Scenario of Wound Care in Malaysia

DR.MOHAMMAD ANWAR HAU ABDULLAH HOSPITAL RAJA PEREMPUAN ZAINAB II

1.10.2012

Wounds
Wound-care important aspect in infection control Wound- potential source of cross infection leads to hospital acquired infection and outbreak (MRSA, pseudomonas etc). Cause of bad smell /odour in the ward Social stigma

Wound - World scenario:

World Union of Wound Healing Societies Wound-care society in our neighboring countries (Singapore, Thailand, Indonesia) Japan Society for Surgical Wound Care and Japanese Society of Pressure Ulcers World Alliance for Wound Federation of Asian Wound Healing Society (we are one of the member) Australian Wound Management Association.

World scenario:
Many countries (developed) dedicated wound-care team in the hospital. Specialist in wound-care (in advanced countries) A lot of R&D and advances in the field of wound-care A lot of wound-care products- various companies.

Trauma

WOUND CARE IN MALAYSIA

Not well covered/stressed Superficially touched in the medical curriculum as well as the curriculums for the paramedics (nurses and health assistant).

Malignant

Wound care
Knowledge and practice: Learned from the seniorsobserving and modeling Lack of scientific evidence Cultural belief/myth

 Not a glamorous field Not a popular field ----> Not many are interested ----> Not many are committed -----> take it lightly and easy ----> assignment- luck

Wound care

Wound care
Patients with wound: Least priority Placed --> end of the ward Senior doctors- not actively involved Care by more junior doctors

Trauma

Wound care
Lack of wound care guidelines SOP for wound dressing Courses- not many No standardised training module

Wound care
Personal preference Different protocol within same unit /department Care: changes rapidly Confusing: junior doctors, staffs and patients

Wound care
Wound care products: Personal preference Many different products Lack of knowledge (advances) Used inappropriately ---> wastage, not cost effective

Necrotising fascitis

Wound care
Different standard: Health clinic (primary care): conventional wound care Hospital: advanced wound care Standard of care: different and lack of continuation
(Issue of money )

Wound care
Not well organised Lack of standardised policy Very few hospital wound care team No professional organisation/ body to spearhead and drive wound care activities (no mans land)

Malignant

Mid-2009
National wound care management committee in Ministry of Health
(members: doctors and paramedics from various specialties and hospitals)

National wound care management committee Policy and planning Training- wound care module and conduct training Secretariat

Wound Data Collection

No of hospitals involved: 7 Duration: 2 months (August and September 2010) Involved: surgery, medical, orthopaedic and others (O&G, peadiatric and etc)
Objectives: Work-load- number of patient and number of wound Time taken for various types of wound dressing Amount of dressing solution and material used Outcome

Findings
1. Workload: 6.5% (11732) of total inpatients and 10% (16586) of total out-patients .
2. Actual dressing time (hidden time): Diabetic foot ulcer (10cm x 8cm): 8 to 25 minutes Pressure sore (15cm in diameter): 20 to 60 minutes Traumatic wound: 15 to 25 minutes
3. Dressing solutions and materials used: RM 1.5

million.

DG Directive
Oct 2011: By 1.7.2012- specialist hospitals- must set up wound care team (KPI for hospital director). Other hospitals: by 1.1.2013

Implementation
Phase I: Formation of wound care team and hospital wound care committee in all state hospitals- July 2012 Phase II Formation of wound care team and hospital wound care committee in all specialist hospitals, to train nurses in health clinic- July 2012 Phase III Wound-care team in non-specialist hospitals, postbasic in wound-care, wound-care nurses in health centers, home-care- January 2013

AIM:
To establish a dedicated wound care team/unit in Ministry of Health hospitals with a vision to develop a wound care unit in future. To provide systematic, standard and quality wound care. To facilitates patient-centered care through holistic approach. To provide training for medical staffs involved in the management of wounds To optimize financial and human resources To improve functional outcome by reducing morbidities and mortalities hence improve patients satisfaction

HOSPITAL WOUND CARE COMMITTEE

DEPUTY HOSPITAL DIRECTOR WOUND CARE TEAM
Secretariat

WOUND CARE TECHNICAL MEMBERS -VARIOUS DEPARTMENTS

PHARMACIST

MICROBIOLOGIST

DIETICIAN

INFECTION CONTROL UNIT

HOSPITAL WOUND-CARE TEAM

HEAD clinical specialist nominated by Hospital, COORDINATOR senior medical officer UD48 , coordinator, Sister 2 staff nurses 2 assistant medical officers
HEAD (NOMINATED BY DIRECTOR) TEAM COORDINATOR

SISTER

STAFF NURSE

ASSISTANT MEDICAL OFFICERS

WOUND CARE TEAM:

The wound care team/unit shall consist of: Chairman Deputy Director of Hospital (Administrative) Committee members representative from various clinical departments Coordinator specialist/senior medical officer UD48 Medical officers from various clinical department Wound care paramedics sister, staff nurses and assistant medical officers from various disciplines Pharmacist Microbiologist Dietician Infection Control member representative of infection control unit.

Trauma

Wound care committee/team

Standardised practice (not regulatory)- SOP Improved standard Cost effective Improved satisfaction

Wound care guideline:

Training module Used by health care providers in the health centers /clinics/hospitals

Wound care algorithm

Simplified Simple, practical and easily understood Used by any health care providers

Wound care chart

Wound care training- in various hospitals and regions (standardised module)

- participants from private colleges/ universities - Identify Local champions

> 20 MOH hospitals- form wound care team, others in progress! (ENT surgeon as coordinator!)

future:

FUTURE
Staffs in health clinic wound care trained Effectiveness of wound care team in various hospitals

Professional body on wound care ---------------------------------Malaysian Society of Wound Care Professionals

 Collaboration with Non-MOH (ministry of health) hospitalsuniversity and private hospitals. Experts from non-MOH in the team/committee

Future:
Specialists in wound care (post-basic, degree, fellowship in wound-care) Wound care- recognised as a specialty and specialised field. Stand alone- own staffs and budgets

Road ahead
Long, winding and bumpy and full with obstacles Work together Best care to our patients and our self.

Thank you very much for your kind attention