Store and forward wound teleconsultation in rural home health: a practice improvement project

Abstract

Wound prevalence is increasing due to the aging demographics of the population and a rise in chronic diseases. Home health organizations face many challenges managing the rural home health patient with wounds as this population consumes a high number of resources and lacks access to wound experts. Store-and-forward (SAF) wound teleconsultation allows the home health patient to receive treatment recommendations from a wound expert using photographs taken by the home health nurse. The purpose of this practice improvement project was to explore patient, nurse, wound expert, and primary care provider satisfaction and perceived benefits of wound photography and SAF wound consultation in rural adult home health patients with wounds. Rozzano Locsin's Technological Competency as Caring in Nursing theory provided the guiding framework for this project. A standardized wound photography protocol utilizing the NE1 Tool was developed and implemented in a home health department as an adjunct to the weekly written assessment. One month later, three adult patients were recruited to a 12-week SAF wound consultation pilot using AthenaText application on mobile devices. Following the project period, a quantitative survey assessment of satisfaction and perceived benefits was conducted using three group-specific surveys. Seventeen participants completed the survey: (1) wound expert, (2) patients, (5) providers and (9) nurses. All groups reported moderately high satisfaction with photography and 100% indicated agreement that photographs should be a standard component of care. Additional perceived benefits were noted in communication and identifying wound changes. All participant groups were highly satisfied with SAF wound consultation. Patients and the wound expert rated SAF wound consultation the highest citing benefits of reduced travel and promotion of rapid changes in treatment. Patients reported SAF consultation was equivalent to clinic care; however, comments suggest home-based wound care is superior to clinic-care in cases of severe immobility and difficult to reach wounds. This project demonstrated high satisfaction and multidisciplinary benefits related to wound photography and SAF wound consultation in the rural home health population. Standardized wound photography and SAF consultation is a cost-efficient, feasible, and essential component of wound management that improves access to wound expertise in the rural home health setting.