Wound care clinic is one of the initiatives of the new Model of Care (MoC) in the Al-Qassim Region, linked within the programs of the planned care system

wound care clinic is equipped and staffed so that patients who have Diabetic foot, Chronic wounds, Surgical-site infection will be managed. 

It aims to Reducing the burden on hospitals and the specialized diabetic foot center, enable patients to consistently receive best possible outcomes from the planned procedures and to ensure continuous of care after discharge while reducing length of stay.

Wound care clinic will be mainly applied at primary care levels such as in PHCs. It can also be applied at healthcare institutions offering secondary care services such as hospitals.

Before the establishment of wound care clinic, All cases of diabetic foot were referred from health centers to specialized center (diabetic foot center) through manual papers. This led to long waiting periods for patients to reach the clinic and consequently increasing the incidence of complications.

Based on the initial patient's assessment, PHC physicians will assess the patients who have one of these cases (diabetic foot, chronic wounds, surgical site infection) are recommended to be referred to one of these clinics according to the criteria for each specialty (general surgery, orthopedic, vascular, plastic) through mawid system by the PHC physician 

PHC physicians will document history and physical examination of the patient in mawid system to be referred.

-The patient will Booking an appointment at PHC physician in primary health care center

-nurses will document patient vital signs (blood pressure,tempreture,heart rate) 

-The physician will take history,  physical examination and should follow the wound infection assessment form to make decision. 

-referral the patient to specialized clinic through mawid system

Depend on patient segmentation and referral criteria.  

-referral criteria and patient segmentation for each specialty:

Depend on site and cause:

vascular surgery

if the patient is diagnosed with venous and arterial ulcers, the physician at primary health care center should refer the patients to secondary hospital for vascular surgery.

 2.plastic surgery

if the patient is diagnosed with Bed sores and upper extremity, the physician at primary health care center should refer the patients to secondary hospital for plastic surgery.

3. general surgery

if the patient is diagnosed with other cases, the at physician at primary health care center should refer the patients to secondary hospital for general surgery.

Surgical Site Infection:

After the surgery operation, the patients should be seen by their surgeon.

Diabetic foot:

If the patient is diagnosed with diabetic foot, the physician at primary health care center should refer the patients to podiatrist if available, if not they should be distributed through cluster week by week among all four specialties: (General Surgery, Vascular Surgery, Orthopedic Surgery, and Plastic Surgery).

Prevention:

Glycemic control: Maintaining optimal blood glucose levels through medication, diet, and exercise helps prevent diabetic foot complications.

Foot care education: Patients should be educated on daily foot care practices, including proper hygiene, regular inspection of feet, and appropriate footwear.

Regular foot examinations: Patients with diabetes should undergo regular foot examinations by healthcare professionals to detect any early signs of foot problems.

Treatment of Foot Ulcers:

Debridement: Removal of dead or infected tissue from foot ulcers to promote wound healing.

Wound dressings: Application of appropriate wound dressings to maintain a moist wound environment and facilitate healing.

Offloading: Redistribution of pressure away from the ulcerated area using methods such as padding, orthotic devices, or specialized footwear.

Infection control: Treatment of any underlying infections with antibiotics, if necessary.

Vascular assessment: Evaluation of blood flow to the feet to identify and address any vascular issues that may impede wound healing.

Surgical intervention: In severe cases, surgical procedures such as debridement, skin grafting, or amputation may be necessary.

Management of Peripheral Neuropathy:

Pain management: Medications, physical therapy, or other interventions may be used to manage neuropathic pain.

Sensory protection: Patients should be advised to avoid walking barefoot and to inspect their feet regularly for signs of injury.

Footwear modifications: Patients may benefit from wearing cushioned, well-fitting shoes to reduce pressure and friction on the feet.

Optimization of Vascular Health:

Smoking cessation: Encouraging patients to quit smoking to improve vascular health and reduce the risk of complications.

Blood pressure control: Monitoring and managing blood pressure to reduce the risk of vascular complications.

Vascular interventions: Patients with peripheral arterial disease may benefit from interventions such as angioplasty, stenting, or bypass surgery to improve blood flow to the feet.

Multidisciplinary Care:

Collaboration among healthcare professionals, including podiatrists, endocrinologists, vascular specialists,plastic surgery, wound care specialists, and orthopedic surgeons, to provide comprehensive care tailored to the individual needs of patients with diabetic foot problems

Managment of chronic wounds:

Wound Bed Preparation:

Debridement: Removal of necrotic tissue, slough, and debris from the wound bed to promote granulation tissue formation and facilitate healing.

Cleansing: Gentle cleansing of the wound with a mild, non-toxic solution to remove bacteria and debris without causing further trauma to the wound.

Moisture Balance:

Moist wound environment: Maintaining a moist wound environment using appropriate dressings to promote cell migration, angiogenesis, and wound healing.

Exudate management: Selection of dressings that effectively manage wound exudate while preventing maceration or dehydration of the surrounding skin.

Infection Control:

Assessment for infection: Regular monitoring of the wound for signs of infection, such as increased pain, erythema, warmth, or purulent drainage.

Antibiotic therapy: Systemic or topical antibiotics may be indicated for infected wounds, guided by culture and sensitivity results.

Biofilm disruption: Management of biofilm, a complex microbial community that can impede wound healing, through debridement and antimicrobial interventions.

Nutritional Support:

Nutritional assessment: Evaluation of the patient's nutritional status and supplementation as needed to support wound healing, especially in cases of malnutrition or nutrient deficiencies.

Protein intake: Adequate protein intake is essential for collagen synthesis and tissue repair.

Vitamin and mineral supplementation: Ensuring adequate intake of vitamins (e.g., vitamin C, vitamin A) and minerals (e.g., zinc) that are important for wound healing.

Wound care toolkit:

https://drive.google.com/file/d/1u1jWbZCdOW8Wp24et_BYb9PfI41-5idb/view?usp=sharing

Wound care policy:

https://drive.google.com/file/d/1y9hJJgN7ZdLydRggpHOn49fWOwUEL2TZ/view?usp=sharing