Slovak Society for the Care of Open Wounds (SSOOR)

Author: PhDr. Beáta Grešš Halász, PhD., MPH, Chair SSOOR, Slovakia

Ms. Jozef Košková, Honorary- Emerita Chairwoman of the SSOOR governs and commits the current mission: “SSOOR strives for Slovakia to move forward with the world trend, so that our commitment - the period 2011-2050- a historic milestone in wound healing will be fulfilled - we believe that even sooner."(Jozefa Košková, 2012).

SSOOR (Slovak Society for the Care of Open Wounds) was founded in 2008. We are a civic platform in Slovakia that brings together professionals and patients/clients and their relatives in relation to the management of chronic, hard to heal or non-healing wounds. We are actively involved in activities related to the certification preparation and standardization of comprehensive care for such patients. We provide professional advice to patients/clients and their relatives. We inform the public about the functioning of the health care system in the area of ​​chronic wounds´ management. We actively participate in the development of Slovak legislation related to education, training and practice in the area of chronic wounds. We represent professionals and patients/clients at the national, European and international levels. The mission of SSOOR is to defend and promote the interests of patients/clients with chronic/hard to heal/non-healing wounds, and their relatives, as well as to communicate with relevant institutions in relation to the management, coordination, cooperation and rationalization. We also communicate with relevant institutions in relation to the education and practice of professionals. The aim is to bring together patients/clients and their relatives, and healthcare professionals and specialists with an emphasis on a holistic approach and the voice of the patient/client with chronic wound.

History of the SSOOR in the years 2007-2018

The SSOOR was founded in 2007, registered at the Ministry of the Interior of the Slovak Republic with final validity on 12 February 2008 under No. VVS / 1-900 / 90-31404. The statute of the SSOOR, which was approved at that time, was not amended throughout the period of 2007-2018. The society was founded and built on the idea of ​​human values, primarily to help to those suffering. The founders of the company were surgeon MUDr. Peter Sedlák, patient Ing. Miroslav Havránek and a graduate nurse working in Austria, nurse Jozefa Košková, with experience as an instrumental nurse in the operating room, a paramedic in the field, and after the revolution as a nurse in community home care nursing. She completed retraining courses: a modern organizational worker, a manicure and pedicure course. In a short time, other members joined- Mgr. Marta Skachova, PhDr. Viera Macháčková, Ing. Milan Jakubček. Mgr. Serena Hermannová, anesthesiology nurse and social worker. After the revolution, she completed a course in cosmetics, manicure and pedicure. Judita Steinerová, a nurse, former citizen and native of the Slovak Republic, moved to Israel with her parents in 1963. After the revolution, she returned to Slovakia and became an active member of SSOOR. To a large extent, she was responsible for the beginning of the SSOOR. Professor PhDr. Oľga Slivková, with an extensive experience in teaching and publishing, has also become an important member of the society.

From 2007-2018, SSOOR´s Assembly approved the Executive Committee as follows:

Chairwoman: Jozefa Košková

Vice-Chairwoman 1: Viera Macháčková

Vice-Chairwoman 2: Serena Hermannov

Secretary: Milan Jakubček

Executive Committee Member: Marta Skachová

SSOOR's role was to work together to meet the main objectives of the SSOOR, in particular to mobilize professionals interested in improving the chronic-wound-care system, to convince competent and affected persons of the need to address the problem of chronic wounds´ management, and to set up a certification study in wound management for professionals.

The day of November 20, 2009 became a memorable day of the organization, when the constitutive assembly took place, and for the SSOOR it became a springboard for the fulfillment of the proposed resolutions. The priority program resolution of the association was the idea of ​​introducing a wound management division at medical universities in Slovakia with an aim to teach modern wound care. Education is a priority of the society; to acquire knowledge, skills and expertise from a theoretical, and especially practical point of view, and to pass them on to the immediate and wider environment. Other priorities of the society at that time were to organize courses, seminars, conferences, congresses, and to exchange useful knowledge and experience in the form of discussions, start educational activities for the lay and professional public, lead citizens to realize the general need for wound care and bring up the necessary habits. Other priority goals of the society were:

• open a center for the care of chronic wounds,

• set up sickbays/mobile sickbays with complete equipment, especially for immobile patients with infected wounds,

• to adapt the environment at home to meet the basic hygiene requirements and principles of wound care,

• solve the problem of the method of storage and disposal of waste dressing material so that it does not become a source of infections,

• to fulfill the main goal of nursing care of wounds - to make life easier for the patient, to relieve him of suffering, to cure him so that he can return into normal life and ultimately contribute to the overall recovery of the population and the environment.

