How to do it ... wound care
Wound care programs can be the bane of long-term care providers, or they can be a source of clinical pride and marketing material, as well as a strong revenue stream. This“How To” piece offers expert advice on how to save money and maximize efficiency in wound care.
1 - Experts agree that having a well thought-out formulary is the first step to improving outcomes and saving money.
“The next step is to make sure that all the staff understands how and when to use each of the formulary products. Staff education is more than just telling them what to do,” says Margaret Falconio-West, BSN, RN, APN/CNS, CWOCN, DAPWCA, the senior vice president of clinical service, Medline Advanced Wound Care Sales.
2 - Falconio-West says it's “mandatory” to know the patient/resident's goals.
“If the treatment goals are palliative vs. healing, the approach to care and the actual treatment could be very different,” she notes.
3 - The use of the formulary must be evaluated. Falconio-West reverts to the “simple nursing process — assess, plan, implement and evaluate” to make sure nurses are thinking critically.
“Change (products) as needed if there is an issue, but not just because someone prefers another brand,” or because it worked for a different person, or at a previous time, she says. Each resident must be assessed as an individual.
4 - Experts also stress evaluating the overall cost of a wound care product. If a treatment is cheaper but requires much more labor, it's possible the “true” cost is high.
Keep an eye out for “clinically effective and cost-effective brands” as opposed to “clinically effective premium brands,” adds Valerie Johnson, marketing manager, advanced wound care division, MediPurpose.
5 - Falconio-West also calls for providers to rely on the “common sense factor” when evaluating cost.
“I am the first to say, ‘If it isn't broken, don't fix it,'” she says. “But it is also very important to realize that if it is broken — or not progressing toward closure, in this instance — then fix it.”
6 - Eliminate products from the formulary if they have duplicate functions, experts says.
“This helps to reduce waste and confusion,” explains Elaine McGowan, BSN, RN, CWCN, DAPWCA, vice president of clinical affairs for Dermarite.
She also recommends providing simple, formulary-based reference guides on every treatment cart and unit, which will help staff use appropriate products properly.
7 - Ongoing education of both nursing aides and licensed nurses is vital, McGowan feels. Aides should be regularly reminded what is on the formulary, how it is best used and when they should consult licensed nursing personnel.
Modifying the topical management as a wound progresses is also important.
“Rarely does one product suffice from the outset of treatment to wound closure,” McGowan notes.
8 - The prevention of wounds that can occur or be exacerbated by incontinence should be a “team” activity, says Bill Lampe, PT, DPT, MS, a clinical director at SCA Americas.
“[Staff should] communicate with each other not only their daily findings, but how they are proactively keeping their residents from a higher risk of skin-related issues,” he says.
9 - When it comes to
hands-on care advice, practices such as minimizing taped attached directly to skin can bring big benefits, says Sharon Hamilton, RH, MS, a clinical consultant for Briggs Healthcare.
“Generally, try to put tape on tape as much as possible,” she advises for dressing applications such as those with PICC lines.
10 - Regarding wound product use, it always pays to keep up on the latest developments.
For example, some items now have dressings with a minimally adherent contact layer, which can be a big benefit, says Gayle Jameson, BSN, RN, CWON, CWS, FACCWS, director of clinical nursing for Devon Medical Products. Quieter, lighter products that have features such as rechargeable batteries also help, she adds.
Mistakes to avoid
- Allowing staff to not adhere closely to your formulary.
- Not having a well thought-out and continually reviewed formulary.
- Not supplying ongoing education for all nursing staff members on products, practices and other features.