Dear Readers: A multidisciplinary wound care team can serve as a focus for knowledge, understanding, and healing for all types of challenging wounds.¹ Such a team approach can also improve wound-related patient outcomes other than healing, eg, reducing frequency and level of amputation in patients with diabetes,^2,3 improving outcomes following hip fractures,⁴ or preventing pressure ulcers.⁵ Whether it is called “multidisciplinary” to emphasize the variety of disciplines on the wound care team or “interdisciplinary” to emphasize collaboration between different disciplines that work together to diagnose and alleviate the cause of tissue damage, wound care teams work. This month’s column describes 2 recent articles that add to the growing body of evidence supporting the multidisciplinary team and reinforces the value of patient inclusion.

Including Patients in the Team to Improve Venous Ulcer Outcomes

       Reference: Edwards H, Courtney M, Finlayson K, Lewis C, Lindsay E, Dumble J. Improved healing rates for chronic venous leg ulcers: pilot study results from a randomized controlled trial of a community nursing intervention. Int J Nurs Pract. 2005;11(4):169–176.
       Rationale: Venous ulcers respond well to evidence-based care, but effects of including the patient in the wound care team have not been explored in a randomized clinical trial.
       Objective: This randomized, controlled study compared healing, quality of life, health status, functional ability, and pain outcomes of patients with venous ulcers treated weekly in a “Leg Club” to those of similar patients receiving the same evidence-based protocols of care administered weekly by a trained home care nurse in the client’s home.
       Methods: Sixteen patients with confirmed venous ulcers were randomly assigned to receive 12 weeks of care in a Leg Club that had peer support and a professionally guided goal setting, while 17 similar patients received 12 weeks of home care administered by a trained wound care nurse using the same evidence-based practices. All patients in both groups received standardized assessments including ankle/brachial systolic pressure index, vascular assessment if indicated, short-stretch compression, venous insufficiency advice, and follow-up assessment every 12 weeks. Leg Club members were encouraged to attend morning or afternoon tea, engage in social activities, and plan coping strategies with a trained professional.
       Results: Groups were not significantly different on entry into the study; most patients experienced one or more comorbidities that impaired mobility. Ulcer area reduction was greater for the Leg Club group (p = 0.004). During 12 weeks, 43.8% of the Leg Club group and 23.5% of the control group healed. Scores reduced significantly more on the Pressure Ulcer Scale for Healing for subjects in the Leg Club, though this may be an inappropriate measure for venous ulcers.
       Conclusion: While the study omitted several results included in the original objective, the authors conclude that added social support, coping skills, and goal setting experienced by subjects in the Leg Club significantly improved venous ulcer healing as compared to similar evidence-based home care by a community nurse that did not have the added social support of the Leg Club.

Team Approach to Improve Wound Infection Control

       Reference: Sturkey EN, Linker S, Keith DD, Comeau E. Improving wound care outcomes in the home setting. J Nurs Care Qual. 2005;20(4):349–355.
       Rationale: After the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Medicare surveyors found deficiencies in their home wound care infection control processes in 2001–2003, initial attempts failed to improve practices in the authors’ facility.
       Objective: An interdisciplinary performance improvement team assessed, planned, and implemented improved wound care practices based on the best available evidence to decrease infection rates and improve wound patient outcomes.
       Methods: This was a quasi-scientific prospective study of staff practices and client (numbers unspecified) outcomes during 2001–2004. In 2003, when the hospital opened a wound care center, nurses and physicians became part of a team planning patient discharge to home care. Resources and educational materials were made available. A performance improvement team implemented standardized competency checklists for home visits and staff nurse supervisory forms with follow-up education. Caregivers were involved in bimonthly interdisciplinary team meetings to share outcome data, discuss and practice wound care, infection control, and documentation techniques, and review individual patient care plans with the team.
       Results: Wound infections as reported in the Outcome and Assessment Information Set (OASIS) Adverse Event Report declined from 1.83% (above national reference levels) in 2001 and 2002 to 1.09% in 2004 (below national reference levels), while home care nurse visits decreased from 20 visits per patient pre-2003 to 14 visits per patient in 2004. Costs per patient declined while staff participation and satisfaction increased. An unannounced JCAHO/Medicare survey found 100% acceptable wound care practice and no recommendations were made for improvement in any area.
       Conclusion: The interdisciplinary performance improvement team was successful in improving the agency’s wound care practices and outcomes while conserving resources by reducing the frequency of home care visits.

Clinical Perspective

       Typically, a multidisciplinary team addresses all relevant aspects of each patient’s care: diagnosis and treatment of vascular, nutritional, immunological, metabolic, mobility, continence, and other challenges. These studies underscore the value of multidisciplinary teams focused on improving specific aspects of wound care. The first study suggests that involving the patient in the wound care team may improve aspects of venous ulcer healing. It may take more research to know whether extra ambulation, the added social aspect, or that extra cup of tea at the Leg Club caused the difference, but something about patient involvement worked. The second study illustrates the value of involving physicians, nurses, and supervisors in practice improvement and providing feedback about outcomes achieved. The take-home message is that teamwork gets results.