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Quality of care in the treatment of non-healing wounds (in wound management)
HOLUBOVÁ, Adéla
Introduction: Quality care for patients with non-healing wounds requires a systematic approach that should include a complete wound assessment and an objective description of the wound assessment. Goals: The goal was to assess how non-healing wounds were evaluated and documented in clinical practice at selected health care facilities and social care providers in the Czech Republic. To verify whether a clinical algorithm for evaluating non-healing wounds is available in clinical practice for selected providers and whether it is used. Methods: A mixed research design was used. The first research method was a cross-sectional retrospective study - content analysis of documentation for non healing wounds in clinical practice at selected health care and social care providers in the Czech Republic. Statistical methods of one-stage and two-stage sorting were used to evaluate the information obtained through content analysis of the data, and absolute and relative frequencies were determined through disaggregation. Identification of potential groups was performed by calculating a similarity matrix based on Gower metric followed by application of a hierarchical agglomerative clustering algorithm. One-stage and two-stage data classification was used to evaluate the information obtained from the questionnaire survey. Two-stage sorting was performed to assess the independence between the selected pairs of questions using appropriate tests according to the nature of the data obtained (chi-square test, Fisher's exact test, Kruskal-Walli's test followed by pairwise comparison) at a significance level of ? = 0.05. Results: The research was carried out in selected health care facilities and social care providers in the Czech Republic (3 faculty health service providers, 5 non-faculty health service providers, 4 social care providers and 4 ambulatory health service providers). 331 health documentations of patients with non-healing wounds were analyzed. The total number of questionnaires analyzed was 565. The resulting data of the cross-sectional retrospective study conducted in 14 selected health care and social care providers can be separated into three separate groups, with the highest quality of wound assessment being the nursing documentation of wound healing consultants, in which the most frequent use of objective scales and the highest number of assessment parameters were verified. Use of the Clinical algorithm was only confirmed in non-faculty healthcare providers. More frequent use of the Clinical algorithm was verified when a wound healing consultant was present (p <0.001; chi-square test). From the outcome data of the questionnaire study carried out in 11 selected health care facilities and social care providers, it was validated that statistically significant differences in the wound documentation process were most frequently demonstrated between faculty and non-faculty health care providers (p <0.05; chi-square test). Respondents working at health care faculty-based facilities rated the following items as more significant: type, etiology, wound location and size, wound bed, wound infection continuum, granulation quality assessment, wound odor, and comorbidities. Conclusion: It was verified that the process of assessment of non-healing wound parameters was very inconsistent. The recommended procedure for assessment of non-healing wounds was not properly followed and accepted in the clinical practice by the assessed care providers. We verified that the presence of a wound healing consultant was associated with the more frequent use of objective wound assessment scales to document wound care and condition. This study is educational, informative and pragmatic in character.
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