Providence VA Medical Center, Rhode Island
Vascular Wound Clinic - Collaboration and Care Coordination is the Key
There has been much talk within healthcare these days about collaboration and care coordination—it’s simply impossible to provide patient-centered care without these two key ingredients. One shining example here at the Providence VA Medical Center is the Outpatient Vascular Wound Clinic, managed by Elise Chapman, MA, RN, WCC. Working closely with the Outpatient Vascular Clinic, the Outpatient Vascular Lab, the Outpatient Dermatology Clinic, and the Outpatient General Surgery Clinic; Elise serves patients with peripheral vascular and venous diseases, pressure ulcers, lymphedema (swelling that occurs most often in the arms or legs), varicose veins, and patients undergoing dialysis.
A patient typically comes to the Vascular Wound Clinic from the Emergency Department or from Primary Care, by way of the specialty clinics mentioned above. Elise thoroughly assesses each patient and is responsible for triaging those that need immediate attention. Based on the patient’s condition and needs, Elise can offer a variety of treatment services. She might offer compression therapy, which involves the use of calamine or zinc-impregnated unna boots (moist, gauze compression bandages) or three/four layer wraps for treatment of venous insufficiency. She might also offer topical/local wound treatment, which involves the use of a variety of wound care products to treat venous ulcers, diabetic ulcers, and other various wounds such as burns, skin tears, and fragile skin. Compression stockings and socks are another option--specialized hosiery items designed to increase blood circulation. Their main therapeutic purpose is to provide graduated pressure on the lower leg and foot and, in some cases the thigh, to alleviate circulatory problems such as edema, phlebitis, and thrombosis.
Elise works closely and collaboratively with nurses from the Home-Based Primary Care Department, from Visiting Nurse Agencies, as well as from a variety of nursing and assisted living facilities. She often collaborates with the hospital Certified Wound Care Nurse on treatment/prevention modalities for patients requiring pressure ulcer care—for lesions which are caused by many factors such as unrelieved pressure, friction, humidity, temperature, age, and medication.
When asked what her biggest role in the Vascular Wound Clinic, Elise says it is to provide education to patients, families, and caregivers on the appropriate disease processes for which the patients are being treated; how best to live with what they have; and even more important how to prevent future issues. She often encourages patients to see people from ancillary services such as nutrition, diabetes management, physical therapy/occupational therapy; she refers many to the MOVE! (Managing Overweight Veterans Everywhere) program to help them lose weight and/or maintain healthy lifestyles.
In addition, many providers consult with Elise for her knowledge on a variety of wounds. She is the primary trainer of all clinic C staff in compression boot therapy, and they are the only ones who have the competencies.
The Vascular Wound Care Clinic had 275 visits during FY10.