A clinical pathway approach to foam dressing rationalisation - a pilot
Foam dressings are a mainstay of wound care treatment. They absorb and handle wound exudate throughout the wound healing process. Foams can be used as a primary or secondary dressings and therefore constitute a considerable portion of the formulary budget.
Silicone foam dressings were introduced in the UK over 10 years ago and whilst they were intended for use on patients with friable skin with low to moderate exudate, their usage has exponentially increased to include almost every patient with a wound. These are often applied more frequently and sometimes inappropriately, in order to cope with moderate to high levels of exudate
Spend on Foam dressings in Cumbria Partnership NHS Trust has continued to increase, we therefore decided to undertake a pilot to investigate if the introduction of 2 clinical pathways (The Exudate Pathway and Wound Decision Tool) could rationalise usage of foam, increase nursing knowledge and decrease spend in 3 pilot nursing bases.
The Exudate Pathway1 helps nurses assess underlying factors in exudate production and to document, manage and dress wounds according to exudate production.
The Wound Decision tool2 helps nurses to choose whether a foam adhesive, non adhesive or silicone foam is appropriate for the needs of the patient using clinical rationalised criteria.
No adverse events or skin damage were reported at any of the bases, during the 3 month pilot trial.
Nurses failed to fill out or return the knowledge quizzes so a pre and post comparison of educational transfer was not possible.
Figure 1 shows the results of the sales for foam adhesive and silicone over the 3 month pilot. October showed an increase in foam for all categories.
However by November prescribing habits were changing as shown in Figure 2. Although foam adhesive sales were increasing by 38.5%, total sales of foam decreased by 4% in November.
In December foam adhesive sales were 38% higher compared to monthly average but silicone sales decreased by 40%.
Total cost of foam dressings was reduced by 26% as were the number of foam products used
These results suggest that significant cost savings can be made by using these clinical pathways to guide nursing choice of dressings.
This study suggests that safe rationalisation of foam and effective exudate management can reduce dressing numbers used, dressing costs and potentially nursing time.
The reduction in silicone foam dressing usage did not result in raised levels of skin damage during the pilot, suggesting that the Wound Decision Tool might be a safe way to clinically rationalise when a silicone foam is clinically appropriate for a patient.
October foam dressing sales increases could be due to the extra education and focus given regarding these products or alternatively a lag in the sales data. The December results showed that although more foam adhesive products were used, total product quantities and costs were reduced by 26%
This may be due to the fact that the adhesive dressings were in situ for longer periods.
A longer evaluation and an audit into foam product usage might further corroborate these findings