Clinical Excellence & Cost Effective Care through Standardization of Wound Care Formulary

Background There are 6.5 million people in the U.S. with chronic wounds costing $39 billion dollars annually. As the pendulum of patient care shifts to post-acute care, such as home care and hospice, so will the labor/costs. In this space, 33% of home care patients and 35% of hospice patients have wounds[1]. Home care and hospice are already challenged with rapid expansion due to an aging population, rising healthcare costs, limited clinicians, and changes in reimbursement. This, combined with the large number of patients with wounds, presented an opportunity to evaluate wound management. We knew we needed to enhance clinical/financial outcomes and maximize nursing time/talent. Problem Our 53 site home care and hospice wound formulary had to be streamlined due to redundant, obsolete, and inappropriate sized items, and PAR levels. This existing formulary caused clinical confusion, inconsistent care, over/underutilization of supplies, increased cost and increased nursing visits. Methodology A wound care specialist team was organized to standardize the formulary. Evidenced based products were tested. Appropriate PAR levels and unique supply descriptions were assigned to enhance efficiency in the clinician ordering process. Evidenced based protocols were established. Collaboration occurred between managers/educators and wound care team on the education plan: Train/trainer event Dressing toolkits Visual product boards Dressing selection guides On-line learning modules for dressing selection/utilization On-line skill modules highlighting product user guides and video clips On-line Wound Product Resource Center Data analysis for 6 months pre/post implementation. Outcome Trends Observed Improved clinical performance as evidenced by decrease in % of wounds by end of the home health Episode of Care (60 days) Decrease total wound dressing supply spend Decrease in nursing wound care visits per episode