Best Clinical Practices, Based on Single Dressing Type, Improves Wound Healing while Reducing Health Care Costs

Clinical Problem

Governmental health care initiatives such as Value Based Purchasing (VBP) will be providing financial incentives to reward and encourage implementation of best clinical practices, combined with cost saving measures. The challenge in home care will be to integrate the initiatives to practice.

Past Management

Past daily management included a variety of advanced wound care dressings for 3 cases.

Current Clinical Approach

Polymeric membrane dressings (PMDs) were applied on1 patient with  a failed skin graft covering a basal cell melanoma excision site and 2 patients with stalled venous ulcers, one up to a year’s duration and one had thick eschar. Depending on exudate level, extra thick PMD with or without silver PM cavity filler were applied. PMDs were compared to past management in terms of: 1) rate of healing and autolytic debridement; 2) pain; 3) number of dressing changes; 4) cost savings in both wound care supplies and nursing visits; 5) wound closure. Dressings were changed per the PMD change instructions.

Patient Outcomes

With PMDs, patient 1 started healing immediately. Patient 2’s eschar autolytically debrided within 2 weeks. Patient 3 began granulating within days. Patient 2 and 3 respectively previously rated their pain an 8 and 7 (0-10 scale); with PMD pain decreased to 4. Once PMD initiated, daily dressing changes decreased to 2 times a week, then to once a week. PMDs resulted in 63% estimated average cost savings, considering both wound care supplies and nursing visit costs.   Patient 1 utilized 2 certification periods to heal the wound in 119 days. Patient 2 was transferred to outpatient setting after 1 episode due to homebound status and the wound was 100% granulated. Patient 3’s wound is near closure.

Conclusions

Significant improved clinical and financial outcomes were achieved by using PMDs. This report re-affirms PMDs are Home Care best practices.