BEST PRACTICES

Systems approach gains momentum at the VA

A Veterans Administration hospital in Tampa demonstrates how skin health becomes a priority as part of its move to a holistic approach to health care.

Exterior view of James A. Haley Veterans Hospital in Tampa, Florida.

Holistic health is big in the VA. In this third in a series of articles, we continue to examine the benefits of taking a systems approach to skin health. Here, we look at how the VA makes skin care a health priority as part of its move to a more holistic approach to health care.

“There is a national push to make evidence-based practice a mindset, not a one-time thing,”says Linda J. Cowan, Ph.D., FNP-BC, CWS, associate chief, Nursing Service Research, and associate director, Patient Safety Center of Inquiry, James A. Haley Veterans Hospital, Tampa, Florida. “We’re taking the best available scientific evidence and combining that with clinical experience and patient/family preferences and values,” the certified wound care specialist and researcher explains.

At the VA, this holistic approach to clinical decision-making includes skin care and pressure injury prevention. “As far as skin health goes, every person on the team — including the physician, nurse, nurse practitioner, aide or patient care technician (PCT), dietician or nutritionist, pharmacist, physical therapist — is on the same page with the care plan,” Cowan says. “Each member on the team provides vital input on the total care of patients.”

To illustrate the importance of this approach, Cowan describes a hypothetical elderly stroke patient who has dementia. The patient groans with pain when he is moved, which greatly concerns his family. Drawing on both clinical expertise and evidence-based practice on turning the patient every two hours, an inter-professional team works with the family to devise a care plan acceptable to everyone. To maintain skin integrity, the plan includes using an alternating pressure mattress system, medicating the patient prior to turning and offering relaxing music to be played in the patient room.

More ways the VA is prioritizing skin health:

Telehealth: At its Gainesville, Florida, facility, ostomy patients no longer need to travel up to four hours for an annual evaluation. They now can go to one of more than a dozen nearby outpatient clinics and talk to an ostomy specialist via Telehealth from a private exam room.

Electronic medical record (EMR):
The VA is working to standardize an EMR template that documents both skin assessment and follow-up wound care.

VA Pressure Ulcer Resource (VA PUR) app:
This free pressure injury prevention app educates patients and their caregivers on good skin care, safe and skin-friendly patient transfers, and nutrition to improve wound healing and overall skin health.

Executive buy-in:
“Administrative buy-in on skin care is super important,” Cowan says. However, she cautions wound care nurses to be patient in overcoming challenges in getting executives’ support on skin care initiatives.

Read more in our “Systems at Work” series, how different healthcare facilities make skin health a priority.