Improving Wound Outcomes and Saving Healthcare Dollars in the Homecare Setting by Adding Hypochlorous Acid (HClO0.033%) to a Wound Supply Formulary: A Financial and Outcome Analysis

Abstract

Introduction
Home care agencies (HCAs) are tasked with treating all wound types in many different uncontrolled environments. Over the past several years HCAs have experienced an influx of patients who are more acutely ill and who are in need of advanced therapies in the home setting.

Many of these patients require advanced and extensive wound care among other treatments. These wound care needs can exceed $1M yearly depending on the size of the agency.

In an environment where health care dollars are stretched to maximum levels, it is imperative that HCAs find ways to improve outcomes, but also maximize the efficiency of the treatments they use.

Background
The VNA of Western New York is a large HCA located at the western most tip of New York state. They encompass 10 counties and make approximately 500K patient visits per year. They treat around 14,000 individual wounds per year and yearly wound care expenditures can exceed $800K.

Methods
The VNA of WNY was introduced to hypochlorous acid (HClO0.033%) wound cleansing solution in the spring of 2015. It was used for a 30 day trial period to evaluate its ability to reduce bioburden in wound beds, improve wound bed tissue quality and reduce healing time. After the initial trial period it was determined that HClO was helping improve wound outcomes within the first few applications. The decision was made to add HClO0.033% to the ordering formulary to be accessible to patients with insurers contracted with the VNA to pay for wound care supplies.

For the purposes of the VNA of WNY the general recommended use for HClO was to use it on wounds that have delayed healing, suspected bioburden and wounds with moderate to excessive amounts of non-viable tissue. Manufacturer’s guidelines were followed for application. Prior to the spring of 2015, 0% of patients were using HClO. In 2016, HClO was being used with approximately 23% of patients receiving advanced wound care treatments (n = 3,039). In 2017, year to date, 25% of these patients were using HClO (n = 742).

Discussion
Although multiple factors are involved in the healing of wounds (clinician and patient education, patient comorbidities, environmental variables, etc.), it is important to control variables whenever possible.

Multidisciplinary and multifactorial approaches to wound care are the cornerstone of any successful wound outcome. A fundamental part of this approach is proper wound bed preparation to remove microbes and debris whenever needed at the same time preserving the healthy growing tissue. As an agency, we have found that the use of HClO 0.033% to effectively prepare a wound bed has proven to be successful, cost effective and efficient. Being the only antimicrobial wound bed-prep product to be added to the agency’s supply formulary in 2.5 years –a correlation may be made between HClO utilization and positive wound outcomes as well as significant healthcare dollars saved.

References
† Medline Industries

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