Wound care places a massive financial burden on limited NHS resources. Vowden et al (2009) estimated the annual NHS cost of wound care to be £2.0million/100,000 population which equates to £1.3 billion for the UK. In the community wound dressings are traditionally obtained using a prescription where the product belongs to the patient and surplus dressings result in waste. In addition delays obtaining dressings may interrupt patient care
Direct purchase of wound management products may reduce costs and minimise wastage as the products would belong to the NHS and not the patient. Quality of care and outcomes may improve as there will be no delay or interruption in treatment waiting for wound management products to arrive.
This project aimed to look at the effectiveness and quality of an alternative way of obtaining dressings in the community
The off script dressing scheme was introduced in stages across a pilot site within Community Health Services in Knowsley. Products were selected from the Advanced Wound Formulary which was developed by NHS Shared Business Services with support from Tissue Viability Nurse Specialists. Unlike other direct purchase systems this is not linked to a pharmaceutical company and therefore there is no obligation to have specific company products listed. The scheme enables different staff groups to have their own formularies.
Each formulary has a unique log on which determines the delivery site and products available within the formulary. For example silver based products are only available via the TV Formulary and additional pressure ulcer prevention products are available to district nursing and nursing homes but not the leg ulcer clinic. A small supply of stock is kept in each of the locations and further additional stock is available to order for the next day.
Dressing costs were compared prior to commencing the Off Script Dressing Project and then monthly afterwards. Patient experiences were captured with case studies and staff were asked to complete a survey to give their feedback.
Initially spend per month was lower than anticipated as staff were using patients existing products. Over the next few months expenditure on dressings did increase. This may be due to staff over ordering during early months whilst they gained confidence in the system. After further education was provided on Month 5 we have seen a decline on the amount of dressings ordered and the overall expenditure (figure 1).
This project is also about improving quality and staff and patient feedback has also been important. Staff feedback was obtained via Survey Monkey and the results demonstrate that staff preferred the off script route of obtaining dressings (figure 2).
Patients have reported it much easier than repeated visits to local pharmacists and prefer not having space taken up with surplus dressings. Figure 3 are some of the staff comments that were received as feedback
The above evaluation demonstrates that the Off Script approach to procuring wound dressings is an effective route of supply of dressings. There is no waste as the products belong to the NHS and not the patient. There is improved efficiency as there is no waiting for prescriptions to be signed and there is no delay waiting for appropriate dressings from the formulary leading to better outcomes.
Based on the initial successes of this pilot we are now introducing this system of obtaining dressings across all areas of the community