Assessment-Based Dressing Selection Based on Functional Categories of Products to Decreased Resource Utilization and Streamline Practice

Problem:  Since the introduction of advanced wound care products, there has been an explosion of options for optimizing wound bed preparation.  Dressing selection is ideally based on matching the function of the dressing to the wound assessment.  This concept falls by the wayside due to inaccurate assessments, restricted formularies, cost/ billing influences, and clinical apathy.   Standards for wound assessment are well established, yet assessment alone does not guide dressing selection,¹ .   Furthermore, CMS Surgical Dressing Policy classifies wound care products based on ingredients, not function.² Therefore, the provider must balance dressing selection to achieve clinical outcomes in addition to knowing the requirements for the payer source and managing cost.

Objective:  Create a model for assessment-based product selection based on depth, exudate, and bioburden with the desired outcomes of decreasing dressing over-utilization, optimization of individual wear times, and decrease overall costs.   The model will minimize cross-functional product selection and mismatching exudate levels with the dressing moisture vapor transfer rate (MVTR).³  i.e. hydrogels under foam dressings or foams on lightly exuding wounds.

Proposed Model:     Dressing are classified into functional categories of hydration, moisture retention (MVTR >35g/m²/hr)⁴ absorption, and super-absorption with or without antimicrobial additives.   Superficial wounds are dressed with a single primary dressing based on exudate level and bioburden.  Deep wounds are managed by a primary dressing filling the dead space and covered by a non-antimicrobial secondary dressing from the functional category in the superficial wound section.  Navigation up or down the functional category is based on dressing compromise requiring dressing changes > 2-3 days, or up to 7 days in certain cases. 

Implications for Practice:  Using this model will reduce dressing utilization, reduce inappropriate cross-functional dressing combinations, reduce cost, and encourage appropriate use of advanced wound care dressings.  Furthermore, providers will have versatility of a dressing formulary for managing wounds across the spectrum of assessments.