For several years before the establishment of SSOOR, approximately in 2004, Ms. Jozefa Košková became independently involved in the activities and addressed the competent authorities at the Ministry of Health of the Slovak Republic (MH SR) and the St Elizabeth University of Health and Social Work in Bratislava with a proposal to introduce a wound management education. Ms. Košková's effort was to take over the educational certified model of the ZWM-KAMMERLANDER-WFI Wundmanagement academy, following the example of Switzerland, Germany and Austria. Subsequently, around 2007, the EWMA became an inspiration for Jozef Košková to propose the creation of a new educational certification study "wound management".

SSOOR as a member of EWMA

EWMA is a European non-profit organization umbrella uniting national wound management organizations, individuals and groups interested in wound care. The main goal of EWMA is to support the implementation of interdisciplinary and cost-effective wound care at the highest level of quality. EWMA works to achieve its goals by being a source of education, organizing conferences, contributing to international projects in the field of wound management, actively supporting the implementation of existing knowledge in wound management, and providing information on all aspects of wound management. EWMA was founded in 1991. The association strives to support the development of education and research in the field of native epidemiology, pathology, diagnosis, prevention and treatment of injuries of all etiologies. Through collaborations with 53 national wound management associations in Europe, EWMA today works with more than 25,000 healthcare professionals working with patients suffering from acute and hard-to-heal wounds. It organizes projects and publishes documents, its own journal with a specific focus on the activities of member organizations, including the sharing of relevant reports, scientific knowledge and clinical experience among EWMA target groups.

Jozefa Košková wanted to take the opportunity to join this association. Subsequently, in the same year (2007), the civic association SSOOR was established, Ms. Košková as the chairwoman applied for EWMA membership in the hope that it will bring positive changes for the future in the field of wound management.

Already in 2009, representatives of the EWMA management visited Slovakia, headed by the then vice-president of the association, Professor Finn Gottrup. This visit was medialized in the SME daily (link: primar.sme.sk/c/4372838/spolocnost-pre-osetrovanie-otvorenych-ran-ma-podporu-aj-v-zahranici.html). The General Director of the Health Section of the Ministry of Health of the Slovak Republic, MUDr. Adam Hochel welcomed guests form EWMA and SSOOR. At the end of the negotiations at the time, certain steps were planned, which were unfortunately not fulfilled during the period 2007-2018, and not even after.

The first SSOOR and EWMA conference in Slovakia

 At that time, SSOOR, in cooperation with the Slovak Medical University, had the ambition to apply for accreditation for certification program in wound management for professionals. Unfortunately, this ambition has not been fulfilled either. In October 10, 2011, SSOOR in cooperation with EWMA and medical organizations organized a conference in Bratislava at the Danubius Hotel entitled "Leg Ulcer and Compression”. The conference was funded by EWMA. The conference was a success with high participation. Part of the conference was a political debate at a round table, led by MUDr. Iveta Vaverková, general practitioner and president of SSVPL SLS (Slovak Society of General Practitioners), and MUDr. Peter Sedlák, surgeon, founder of SSOOR. Prof. Finn Gottrup from Denmark. He said that wound management centers were established in several countries, and that the training took the form of wound management courses by obtaining a "wound manager" certificate. The existing wound healing and care centers are the guarantee of the right assessment, diagnosis and therapy, and are associated with successful wound healing. After giving a specialized care to patients in centers, they are followingly treated at home. He emphasized that there is a need to avoid conflicts in the team between a doctor and a nurse. He considered the good cooperation to be one of the basic conditions for successful treatment of a patient. He considered it important to have statistical indicators available. He recommended setting up a working group of 6-8 experts to draw up national guidelines for wound management, which over time, it can determine the main pillars for dealing with various complicated situations, which should result in a uniform procedure. The establishment of national wound centers modeled on the Copenhagen Wound Center could be seen as a concept for obtaining EU funding.

