If your kids can use Zinc Oxide, then why can't your staff? - WOCNs making a difference

Radoslava Stoddard, BSN, RN, CWON, CFCN, Nursing Administration, SSM St Louis University Hosptial, St. Louis, MO
Introduction:  CWOCNs are integral to the hospital wound and ostomy formulary.  When a new product is added, who becomes the gatekeeper and can we influence new product decisions? Evaluation of evidence based products falls in our domain and navigating supply chain value analysis teams can be daunting.

Problem: Our facility was using a 40% zinc oxide paste to manage moisture associated skin damage (MASD), specifically Incontinence Associated Dermatitis (IAD).  This required a provider’s order, dispensing from Pharmacy, and a licensed nurse to apply. These requirements delayed treatment for IAD and limited our unlicensed Patient Care Technicians (PCTs) from providing complete incontinence care, including application of the zinc-oxide paste. 

Proposed Solution:  Evaluation of a spray-on 25% zinc oxide/20% dimethicone (SOZO) to replace the 40% zinc oxide paste, have it dispensed through central supply, and write a Clinical Practice Guideline for use by nurses and PCTs to expedite IAD management. 

Results:  Clinical staff and PCTs validated SOZO and reported clinical effectiveness, easier application with reduced cost.  However, during approval and implementation of the product, Pharmacy intervened and declared the product as an “OTC Medication” requiring the same pharmacy dispensing that we were trying to eliminate to improve care delivery processes. 

Under the FDA Code of Federal Regulations, the “Skin Protectant Monograph”1 (SPM) states that products with zinc oxide ingredient of 1-25% and dimethicone 1-30% can be labeled as a skin protectant. We found many other products stocked on the floor and distributed through Central Supply including, a 6% dimethicone cream and a 43% petrolatum barrier. Since they are regulated by the same SPM, there was no credible argument to limit SOZO’s use through pharmacy.  

Conclusion:  As advocates of effective and efficient care, our facility now benefits from SOZO stocked in Central Supply for immediate use. Yes, certified WOCNs can influence product placement.