Public Policy

Canadian Association of Wound Care
The 8th Annual Conference
Sheraton Wall Centre
Vancouver, British Columbia
Friday November 15th, 2002

CAWC Health / Public Policy Forum Minutes

The meeting held during the 8th annual CAWC conference was the one of the first opportunities for the members to express their ideas, concerns and hopes for the future of wound care in Canada. It was a thrilling experience for the members of the committee to see such enthusiasm and interest in the area of public policy. Clearly this is a need not yet met and its address is timely. The committee expressed their appreciation to the delegates for their thoughtful contributions to the next challenges the committee will undertake.

The delegates made the strength of their voice clear with the very successful response to the survey distributed at the conference. The survey looked at where people worked, what they did, whether they felt there was standardization of care, and if they felt the CAWC had a role to play with standardization. It also looked at the role, development and review of guidelines and protocols as part the CAWC mandate. There were over two hundred responses including over seventy with comments. The survey results and the themes from the comments were touched on in the meeting, however final results of the survey will be put onto the CAWC web site for convenient review by the membership.

During the meeting Friday afternoon, at the end of an invigorating and exhausting day, several still alert and intelligent delegates contributed to a lively discussion. Guidelines were a large part of the discussion as were regional protocols. Also the role of the CAWC was discussed, it’s limits as well as it’s potential responsibilities.

Guidelines are being used in many institutions across the country though consistency and use of evidence base information widely varies. It was discussed whether the CAWC had a role in developing or reviewing guidelines. Could the CAWC develop a tool to be used by members in evaluating guidelines to ensure evidence based practice while allowing for individual needs and challenges different areas may face? The greatest concern was of guidelines being used as "recipe books" for wound care. Some thought this a dangerous direction to go, as there would be less emphasis on learning the basics where critical thinking would be used to make decisions. However, there was equal concern expressed for the reality that some health care professionals delivering wound care may not know the basics, this may be a new nurse that is otherwise overwhelmed or someone who is either unwilling or unable to establish a knowledgeable base for wound care. In this circumstance, it was thought that a "recipe book" or protocol would be useful to provide them with a safe basic tool with which to decide on a particular dressing while if not contributing to an appropriate care plan, would at least do no harm. Then appropriate guidance could be sought. Concern was raised whether in fact this "guidance" would be sought and that there needed to be some way to ensure that it was not only done but that it would be possible for the person to do so easily. These concerns certainly point to the novice vs. expert question and how to deal with the realities of who is actually delivering wound care in hospital as well as the community. It was asked; how do we as experts deal with the lack of knowledge out there? This is not content learned in nursing school, if in fact it is even a registered nurse providing the care. Can protocols ensure safe care? Should the CAWC get involved in this question? Could the CAWC develop guidelines, or review and put evaluated guidelines on the web site for people to access? Should they focus on dressing choices or assessment and principles? Best practice needs to be the focus. Should the CAWC evaluate, conduct a trial and then re-evaluate before posting on a web site? Is that realistic? These questions are representative of the discussion that took place.

Protocols were also a topic of discussion. There was concern expressed about the Nova Scotia Protocol in that many felt is was not necessarily evidenced based and there was certainly no review done by the user groups and therefor no established buy in. There were questions of whether the CAWC had reviewed this protocol. While many believe protocols such as this may play an important role, there was emphasis on the way in which they should be developed. The Ontario Protocol was also discussed and its focus seemed to be based on a national perspective with the focus on principles, assessments and best practice. It did not have the feel of a "recipe book". This was more to the liking of many present as it allowed room for choice and critical thinking. The concerns expressed with regard to protocols included the fear of being dictated to by companies and health care administrators. Not being able to freely choose certain products because they were not made by a certain company was another frustration. There was a strong contingent from Ontario present at the meeting that are dealing with significant frustration having to practice with strict protocols as to what they can use in products and feeling they have no input. The ethics of caring and providing ethical care was felt to be at risk with the use of some of these protocols. While their use was established as having potential, their development needed significant nursing input.

Though no solutions were arrived at during the meeting the concerns were recognized and they galvanized the importance of the CAWC having a strong public policy initiative. It is this initiative that was established at the meeting and there was strong support for the committee to take these concerns forth and create change. There will be ongoing consultation with the membership to ensure their concerns are driving the initiatives of the committee. All feedback and involvement will be welcome while transparency of the process will ensure the committee is acting ethically and appropriately on behalf of the CAWC membership and indeed all those providing wound care across Canada.

Please contact us at: cawc@sympatico.ca.