The result of the meeting was that the system of education of nurses and doctors is generally good. The problem is in patient management, as there is no uniform algorithm (national guidelines) and administrative competencies are not solved (who, when and what can implement). The problem is the financing of treatment and medical services by health insurance companies. Cooperation from the patient/client is also a problem - reluctance, ignorance, financial and time-consuming treatment. The conclusions of the findings have been defined, but the recommendations from this round table discussion have not yet been implemented since.

In 2012, the representatives of SSOOR Jozefa Košková and Ing. Mgr. Ľubica Kočanová participated in the EWMA conference in Vienna, entitled "Wound healing- Different Perspectives, One Goal". During that period, SSOOR participated in the worldwide STOP PRESSURE ULCERS event in Slovakia and since then it has been done every year. At that time, PhDr. Beáta Grešš Halász, PhD, MPH.- a nurse who completed her education and practice at home and abroad, became an active member of SSOOR. Since 2012, she has been actively cooperating with EWMA and representing SSOOR and Slovakia at EWMA conferences with contributions.

SSOOR also has support in religious circles- received the Bishop's blessing from the then-chairman of KBS Mons. František Tondra on October 20, 2009, later episcopal blessing from the chairman of KBS Mons. Stanislav Zvolenský on 13 November 2012, and the General Bishop of the ECAV in Slovakia, Miloš Klátik, acknowledged SSOOR with a request from the Lord God for a blessing.

SSOOR did not have any financial subsidy or sponsorship for its activities. In its work, it could not be very active in continuing the program commitments that was set out in the statutes. Many goals have not been met politically. Those who promised to help, did not help. The members tried to work within their own time and financial possibilities. They developed and proposed several projects, which, however, did not have the opportunity to be implemented. Wherever they appeared, they met with admiration, but not with an interest in giving a helping hand. It is sad that SSOOR's involvement was ultimately not fully supported, despite its promises. The organization felt frustrated and suspended its activities for some time. The work of committee members has been minimal in the last five years, consisting of consulting, solving and commenting on current problems. The work of the SSOOR was finally put into decline after 2012 for a relatively long period. Due to the situation, the health status of the members of the committee and the feeling of stagnation, the chairwoman Jozefa Košková convened the Assembly on October 24, 2018 with the intention of electing the executive committee and "selling the scepter to the young generation".

Objectives, activities and perspectives of SSOOR

Based on a direct vote in the Assembly in October 2018, a 5-member Executive Committee was elected as follows:

Chairwoman: Beáta Grešš Halász

1st Vice-Chairwoman: Marianna Hrehová

2nd Vice-President: Ivana Rónayová

Secretary: Silvia Cibríková

Member of the Executive Committee and Honorary: Emerita Chairwoman Jozefa Košková

The newly elected Executive Committee undertook to continue the activities and visions of the previous Executive Committee. The aim of SSOOR's interest is to continue to bring together health professionals and other professionals, as well as Slovak patients suffering from chronic wounds, streamline health care and services to citizens, engage in certification and educational activities, commenting on legislation related to standard procedures in health care, to improve nursing care as well as the lives of patients/clients and their families, all in the context of holism and justifying and advocate the patient/client's voice as a partner. SSOOR enables voluntary activity of its members professionally, materially and financially to ensure accessible, safe and high-quality care for chronic wounds, to support the implementation of proposed and developed projects, to support education in certification study in nursing and medical care, to support the education of its members, to support social and professional events in order to strengthen the position of its members in society.

The resolution of the Assembly resulted in:

• Collaborate with nurses/medical doctors/field specialists who are involved in wound management, as well as other nurses/doctors/professionals.

• Enforce the implementation of nurses with advanced experience in wound management and increase competencies in cooperation with the Ministry of Health of the Slovak Republic (currently the nurse cannot autonomously make decisions without medical doctor's approval in many fields- to consider nurses able to work independently, enforce the cooperation of professionals in wound care on the basis of clearly defined competencies).

• Support the licensing of nurses in an independent practice (Act No. 578/2004), support the home care and community service and its financing from public sources.

