. Escher wd.

Chi-Square Tests

1.746a 2 .4181.759 2 .415.369 1 .543

62

Pearson Chi-SquareLikelihood RatioLinear-by-Linear AssociationN of Valid Cases

Value dfAsymp. Sig.

(2-sided)

2 cells (33.3%) have expected count less than 5. The minimumexpected count is 1.45.

a.

P>0.05No significant difference between two groups

Nurse-led Wound Clinic in NTWC of Hospital Authority 17

Wound type Distribution

0

5

10

15

20

25

30

35

ControlGroup. 30 7 2 3 7

Study Group.

32 11 3 1 3

Venous/Arterial/ Diabeticleg ulcer

Infected Surgical wound

Malignantwound

Pressureulcer

Others

Chi-Square Tests

4.426a 4 .3514.567 4 .3352.207 1 .137

100

Pearson Chi-SquareLikelihood RatioLinear-by-Linear AssociN of Valid Cases

Value dfAsymp. Sig.

(2-sided)

4 cells (40.0%) have expected count less than 5. The miexpected count is 2.00.

a.

P>0.05No significant difference between two groups

Nurse-led Wound Clinic in NTWC of Hospital Authority 18

No. of weeks of wound existed before recruit

25 50 75 100

Weeks before recuit

0

10

20

30

Count

Control

Std. Dev=14.78 Mean=12N=50.00

Intervention

25 50 75 100

Weeks before recuit

Std. Dev = 19.28 Mean = 16N = 50.00

Test Statistics a

948.0002223.000

-2.095.036

Mann-Whitney UWilcoxon WZAsymp. Sig. (2-tailed)

Length ofwound existed

(weeks)

Grouping Variable: GPa.

P<0.05Significant difference between two groups

Nurse-led Wound Clinic in NTWC of Hospital Authority 19

Number of each chronic disease before recruit

Cou

nt20

15

10

5

0

Group

Intervention

Control

Others

IVD

Hyperlipidemia

Obesity

Smoker

PVD

CVA

Cardiac disease

Anaemia

Vericose vein

HTDMNil

9

2

43

12

7

5

16

6

4

2

7

10

33

17

14

18

6

Chi-Square Tests

5.828b 1 .0164.720 1 .0306.002 1 .014

.028 .0145.769 1 .016

100

Pearson Chi-SquareContinuity Correctiona

Likelihood RatioFisher's Exact TestLinear-by-Linear AssociationN of Valid Cases

Value dfAsymp. Sig.

(2-sided)Exact Sig.(2-sided)

Exact Sig.(1-sided)

Computed only for a 2x2 tablea.

0 cells (.0%) have expected count less than 5. The minimum expected count is 11.00.b.

P < 0.05Significant difference between two groups

Nurse-led Wound Clinic in NTWC of Hospital Authority 20

Baseline comparison Summary

No significant different between two groups (Venous / Arterial / Diabetics ulcer only)

Average surface sizeWound bed tissue Wound type

Except the “no. of weeks before recruit” & “ chronic disease”

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Result :Data comparison after 4

months from recruit

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After 4 months

Control Group :9 cases dropped out from the study

- 4 cases defaulted FU- 3 cases refuse GOPC services- 2 cases admitted

Study group :2 cases dropped out from the study

- 2 cases admitted

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No. of wound healed cases after 4 months from recruit

STATUSNot healHeal

Cou

nt

50

40

30

20

10

0

Group

Intervention

Control

2120

9

39

81 %

48 % 52 %

19 %

Chi-Square Tests

10.433b 1 .0019.030 1 .003

10.615 1 .001.002 .001

10.315 1 .00189

Pearson Chi-SquareContinuity Correctiona

Likelihood RatioFisher's Exact TestLinear-by-Linear AssociationN of Valid Cases

Value dfAsymp. Sig.

(2-sided)Exact Sig.(2-sided)

Exact Sig.(1-sided)

Computed only for a 2x2 tablea.

0 cells (.0%) have expected count less than 5. The minimum expected count is 13.82.b.

P<0.05There is a significant difference between two groups.The approximate 95% confidence interval for the effect of NLC is 0.32 ± 1.96 SEi.e. 0.14 to 0.51

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No. of weeks for healing after 4 months from recruit

3920N =

Group InterventionControl

Wee

ks f

or h

eal

afte

r re

crui

t

70

60

50

40

30

20

10

0

-10

Test Statistics a

593.5001058.500

-1.555.120

Mann-Whitney UWilcoxon WZAsymp. Sig. (2-tailed)

Number ofweeks forhealing

Grouping Variable: Groupa.

P > 0.05No significant difference between two groups

Nurse-led Wound Clinic in NTWC of Hospital Authority 25

Total number of visits for healing after 4 months from recruit

3920N =

Group InterventionControl

Tot

al n

umbe

r of

vis

it

250

200

150

100

50

0

Test Statistics a

610.0001885.000

-3.019.003

Mann-Whitney UWilcoxon WZAsymp. Sig. (2-tailed)

Total numberof visit

Grouping Variable: GPa.

P<0.05 There is a significant difference between two groups.

Nurse-led Wound Clinic in NTWC of Hospital Authority 26

Efficacy Gain in NLC

3,196 x 20 mins= 63,920 mins= 1065 hours= 133 workingdays

1,4844,68039Cases with wound healed

Nursing time saved (20min/attn.)

Observed(Total attendencewith nurse-led service)

Expected(Total attendencewithout nurse-led service)

No. of Cases

Type

Nurse-led Wound Clinic in NTWC of Hospital Authority 27

The detail information of the population of chronic wound cases in Hong Kong is seldom collected. The realistic situation and the financial expenditure in wound management cannot be estimated.

Not enough referencing materials due to too little related study on wound care management in Hong Kong.

For further development, we should optimize the service of GOPC in order to manage more complicated wound in the community.

Discussion

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The effect of NLC has significantly reduced the no. of visits for healing of chronic wound cases. As a result, it increased the efficacy gain in wound healing service.

It also significantly increased the number of healed cases when compared with conventional wound care.

It achieved 80% of healing rate in chronic wound within 4 months intervention.

Conclusions

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Acknowledgements

Co-investigators:• Dr. Au Si Yan Ms. Queenie Leung• Ms. Camille Hui Ms. Lee Yuen Man• Ms. Yau Pui Han • Research assistant:• Ms. Chiu Hang Wai

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