Here - EWMA 2013

ORAL PRESENTATIONS
49
Key Session: Home Care -Wound Care
Home Care – What are the issues and challenges of woundtreatment
Sebastian Probst 1
1 Zurich University of Applied Sciences, Department of Health, Institute of Nursing (Zurich,
Switzerland)
The management of chronic wounds in Europe has, during the past decade, gone
through a dramatic shift in the location of service delivery from hospital towards home
care settings. The changes are primarily due to health economic aspects which cause a
drive towards an earlier discharge of hospitalised patients. As a consequence, more
wound patients are treated at home and more patients with a chronic wound develop a
complex pathological picture due to untreated co-morbidities. Today, it is estimated that
around 70-90 % of wound care is conducted in the community, the majority by nurses.
Challenges of managing wounds in the home care setting are that there is a need of
specific knowledge and skills as well as there are no guidelines and recommendations of
minimal requirement of providing best care to patients and their families with non-healing
wounds in the home care setting.
KEY SESSION: HOME CARE -WOUND CARE
50
Key Session: Home Care -Wound Care
Using a Health Technology Assessment tool for patients with
pressure ulcers in the home care setting
Inger Futtrup 1 , Anne Lee 2 , Iben Fasterholdt 2 , Jørgen Lauridsen 2 , Jens Lykke Sørensen 3
1 Odense University Hospital (Odense, Denmark);
2 University of Southern Denmark (Odense, Denmark);
3 Roskilde Hospital (Roskilde, Denmark)
Patients with chronic pressure ulcers are usually treated by nurses in the primary health
care, guided by hospital wound care department specialists. Quality of treatment
depends on compliance to guidelines from the hospital.
Methods: In a randomized setup, the consequences of outgoing wound specialist nurse,
guiding the assessment and treatment in the home (I grp.), were compared to treatment
at the hospital outpatient woundclinic (C grp.)
Results: 85 patients with pressure ulcers Clinical consequences: More ulcers healed in
the (I grp.) 40% versus C grp.: 31% Pain experience was reduced 2 / 3 of the level at
baseline (I grp.) vs reduction of 1 / 2 of the level at baseline (C grp.) Economic
consequences were evaluated in relation to timeconsumption (outpatient clinic, outgoing
specialist and primary nurses), transport, materials and other healthcare services. The
cost pr. patient treated* were 15.250 DKK (I grp.) and 16.000 DKK (C grp.) In order to
avoid hospital visits, patients expressed satisfaction with home visits. They experienced
good cooperation between specialist and primary nurses, a higher degree of
involvement, better quality of wound care. 94% recommended the outgoing specialist
nurse. Primary nurses acknowledged the bed-side supervision. Home visits attributed to
understanding of ulcer etiologi and treatment. Guidelines were adjusted to home
environments and needs of the patients, enhancing prevention and increasing treatment
compliance.
Conclusions: The intervention is viewed as an attractive alternative when outpatient
treatment is a challenge or there is a need for improving treatment quality.
Supported by the National Board of Health.
44