• Carry out data collection in connection with wound management at the national level (interest in studying, level of knowledge and experience of nurses/physicians in the field of wound management, prevalence, incidence, prevention, treatment, procedures, etc.).

• Identify interest in the establishment of outpatient clinics/centers in the management of chronic wounds (model of the Copenhagen Wound Center)

• Create and activate a Research Center for Nursing focused on the management of chronic wounds.

• Collaborate with AOPP, EWMA, ICC, EPUAP and other associations and organizations on national, European and international level.

• Education of patients/clients, family members in cooperation with companies, organize lectures.

• Conferences in the field of wound management (participation od SSOOR as well as organization by SSOOR).

• To support the proposal for certification study, the proposal for specialized study focused on the management of chronic wounds for both nurses and medical doctors in cooperation with stakeholders.

• Proposal for standard diagnostic and therapeutic procedures for the management of chronic wounds - proposal to, cooperation with the Ministry of Health of the Slovak Republic.

Membership in SSOOR

The Statutes of SSOOR state that members of the company may be persons – medical/health and other professionals, and citizens of the Slovak Republic and outside the Slovak Republic, who apply in writing on the basis of an application for membership. Members can be healthcare and other professionals, patients with wounds, or patients/clients in recovery after wound healing, their relatives, carers, but also citizens who support the company's activities morally, promotionally, financially and with property donations. Members may participate in the meetings of the company, submit proposals, criticize the activities of administrative bodies, have the right to vote and be elected to the administrative bodies of the society, participate in the activities of the society according to their expertise and interests.

Members of the society are mainly nurses, medical doctors, other healthcare professionals, patients/clients and their relatives, university teachers and researchers, representatives of pharmaceutical companies whose common interest are wounds. Anyone who wants to support our goals and the idea of ​​reducing chronic wounds in Slovakia and participate in activities can become a member of the society.

SSOOR fully supports and actively participates in the planning of postgraduate certified education in Slovakia. The member has the opportunity to comment and actively participate in the preparation of materials in connection with postgraduate education.

SSOOR fully supports and actively participates in the preparation of legislation, standards and clinical recommendations in the context of wound management and in relation to the competencies of professionals, supports unlicensed and licensed professionals working in the institutionalized and community field. The member has the opportunity to comment and actively participate in the preparation of legislative materials, standards and clinical recommendations. The advantage is free participation in selected activities and conferences with the allocation of credits for active and passive participation, participation in SSOOR activities, gaining contacts for experts and cooperation with experts in the field of wound management.

SSSOR is currently an active member of EWMA. EWMA covers the cooperation of associations, companies, organizations and companies focusing on wound management in the context of multidisciplinaryty not only in Europe but also at the international level. SSOOR became an active member of the AOPP (Association for the Protection of Patients' Rights), which unites patient organizations in Slovakia and currently is the highest ranked platform.

SSOOR actively promotes multidisciplinary cooperation, with the patient and his family the focus. The patient's voice is most important to us. Membership of patients with chronic/non-healing wounds and their families/carers is therefore desirable.

SSOOR´s most current mission and latest activities

Our recent activities arisen from our latest set steps of mission:

• submission, commenting and enforcement of legislative proposals,

• publishing and disseminating information and educational materials,

• organizing educational and information events for members and supporters, citizens,

• supporting the activities of our members methodically, organizationally and advisoryly, supporting promoting their projects and promoting their events,

• cooperation with the Ministry of Health, the Ministry of Education, Science, Research and Sports, state administration and self-government bodies, trade unions, health insurance companies, health care providers, educational institutions, pharmaceutical industry manufacturers and representatives, other civic associations and non-profit organizations,

• cooperation with European and international organizations with a similar focus and mission.

