WOC Nursing and Pressure
Ulcer Prevention
History and Current Status
Heath Brown RN, WOCN
Wellstar Kennestone
History

1958: Dr. Turnbull
created role of “ET”
(Enterostomal
Therapist)
◦ Purpose: Provide
rehabilitative care to
new ostomy patients
◦ First ETs: individuals
who had an ostomy or
a family member with
an ostomy
Milestones in Role Development




1960s: Formal training
programs developed
1976: RN established as
“entry into practice”
1983: Baccalaureate
degree required for entry
into practice
Scope of practice
expanded to include
wound care and
continence care
WOC Nursing in 2011: Statistics
Approximately 5000
WOC nurses in US
 60–70% prepared at
baccalaureate level –
30 – 40% at master’s
level or higher
 Practice settings:
acute care (majority);
HH; outpatient

Certification in WOC Nursing

Pathways:
◦ Completion WOCNaccredited program (10
weeks full time: theory
+ clinical)
◦ Experiential pathway:
1500 practice hours +
50 CE hours for each
area for which
certifying
WOC Nurse Role in 2011

Wound Care primary
focus for most WOC
nurses
◦ Diabetic foot care
◦ Fistula management
◦ Consultation/mgmt
regarding wound mgmt
◦ Pressure ulcer
prevention (agency
wide programs)
WOC Nurse Role in 2011

Ostomy Care
◦ Preop counseling/
stoma site marking
◦ Postop: pouch selection/instruction in self
care
◦ Rehabilitative care and
counseling (sexual
counseling)
WOC Nurse Role in 2011
Continence Care
(Setting Dependent)
 Acute Care

◦ Staff education re: CAUTI
prevention
◦ Staff education re: correct
use indwelling bowel dng
systems
◦ Skin care and
containment
Changes and Challenges
Increasing focus on role of consultant vs role of
caregiver/educator
 Increasing responsibility for development
agency-wide programs for pressure ulcer
prevention and evidence-based WOC care
 Increasingly complex wound and fistula
care (e.g., negative pressure wound
therapy) and more challenging stomas
 Advanced Practice WOC Nurses
increasingly common in outpatient care

Pressure Ulcer Prevention

Most PUP Programs are essentially the same:
Catch ‘em at the front door
(Assessment)
Prevent ‘em while they’re here
(Prevention)
Components of a
PUP Program
*
*
*
*
Initial skin assessment on admit
Daily Risk Assessment for all patients
Reassess skin daily or more often
Manage moisture – keep dry and
moisturize skin
* Optimize nutrition & hydration
* Minimize pressure
1 Initial Skin Assessments
Every Admitted Patient
 Required by CMS to show what was POA
 Good Nursing Practice

Braden Scale
◦
◦
◦
◦
◦
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Sensory perception
Moisture
Activity
Nutrition
Mobility
Friction/shear
2 Risk Assessment for PUs

Daily or more often for all patients

Different scores should reflect different
preventive strategies
3. Reassess Skin Daily

Q Day or Q Shift
4 Prevention: Manage Moisture

Keep the patient dry

Moisturize the skin
5 Optimize Nutrition & Hydration

Attend to the microclimate of the skin –
calories, hydration, protein

Registered Dietician Consults
6 Minimize Pressure
Turn Every 2 hours or more often based
on clinical condition
 Use Pillows to redistribute weight
 Offload heels
 Use Pressure redistribution Surfaces to
maximize the time/pressure ratio

On a Programmatic Level
Monitor, Monitor, Monitor
Continuously
Re-evaluate your processes
Monitoring our programs by conducting
quarterly prevalence surveys
 Monitoring and conducting RCAs of HAPUs
 Participating in almost every aspect of
nursing with an eye towards protecting
patients skin from pressure and reevaluating
processes
 Device related pressure ulcers

Questions