Training and Teamwork

People with the most complex conditions, including spinal cord and brain injuries, multi-trauma, and traumatic amputations, are often at higher risk for secondary complications, including pressure wounds. Each patient who arrives at Shepherd Center has, on average, three wounds, including pressure ulcers (injury to the skin caused by pressure to an area over an extended period), traumatic wounds, or post-surgical wounds.

“Having specialized care teams that not only know how to treat spinal cord injuries but also wounds is important to help those wounds heal and to prevent them in the future,” says Dallin Lindahl, M.D., medical director of wound care services at Shepherd.

Shepherd’s Wound Ostomy Continence Nurses (WOCN), Kimberly Levenson, RN, BSN, CRRN, CWOCN, CFCN, and Carolyn Loughner, RN, BSN, CRRN, CWOCN, serve as the first line of defense.  

“We do a head-to-toe assessment of every patient upon admission to identify the types of wounds and develop treatment plans,” explains Levenson. “If they have complex wounds or pressure injuries, we will follow those patients throughout their stay. We round weekly, assess the progression of the wound — hopefully toward healing — and adjust their care plans according to the assessments.”

Dr. Lindahl rounds with Levenson and Loughner. He also sees patients in the outpatient Wound Clinic for follow-up or new developments. For severe wounds that aren’t healing, he consults with plastic surgeon Thomas Hagopian, M.D., medical director of reconstructive surgery at Shepherd. If needed, Dr. Hagopian performs myocutaneous flap surgery, in which some healthy skin and underlying muscles are moved to cover up the wound, allowing it to heal.

The wound care team has excellent results because of the processes they have in place.

“In 2023, our patients had 59 flap surgeries, and our success rate, determined by whether the wound was closed and needed little or no topical intervention, was 91.5%. And our pressure injury rate is lower than the national average,” says Loughner.

However, their goal is to prevent wounds by educating patients, caregivers, and staff and enlisting the help of all patient care team members.

“The training patients and caregivers receive during rehabilitation is invaluable — prevention is the big thing. It's better never to get a wound than to have to treat a wound, so prevention comes first,” Dr. Lindahl says.

“We give patients a toolbox, so they’ll think, ‘When I go home, I have to make sure that I'm doing skin checks before and after sitting, that I'm doing my weight shifts, that I'm offloading properly, that I avoid lying in a single position all night,’” says Loughner.

And with that education comes some reassurance.

“I always tell people, ‘We can fix skin,’” Loughner explains.  “It might take us some time, but you’ll be okay. It’s so important because wounds are scary, and it makes people feel better knowing this is not new to us. We see this all the time.”

Clinical staff are another critical line of defense.

“We educate the staff on the types of wound care, the protocols, and policies. We offer a skin champion program — it's an advanced class for our bedside nurses, which requires critical thinking and assessment of the types of wound treatment plans so these nurses can be a resource to their coworkers at the bedside not only for wounds but for ostomy and continence issues,” explains Levenson.

Departments like the Wheelchair Seating & Mobility Clinic are also vital in preventing wounds.

“In the seating clinic, they pressure map the patients and make sure they're on the right cushion and positioned in their wheelchairs correctly,” Lindahl explains.

Loughner says wound care and prevention at Shepherd is collaborative. Every member of a patient’s care team is instrumental in helping wounds heal and preventing them from occurring.

Levenson agrees.  

“It is a true team effort. We’re all asking, ‘How can we improve this or make it work within the therapy plan for the patient so that they're maximizing their therapy at the same time that we're healing the wounds?’” she explains.

The effort includes a Wound Prevention Workgroup comprised of clinical staff from several disciplines who examine what education, processes, or procedures should be implemented when a wound occurs so it doesn’t happen again.

But it all returns to patient education.

“These are lifelong skills that are going to be required of our patients due to their injuries, so hardwiring that education for the patients and families is paramount. Our staff do an incredible job of that, so we aren't seeing as many people come back with wounds they develop at home. And that's a testament to our great staff here,” says Levenson.

Written by Ruth Underwood