Management of Necrotic Wounds: A Systematic Approach Results to a Better Patient Outcome and Cost Effectiveness

Significant increase of 93% in the cost of enzymatic debridement with collagenase has greatly impacted continuity of care as majority of the facilities to include ECF, LTAC and Home Care had removed this product in their formulary. Ascension Health, one of the largest health system in the country is also impacted by this huge increase in cost. In FY2014 alone, it had spent an excess of $1.5million on enzymatic debridement. An opportunity was identified to review the management of necrotic wound to determine the place of collagenase using clinical evidence.

A group of experts composed of CWOCNs and Pharmacists convened over a four month period to review and grade evidence- based literature for the management of necrotic wounds. Recommendations from the workgroup included the following 1.) Follow a systematic approach for management of necrotic wounds with a guideline taking into consideration amount of necrotic slough area, presence of infection and character of wound base. 2.) Re-evaluation of wound by experts at least once weekly. 3) If current treatment plan remain ineffective with at least 2 weeks of treatment, consider Surgery consult for sharp debridement.

The workgroup developed supporting materials that was summarized in a PowerPoint presentation including an SBAR to provide background information regarding this initiative. This was formally approved through the Ascension Therapeutic Affinity Group and communicated to all health system clinical leaders for evaluation over a 14 day period. Once all concerns were addressed, approval by the Clinical Executive Committee and Ascension CMO was obtained. Ascension sites were given 90 days to implement this initiative.

This systematic approach in managing necrotic wound generated positive outcomes since its initiation in February 2014 to include timely intervention that is safe and effective, increased patient satisfaction and significant cost savings with an average of 57% every month, from $264,000 to $114,000 on enzymatic debridement alone.