First Chronic Wound Management Day and other conferences and round tables

In 15 May 2019, the SSOOR organized the Chronic Wound Management Day as the first multidisciplinary activity involving patients/clients and their relatives to meet and develop multidisciplinary collaboration in the context of the needs, requirements and expectations of patients/clients with chronic wounds, and their relatives within the field of chronic wound management. It was the first year of the event, which we are planning to organize every year as a “traveling” event every year in another city in cooperation with local hospitals according to EWMA model. It took place in Prešov, at the Faculty of Health Care of the University of Prešov in Prešov, which was co-organizer of the event. Another co-organizer was the Faculty Hospital J. A. Reiman in Prešov. The President of AOPP, PhDr. Mária Lévyová was actively involved with her presentations as an honorary guest. Other presenters were medical doctors, nurses, a podiatrist and experts in the field of the advanced wound therapy and modern and alternative therapeutic procedures. The one-day event was supported by industry companies. We received many positive reactions in terms of significant benefits for both the professional and patient/client audience.

Other considerable events were the round table of experts, representatives of professional societies, representatives of insurance companies, and of the Ministry of Health, and web conferences and symposium followed by the press conference in November 2020. Wound management issues were discussed from different perspectives and main outcomes were the establishment of the work group of experts and stakeholders for standards´ development, and a general agreement of the need and vision to establish a wound center (perhaps three for each region) in Slovakia.

Visit of Copenhagen Wound Healing Center

In the context of our mission and issues in relation to wound management in Slovakia, SSOOR had the opportunity to visit t Copenhagen Wound Healing Center in Bispebjerg Hospital. The aim of this visit was to gain a real and complex view of how a such center should function. We would additionally like to thank to the management of the Center for such a instructive time, warm welcome and useful information.

At current times, SSOOR if running discussions with the representatives of the Ministry of Health trying to find ways and resources to establish a Center in Slovakia. Round tables and medialization in the recent past helped to break through with this idea among stakeholders as well as professional a lot. SSOOR at the Ministry of Health are discussing the possibilities of building a new pilot wound center in Slovakia.

Wound Management standard

At current times, the established work group of experts is finalizing the draft of the standard for wound management. The standard is a complex material dedicated to professionals managing wounds and includes recommendations to rationalize the care with an emphasis on prevention, the use of modern materials, devices and technologies, with a suggestion to use telehealth, too. With all hopes, the plan to complete this mission is by the end of 2021, and to put it into force straight after.

COVID era in wound management in Slovakia

The critical situation of the COVID19 pandemic has affected us all. The most vulnerable group were the elderly and/or the sick. This includes patients with chronic wounds. First-contact physicians and nurses, such as home care agencies and outpatient clinics, met these patients on a daily basis. Due to the current critical period with limited material, technical-personnel capacities and access to patients/clients, the situation was slowly becoming more complicated. A medical doctor or a nurse had limited access to patients/clients with chronic wounds. The control of the overall condition and problems of the patient was very problematic, and the contact associated with the visit could not be made as under normal circumstances. There was a high risk of their condition deterioration. Without access, control, evaluation of the wound and the condition of the patient there was a risk that the care as well as the dressing materials and aids will not reach them in time, or at all. On the other hand, it was necessary to minimize the number of visits in order to prevent the spread of COVID.

We have reached the Crisis Staff of the Ministry of Health of the Slovak Republic with a demand to prevent obstacles. SSOOR in cooperation and with the significant support of AOPP (patients´ association), SK + MED (Slovak Association of Suppliers of Medical Devices), the ADOS Association of (community care) and SSPLR (Slovak medical association for wound treatment) we were looking for solutions and therefore we asked the Crisis Staff of the Ministry of Health of the Slovak Republic for:

• Communication, cooperation in the coordination of care for patients with chronic wounds,
• Acceptance of the use of telemedicine/telenursing/care in the context of communication, assessment, consultation and prescription (nurse or general practitioner communicates with a specialist doctor - anigologist, surgeon, dermatologist, etc.) as a regular appointment/visit using accessible routes and devices.
• Possibility of repeated prescriptions/possibility of prescribing materials and aids in larger quantities,
• Necessary amount of protective equipment for staff,
• Strengthen staff numbers.

Together, we saw these requirements as a temporary necessity during the crisis (until further notice) with a vision of their effective development and implementation in the near future, if they prove successful. Requests were heard and fulfilled within actual possibilities. The Crisis Staff accepted us for cooperation and joint negotiations in solving such a complex issue. SSOOR, as well as the other organizations mentioned, were active and helpful.

Correspondence: SSOOR, o.z, Kupeckého 2, 040 01 Košice, Slovakia