By Diane Krasner PhD, RN, CWCN, CWS, MAPWCA, FAAN
Coming together is a beginning.
Keeping together is progress.
Working together is success.
It is important professionally to support the concept of interprofessional wound caring1, but how can you do more than just give lip service to this ideal in your clinical practice—especially in these tough economic times?
- How do you ensure that wound-related standards of care are met when health care organizations, patients and patients’ circles of care face shrinking budgets and ever more limited resources?
- Whose priorities for the wound-related plan of care take precedence—those of the physician, the nurse, the other team members, the patient and his/her circle of care…or the payor/insurance company?
These are difficult questions in a challenging economic environment, no matter where you practice along the continuum of care.
Those of us who have been in wound care for decades remember the “good old days” of complete wound product formularies and unrestricted access to dressings and devices based on our assessment of need and efficacy2. Today, no one has an open pocketbook. Rather, the emphasis is on doing more with less. In the current climate, when dressing and device decisions may be finalized by external players, how does the interprofessional wound care team advocate for patients and commit to optimal patient outcomes?
Scenario and Outcome
In tough economic times, developing optimal, individualized plans of care for wound care takes extraordinary creativity and teamwork. We are challenged to envision new and creative ways to reach our care goals. Here is an example of how one team sought to optimize outcomes in the face of financial constraints and high patient/caregiver expectations.
Mrs. P., an elderly female outpatient with a diabetic foot ulcer of two years’ duration, was referred to a wound center for hyperbaric oxygen (HBO) treatments by her podiatrist. She was told that these hyperbaric treatments were the “only hope” for healing her foot wound. During Mrs. P.’s initial visit, the hyperbaric team discovered that she would not be able to afford the copays for the number of HBO treatments that would likely be required. Mrs. P.’s daughter, who accompanied her to the initial visit, insisted that her mother’s quality of life would be 100% improved if only she could get the hyperbaric treatments and be rid of this foot ulcer. “Something just has to be done for my mother,” she said.
The team explained that there was no guarantee that the treatments would heal the wound and that there were other options to be considered and explored. They suggested that the team look into the other options and that Mrs. P. and her daughter return to the wound center in one week.
The medical director of the wound center called Mrs. P.’s insurance carrier, but was unable to get the HBO copays waived. So, a new plan was envisioned.
The nursing staff consulted with Mrs. P.’s podiatrist to arrange for a new pair of diabetic shoes (under Medicare Part B), because her current shoes were clearly inadequate for properly offloading the first metatarsal head ulcer. The wound center team developed a plan to see Mrs. P. for a limited number of visits: two to three visits over four to six weeks, to devise and implement a topical treatment and to educate Mrs. P. and her daughter in follow-up care at home. An advanced wound dressing was selected; the povidone–iodine wet-to-dry gauze dressing that Mrs. P. had been using for the previous six months was to be discontinued. The staff contacted the insurance carrier to ensure that it would cover 100% of the wound dressing that they were going to recommend.
The plan was presented to Mrs. P. and her daughter for “sign-on” (coherence)1 at the follow-up appointment. They both agreed to give the plan a try—even though it wasn’t the hyperbaric treatments they were expecting. Within three months, Mrs. P.’s diabetic foot ulcer was completely healed.
What’s the moral of the story?
Coordination, access, best practices, interprofessional collaboration and patient-centered care are universal themes for wound care success and optimal patient outcomes.
By partnering with the patient and his/her circle of care and with our colleagues in wound care manufacturing and the payor community, the interprofessional wound care team can aspire to optimize wound care for every patient.
For 15 years, WoundSource, along with its sister publications, has been there to support you. We remain committed to providing you with the best print and online product information.
Let’s all commit to the lofty goal of optimal patient care for our wound patients—while trying to stay lean and mean!
I look forward to hearing from you.
Dr. Diane L. Krasner
(1) Krasner DL, Rodeheaver GT, Sibbald RG, Woo KY. “International Interprofessional Wound Caring” (Chapter 1.1), in Chronic Wound Care 5: A Clinical Source Book for Healthcare Professionals (5th edition, Volume 1). Malvern, PA: HMP Communications, 2012. www.cwc5.com.
(2) Baranoski S, Ayello E. “Wound Dressings: An Evolving Art and Science,” Advances in Skin & Wound Care, Volume 25, Number 2, February 2012, 87–94.
About The Author
Diane Krasner PhD, RN, CWCN, CWS, MAPWCA, FAAN is a certified wound specialist, a Fellow of the American Academy of Nursing, a Master of the American Professional Wound Care Association, a Wound & Skin Care Consultant, and serves on a variety of editorial and managerial boards for prestigious wound care organizations.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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