A hospital - based homecare department faced the dilemma of challenging existing hospital skin tear protocol. The existing protocol though less costly (antibiotic ointment/non adherent gauze/wrap applied every other day) created a financial burden for Homecare. A homecare visit to apply a dressing requires a skilled nurse (cost $120/visit).

Four visits per week accumulated a cost of $480/week. The average Medicare homecare reimbursement per 60 day episode is $2,500 for all services and supplies delivered homecare in that time period. The average age of most homecare patients is 78, an age of high risk for skin tears. Most services are reimbursed by Medicare Part A.

The Homecare CWCN identified that the Hospital Value Analysis Team would have to be persuaded to authorize more costly supplies for a long-standing skin tear protocol “a hard sell”. Her evidence-based recommendation would be utilization of hydrogel followed by silicone based non-adhering dressings for skin tears. Outcomes were: reduced pain and trauma, moist wound healing and a 50% reduction in dressing change frequency.

The Homecare CWCN and acute care colleague realized that the paradigm of the Value Analysis Team would have to shift. The implication of human resource cost would have to be considered in product selection in non-acute settings. The team and ordering physicians would require data and education to drive this change. The CWCNs undertook an educational approach, including financial and clinical data to support a strong argument to change the clinical protocol while gaining authorization for a more expensive product.

This poster presentation demonstrates that CWCNs can be successful in improving patient outcomes and changing the decision criteria for a Value Analysis Team. The process of data collection, education and implementation of a pilot test will be clearly displayed as one, which can be duplicated by others.