Facility in Focus: Providing Wound Care in ‘Steeler Country’

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Joe Darrah

  Washington, PA — Life within the industrialized Pittsburgh Metro region operates under a long-held code, an understanding among residents that has transcended generations.

  “In this area, we’re known as the ‘Steelers’ because we work hard and play hard — that’s the attitude of individuals around here, and they have a lot of pride in what they do,” said James Marks, DPM, FACFAS, FAPWCA, medical director at Washington Health System Wound & Skin Healing Center.

  It’s an attitude that goes far beyond the clichéd, stereotypical image of the steel mill worker who grew up among his hardhat-wearing brethren — the local steel industry’s collapse occurred more than 30 years ago.

  However, a gritty work ethic remains a sense of identity among those who live and work here. And while the reputation may be admirable, it’s not one that lends to great healthcare habits.

  According to the CDC, each of the three neighboring counties that comprise the clinic’s coverage area (Fayette, Greene, and Washington) was associated with some unappealing health statistics as recently as 2008, when Fayette County was linked to the highest rate of diabetes (10.7 percent) in the state and was among 19 counties (including Washington) to have at least 30 percent of residents categorized as “obese.” Additionally, Greene County was determined to have the “least active” inhabitants while all three counties were found to have at least 10 percent of those ages 20 and older to be living with diabetes. Whether these disparities are a result of too much hard-nosed work and play interfering with time to exercise, visit one’s physician regularly, or eat healthy is up to conjecture — what’s not is the increasing rate that wound care has been needed, including for work-related injuries. (See Wound Care Patient Profile.)

  “Because of the Marcellus Shale in this region,” explained Marks, referring to a massive unit of sedimentary rock that has been found throughout parts of eastern North America that serves as a natural gas reserve, “we have a huge influx of people coming here to work and to tap into the natural resource.”

  The trickle-down effect at the clinic, which was founded six years ago by hospital officials in response to what had already been a growing number of patients who lacked an accessible, dedicated wound facility, has been an ever-increasing patient population. In 2012, the clinic’s patient volume grew by 70 percent (or roughly 23% annually) since its doors opened in 2007. The increased caseload is exactly what hospital administration and clinic staff envisioned as they developed a protocol for providing care through a nursing-focused system that stresses relationship-building.

  “We make a concentrated effort to build relationships with everyone involved so that the patient knows we’re committed to them and that caregivers, whether they be a family member or local skilled-nursing facility, visiting nurse agency, or personal care home, understand that we’re a resource and that we’ll provide the best care for their patients,” Marks said.

A Caring Commitment

  These relationships are forged immediately. When patients arrive at the facility, they are briefed by their nurse and physician on the state of their existing wounds as well as their overall health in relation to wound care, their prognosis and expected course of treatment, their timeframe for wound healing, and their responsibilities as a patient to promote wound closure and prevention.

  “The key is to ‘frontload’ the patient with information from the start of the relationship,” Marks said. “They need to know what to expect. Their time is important, and they need to know that we’re giving them 100 percent of our focus when they’re with us.”

  In keeping with the theme of the community, the majority of the clinic’s patients are the working type who depend on providers to keep them healthy enough to not just earn a living but to fund their healthcare. This is where the role of education comes squarely into play, Marks said.

  “These are tough economic times, and unfortunately we see patients who are skipping medications because they can’t afford their copays, or they’re cutting their dosage in half,” he added. As such, overall compliance remains a major concern with patients, who are brought to task by clinic staff just as much as they are kept informed, beginning at the first point of care.

  “Our patients are normally here because they have complex problems with multiple comorbidities,” said clinic manager Rita Palaisa, BSN, RN, CWOCN. “Many of them have been living with their wounds a long time, and our responsibility is to figure out why their wounds have not progressed toward healing. Regardless of what the barrier is, the best way around it is through the development of relationships.”

  Which means establishing trust and honesty, she said. For those patients with their hearts set on getting healthy and salvaging limbs because they want to live a normal life and not lose their job, their commitment to care must be assured.

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