Wound Disruption: Clinical and System Review, incident analysis

Given the broad range of potential causes of wound disruption, clinical and system reviews should be conducted to identify latent causes and determine appropriate recommendations.

Occurrences of harm are often complex with many contributing factors. Organizations need to:

1. Measure and monitor the types and frequency of these occurrences.
2. Use appropriate analytical methods to understand the contributing factors.
3. Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
4. Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the Hospital Harm Improvement Resource. 

If your review reveals that your cases of wound disruption are linked to specific processes or procedures, you may find these resources helpful:

• Agency for Healthcare Research and Quality (AHRQ) www.ahrq.gov
• Selected Best Practices and Suggestions for Improvement PDI 11: Postoperative Wound Dehiscence [in children]. Toolkit for using the AHRQ quality indicators: How to Improve Hospital Quality and Safety. AHRQ, 2016 #5 Selected Best Practices and Suggestions for Improvement (ahrq.gov)
• Selected Best Practices and Suggestions for Improvement PSI 14: Postoperative Wound Dehiscence [in adults] Toolkit for using the AHRQ quality indicators: How to Improve Hospital Quality and Safety. AHRQ, 2016 #6. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4k_combo_psi14-dehiscence-bestpractices.pdf
• Selected Best Practice and Suggestions for Improvement: PSI 14: Postoperative wound dehiscence. Toolkit for using the AHRQ quality indicators.  AHRQ; 2016. http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/index.html
• American Journal of Health-System Pharmacy https://academic.oup.com/ajhp
• Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi:10.2146/ajhp120568 http://www.ajhp.org/content/70/3/195.long
• Bone Joint https://online.boneandjoint.org.uk/loi/bjj
• Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J. 2013; 95-B (11): 1450-1452. doi: 10.1302/0301-620X.95B11.33135. https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.95B11.33135
• Canadian Journal of Infectious Diseases and Medical Microbiology https://www.hindawi.com/journals/cjidmm
• Chow AW, Evans GA, Nathens AB, et al. Canadian practice guidelines for surgical intra-abdominal infections. Can J Infect Dis Med Microbiol J Can Mal Infect Microbiol Medicale. 2010;21(1):11-37. doi:10.1155/2010/580340 Canadian Practice Guidelines for Surgical Intra-Abdominal Infections (hindawi.com)
• Centers for Disease Control and Prevention www.cdc.gov
• Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 https://www.cdc.gov/infectioncontrol/guidelines/ssi/index.html
• Diabetes Care
• Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologist and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009; 32 (6):1119-1129. doi: 10.2337/dc09-9029. http://care.diabetesjournals.org/content/32/6/1119
• Institute for Healthcare Improvement (IHI) www.ihi.org
• Institute for Healthcare Improvement. How-to Guide: Prevent Surgical Site Infections. IHI; 2012. 
  http://www.ihi.org/resources/pages/tools/howtoguidepreventsurgicalsiteinfection.aspx
• National Institute for Health and Care Excellence (NICE) www.nice.org.uk
• National Institute for Health and Care Excellence (NICE). NICE Surgical Site Infections: Prevention and Treatment. NICE; 2019. https://www.nice.org.uk/guidance/ng125
• Society of Obstetricians and Gynaecologists of Canada www.sogc.org
• Harvey MA, Pierce M, Alter JE, et al. SOGC Clinical Practice Guidelines. Obstetrical anal sphincter injuries (OASIS): Prevention, recognition, and repair. J Obstet Gynaecol Can. 2015; 37 (12): 1131-1148. https://www.jogc.com/action/showPdf?pii=S1701-2163%2816%2930081-0
• The Society for Healthcare Epidemiology of America (SHEA) https://www.shea-online.org/
• Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi:10.1086/676022 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267723/
• Wound Care Canada www.woundscanada.ca
• Orsted HL, Keast DH, Kuhnke J et al. Best practice recommendations for the prevention and management of open surgical wounds. Wound Care Canada. 2010; 8 (1): 6-34. https://www.woundscanada.ca/docman/public/wound-care-canada-magazine/2010-vol-8-no-1/362-wcc-2010-v8n1-best-practice-english/file
• Harris CL, Kuhnke J, Haley J, Cross K, Somayaji R, Dubois J, et al. Best practice recommendations for the prevention and management of surgical wound complications. In: Foundations of Best Practice for Skin and Wound Management. A supplement of Wound Care Canada; 2017. 66 pp. Retrieved from: https://www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/555-bpr-prevention-and-management-of-surgical-wound-complications-v2/file
• Wounds Australia : Wounds Australia Homepage - Healing Wounds Together
• Wounds International www.woundsinternational.com
• Ousey K, Djohan R, Dowsett C, Ferreira F, Hurd T, Romanelli M, Sandy-Hodgetts K. World Union of Wound Healing Societies (WUWHS) Consensus Document. Surgical wound dehiscence: improving prevention and outcomes. Wounds International, 2018. https://www.woundsinternational.com/download/resource/7394