At ChristianaCare, there is a nursing team dedicated to disease prevention, healing and maintenance of our body’s largest organ – our skin. This team is known as the wound, ostomy and continence (WOC) team. Led by Erica Harrell-Tompkins, MSN, RN, CWON, CCCN, the team consists of eight nurses:
- Amanda De Rocili, MSN, RN, CCCN, CWCN, COCN
- Elizabeth Donovan, MSN, RN, CWOCN
- Bettina Holden, BSN, RN-BC, WTA-C
- Mary Laws, MSN, RN, CRRN, WTA-C
- Lindsay McGrath, MSN, RN, CWOCN
- Jennifer Murr, MSN, RN, CCCN, COCN, CWCN
- Tamara Schoell, BSN, BS, RN, CWOCN
- Kristine Woodworth, MSN, RN-BC, CWOCN
This exceptional team of nurses provides specialized care to patients in multiple settings. They provide consultation services for inpatients that include evaluation, treatment and education. Additionally, the WOC team provides care for outpatients and virtual visits for outpatients with ostomies.
National Recognition for Exceptional Care
In 2019, ChristianaCare received the 2019 Employer Recognition Award from the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB). This award is presented annually to honor an organization that has demonstrated exemplary support of the certification process in WOC nursing. The WOCNCB’s award supports the mission to “promote the highest standard of consumer care and safety by providing credentialing in the areas of wound, ostomy, continence and foot care nursing.
“Receiving this award is very important as it instills more pride in the team and myself. This award signifies that ChristianaCare believes in what we do as WOC nurses and that they are supportive in advancing WOC nursing practice to help the organization achieve better outcomes for our community,” said Harrell-Tompkins. “It also exhibits our behavior of committing to being exceptional today and even better tomorrow. Achieving tri-certification in WOC nursing demonstrates our commitment to using evidence-based care and practices.”
Ostomy Outpatient Center
Ostomies are placed in patients who have colon cancer or other gastrointestinal conditions that require removal or resection of a segment of the large or small intestine. In the mid-2000s, caregivers in WOC nursing and the nationally recognized Helen F. Graham Cancer Center & Research Institute partnered to open an Ostomy Multidisciplinary Center. This is a nurse-managed health center that provides its’ services as a community benefit.
This is one of the primary areas where Elizabeth “Beth” Donovan provides care. All ostomy patients are welcome to the center whether their surgery took place at ChristianaCare or another facility and regardless of whether it was cancer related. Patients undergoing a planned ostomy surgery can see the WOC nurse in the ostomy center prior to their surgery for education and stoma marking. WOC nurses educate the patients and families on what to expect during their hospitalization and how the inpatient WOC nurses will support them during and after their surgery and hospitalization.
For patients undergoing unplanned ostomy surgery the WOC nursing team begins working with the patient after their surgery. The WOC nurse provides education and collaborates with the patient to build a plan for ostomy care that allows a safe transition to home. After discharge the WOC nurse continues to follow patients in the center for evaluation and treatment of common post-operative stoma complications.
“I have a passion for ostomy patients because these patients need significant support,” Beth said. “Nobody asks for or wants to have an ostomy. Our team works so hard with these patients to help them learn to adapt to their new ostomy and continue living their best lives.”
A major concern of patients and families with a brand-new ostomy is having access to the necessary equipment. The WOC nurse helps by providing detailed instructions on ostomy equipment and order numbers. “The whole WOC nursing team helps to answer and address phone calls from patients in the community with ostomy problems,” Beth said.
A great partnership to support our neighbors living with ostomies is the Wilmington Delaware Ostomy Association. The ChristianaCare WOC nursing team collaborates with this local community organization to provide a meeting space and a WOC nurse to attend the meetings.
“We see too many patients that awake from a car accident or emergent gastrointestinal surgery and realize they now have an ostomy,” Jennifer Murr said. “It is the WOC nurse’s job to help that patient and their loved ones move from that initial shock to a feeling of empowerment, comfort and realization that they can continue living a happy life with their ostomy.”
Pressure Injury Prevention
Pressure injuries are a wound that forms on a patient’s body due to immobility, poor nutrition, loss of sensation and several other causes. Pressure injuries are most commonly found on a patient’s buttocks but can also be found on the heels, behind the ears, the back of the head, the spine and shoulder blades.
