Part 1 in a series examining the reduction of facility costs and the continuation of quality care
By Sue Hull MSN, RN, CWOCN
Remember W. Edwards Deming? We all learned about him in business management, right? He taught and demonstrated that systematic approaches were necessary to improve quality and control costs. Maybe I’m the only one, but I couldn’t really grasp how that principle could be applied to wound care.
Fortunately, there are more creative thinkers than I at North Mississippi Medical Center (NMMC). They used Deming’s principles to move beyond merely trying to maintain quality of care while lowering wound care costs; they improved quality of care while reducing costs.
And, when I say they reduced costs, I mean they went from spending $620,000 to spending $320,000 on advanced wound care products! You might be wondering what that did to wound healing. In fact, standardization of wound care processes and products resulted in a “nearly 40 percent improvement in healing rates” at NMMC (McNees & Kueven, 2011).
After the realization that wound care is expensive, NMMC looked into factors that increased cost unnecessarily. One thing they found was that different kinds of wound care products were being used for the same function. For example, if the function was to absorb drainage, there could be one alginate dressing used in one area of the health care complex, and another used in another area, and a hydrofiber used in yet another. This approach resulted in “a large volume of product usage" (2011).
At the same time, they knew that it would be difficult to implement evidence-based practices without standardization of products. In other words, if everyone approaches wound care differently, how do you keep track of what works and what doesn’t? How do you know which practices are evidence-based and which are not? The clinicians needed to be on the same page.
Before they implemented the changes at NMMC, nine vendors supplied them with 68 different advanced wound care products. You can imagine what that meant for vendor education, not to mention “considerable variation in product selection and protocols" (2011). How confusing! No wonder nurses think wound care is difficult.
They also found that they were not using antimicrobial dressings appropriately, and that fewer than 50 percent of wounds healed within 16 weeks. They wanted to do better than that.
What Does This Mean for the Rest of Us?
When you look in your supply closet, do you see several different absorbent products from different companies? Do you have four different brands of foam dressings?
Do your nurses each approach wound care differently? Do you even know what your wound healing rates are? Do your nurses feel confident about doing wound care, or do they groan when they get another wound care patient?
In upcoming posts, I will talk about what NMMC did to get the results they obtained, along with my own thoughts on wound formulary management, but if you are in a hurry to know, here is the article:
McNees, P., Kueven, J. (2011) The bottom line on wound care standardization. Healthcare Financial Management. (65.3) 70-74, 76.
About The Author
Sue Hull MSN, RN, CWOCN has been a home health nurse since 1992 and a CWOCN since 2003. She currently works for Peace Health Home Medical Group in Alaska. Sue is an educator and author. In addition to nursing in home health and hospital settings, she is also the editor of two wound care education websites.
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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