Authors: (including presenting author): :
Fung PM(1), Chung TW(2)
Affiliation: :
(1)Department of Orthopaedic and Traumatology, the Duchess of Kent Children's Hospital at Sandy Bay, (2)Nursing Division, MacLehose Medical Rehabilitation Centre
Keyword 1: :
Multidisciplinary Wound Round
Keyword 3: :
Orthopaedic Wound
Keyword 4: :
Pressure Injury
Introduction: :
MMRC primarily receives patients referred from QMH for continuity of care and rehabilitation following major orthopaedic surgeries or conditions requiring long-term management. Patient group is diverse and complex, including post-surgical wounds, pressure injuries, and chronic wounds associated with comorbidities like diabetes or spinal cord injury. Significant portion of patients are limited in mobility with high risk of pressure injuries. These factors necessitate proactive, coordinated, and patient-centered strategies. Although rate of hospital-acquired pressure injuries remains low, continuous challenge lies in maintaining this standard while improving patient outcomes, especially in complex wounds requiring advanced care modalities, like care of dermal substitute, graft management, and customized offloading solutions. To address these, multidisciplinary wound round was implemented to collaborate with allied health to optimize wound healing, and sustain functional rehabilitation.
Objectives: :
To sustain a low rate of hospital-acquired pressure injuries (HAPI) while enhancing wound healing outcomes and optimizing individualized rehabilitation for complex orthopaedic and high-risk patients through a multidisciplinary wound round over a six-month evaluation period.
Methodology: :
Multidisciplinary wound round is conducted weekly and led by doctor as decision maker. Core team includes associate nurse consultant specializing in wound, pressure injury link nurses, physiotherapists, occupational therapists, dietitians, and prosthetics & orthotics representatives. Cases are screened weekly by ward nurse based on established criteria, e.g. complex wound requiring specialized wound care, chronic wounds, or pressure injuries. During the round, ANC provides advanced clinical input, e.g. wound bed preparation, conservative sharp wound debridement, and BTM fenestration etc., to promote optimal healing and infection control. Allied health professionals play critical roles in holistic functional care. Post-round case debriefings are held for nurses reflection and learning, strengthening the nursing team’s critical thinking, interdisciplinary communication, and confidence in managing complex wound care scenarios.
Result & Outcome: :
This project aims to maintain HAPI incidence at < 1% within MMRC while enhancing management and healing of chronic and complex wound. Specifically, we aim to achieve at least 20% reduction in 30-day wound healing indicators (size reduction, increased granulation) among reviewed patients. For program throughput, static number of rounded cases and multidisciplinary referrals are expected to be encountered in each round. For staff confidence in wound care, it is expected that ≥25% increased based on pre/post survey. Patient satisfaction can be sustained over 90% with wound care quality, comfort, and team communication. A comprehensive 6-month evaluation was conducted using both quantitative and qualitative indicators. For quantitative outcomes, wound size was reduced for 31%, and proportion of granulation tissue increased for 38% on average in day-30 evaluation. Incidence of HAPI remained at 0%. For multidisciplinary involvement, average number of rounded case was 17.3 and referrals generated was 12.3 per month. Overall 25% gain in nurses' confidence in wound care as measured by pre- and post-implementation survey after 6 months. Lastly, 90% of patient expressed satisfied with wound care quality, comfort, and team communication. For qualitative outcomes, recognizing that wound care benefits extend beyond numbers, evaluation included case illustration of extended role of nurse specializing in wound management, allied-health innovative input (e.g., customized off-loading heel protectors, 3D-printed body contour cushions & other pressure relieving device) and its observed impact in healing.