Unfortunately, development of pressure injuries in hospitalized and long-term care patients continues to be a major health care problem. In the worst-case scenarios, pressure injuries can cause infections and significant decline in overall health and wellbeing.
The WOC nursing team and all ChristianaCare caregivers are committed to reducing this problem through assessment, education, prevention and treatment. Lindsay McGrath serves as a health system leader in the unique role of Pressure Injury Preventionist. “Each WOC nurse has had some type of experience that led them to this role,” Lindsay said. “Some nurses do not tolerate looking at wounds or ostomies, but WOC nurses are driven to them. We have a desire to treat and heal them because we have seen the patient’s happiness when their wound heals and they can get back to living their lives.”
Pressure injury prevention has been led by nursing for over a decade with collaboration from providers, nutritionist, pharmacists and physical therapists. Lindsay is now spearheading these efforts through system-wide protocols, documentation improvements, adoption of innovative technologies, patient and staff education, and partnership with patients.
Tamara said, “I love being a WOC nurse because we get to work across the continuum of care as an expert resource for wounds, ostomies and continence care management.”
Virtual Care and Consults
Management of pressure injuries and wounds is complicated as wounds can begin the healing process but then become infected and get worse. As a patient moves through a health system (emergency department to inpatient to surgery then to home care and a doctor’s office) there are dozens of sets of eyes evaluating the same wound but unsure of how it looked previously. This is where technology and innovation were applied at ChristianaCare. For three years, WOC nurses have been using mobile devices connected to the patient’s electronic health record to take pictures of the wounds, document them in the electronic health record and virtually connect with other health care providers.
This technology has been specifically applied to pressure injury evaluation and treatment. The patient’s primary nurse will take a photo of the suspected pressure injury, upload it into the patient’s electronic health record and notify the WOC nurse. The WOC nurse will then enter the patient’s record, evaluate the wound and other contributing patient factors, and then connect with the patient’s primary nurse to confirm the wound and provide treatment recommendations.
“The use of wound photography helps us coordinate care with providers as well as giving the nurses a clear image of a wound at a point in time to gauge progression or deterioration,” said Bettina. “This has helped streamline our workflow as well as providing a better means of communication between health care staff.”
The design, implementation and continued use of this technology is a collaborative effort between WOC nurses, nursing leaders, information technology experts and quality/regulatory specialists.
Wound Treatment Associate Program
Harrell-Tompkins and the WOC nursing team began advocating for an innovative wound education program at ChristianaCare in 2016. The wound treatment associate (WTA) nursing program began in 2017 and serves as a key strategy in pressure injury prevention and optimal wound care.
ChristianaCare’s WTA program is nine months long, starting with the first three months as online, competency-based training modules on care of wounds. During the first three months, nurses are also completing independent case studies and meeting with experienced WOC nurses for hands-on skill training and competency verification.
At ChristianaCare, our nurses serve together. So, the WOC nursing team partnered with the virtual education simulation training (VEST) center for hands-on practice with wound care skills.
The middle portion of the nine-month training program consists of more time with experienced WOC nurses. The novice wound care nurse spends time shadowing the WOC nurse. Together, they evaluate patients, focus on clinical wound care skills, how to complete a root-cause analysis for pressure injury wounds, and identifying opportunities for increasing perfect, evidence-based nursing care that prevents pressure injuries from happening.
The last three months of the program are focused on preparing for, completing and passing the WTA certification, provided by the WOCNCB. To date, 48 ChristianaCare nurses have gone through the WTA program. Of those 48 nurses, 39 are now professional certified as Wound Treatment Associates. This is another example of why ChristianaCare WOC nurses were award the 2019 Employer Recognition Award from the WOCNCB.
“As WOC nurses, we cover several patient care areas in a consultative role. Wound treatment associates are on the frontlines of wound care,” said Donovan. “The WTA’s expertise results in more accurate evaluation of skin issues and pressure injuries. The WTA also initiates treatments using care management guidelines which facilitates wounds healing faster. It is a great collaboration!”
After completion of the WTA program, nurses are empowered, educated leaders in wound prevention, assessment and treatment. They are advocates in their nursing practice area and expert resources for their colleagues. Past participants of the WTA program have held education fairs, participated in event debriefings and initiated wound care treatment.
These 48 WTA nurses are extensions of the WOC nursing team who support care design and coordination. The WOC nursing team continues to collaborate with WTA nurses on patient care and harm reduction. The WTA program also generates a robust pipeline of future WOC nurses.