Effectiveness of wound, ostomy, and continence nurses on agency-level wound and incontinence outcomes in home care

PURPOSE:: The purpose of this study was to describe the prevalence, incidence, and effectiveness of home health care (HHC) agenciesÊ services with and without a WOC nurse related to wounds, incontinence, and urinary tract infection (UTI) patient outcomes. SUBJECTS AND SETTING:: There were 449,243 episodes of care from a national convenience sample of 785 HHC agencies representing nonmaternity patients who were aged 18 years or older and receiving skilled home health services between October 1, 2008, and December 31, 2009. DESIGN:: This study employed descriptive and comparative designs for data collection and analysis. We analyzed data from HHC agenciesÊ electronic health records and conducted an Internet-based survey of HHC agencies. INSTRUMENTS:: Data for this study were documented by HHC clinicians using the Outcome and Assessment Information Set. An Internet survey identified if a WOC nurse provided care or consultations within an HHC agency. RESULTS:: The majority of HHC agencies (88.5%) had some influence of a WOC nurse. The incidence of wounds, incontinence, and UTIs was higher for agencies with no WOC nurse. Home health care agencies with WOC nurses had significantly better improvement outcomes for pressure ulcers, lower extremity ulcers, surgical wounds, urinary incontinence, bowel incontinence, and UTIs as well as significantly better stabilization outcomes for these outcomes except lower extremity ulcers. Virtually all patients in HHC agencies with and without a WOC nurse had stabilization of their lower extremity ulcers. CONCLUSIONS:: Findings of this study suggest that influence of a WOC nurse is effective in achieving several important positive outcomes of HHC agenciesÊ services for wounds, incontinence, and UTIs.