Case study - Identifying cost saving potential in wound care ...

ISSUE 14 Autumn 12Case study - Identifying costsaving potential in wound careZetuvit ® Plus - A patient’s viewIncluded inside: Pressure ulcerclassification tool from HARTMANNSave the date: HARTMANN National Congress 23rd - 24th April 2013

Did You Know?Zetuvit ® Plus has the fastest growing sales ofany super absorbent in the community market 1Zetuvit ® Plus Super absorbent wound dressing padFor the treatment of heavily exuding wounds• Rapid absorption of wound exudate• Soft and conformable• Cost effectiveFor more information go to www.hartmann.co.ukor contact your local HARTMANN representative.1. IMS Data July 2012All claims can be referenced. Data on file.www.hartmann.co.uk

A patient’s www.hartmann.co.ukview - Zetuvit ® Plus“If someone else with my condition, or similar,could have told me about how effective Zetuvit ®Plus is at controlling exudate; controlling smelland how comfortable it was, I would havechanged to the dressing straight away”Using Zetuvit ® PlusA patient’s view - Scott MckayLife BeforeScott was an active individual who playedfootball twice a week and had achieved Bluebelt with Red Tag in Tai Kwando. One day onthe football field he noticed an insect stuckto his leg, which he knocked away to reveala small amount of blood. When he got homehe cleaned the bite with antiseptic and wentabout his normal daily life. A professional hardworking family man with 2 small children, Scottenjoyed an active life and generally lookedafter his health – that was 8 years ago.What’s important?“Keeping me out of hospital, improvedmy quality of life – it ticks all the boxesfor everyone. It’s not just the cost of thedressing; I must have saved the hospitalmoney by not being there as often!”Scott now lives with chronic leg ulcers, whichhave caused Scott to gain weight due to inactivityleading to type II diabetes and many otherproblems. Scott’s average hospital stay variedbetween 4 and 5 weeks due to wound infectionsand he was admitted to hospital at least 3 timesper year. In terms of dressing changes, Scottattended his GP surgery 4 times per day due tothe amount of exudate from his wounds. As Scotthas had a large amount of time off work his careerprogression has been threatened. Scott decided tostudy for a second degree; however this has beenput on hold until early 2013 due to the amount oftime he has had to spend in hospital.The Best decision I ever made!After several referrals with no real solution fromhis consultant or GP, Scott contacted DavidGray, his local Tissue Viability Specialist. Hehas been under David’s treatment for one anda half years now and explained that this was“One of the best decisions I have ever made!”.David introduced Zetuvit ® Plus as part of Scott’scare regime in order to deal with the highvolumes of exudate from Scott’s leg wounds.“Some days there is over 1.5 litres of fluid. Mywooden floors have been ruined and it got tothe stage that I had to sleep upright in a chairin the living room, to save having to replace themattress and bedding so often”Scott describes Zetuvit ® Plus as a soft effectivedressing that provides comfort and treatment.“It is easier to apply than my previousdressings due to the sizes available”. Scott alsocommented that his previous dressings causedmore problems than solutions. “Zetuvit ® Plusdoes not cause any friction or rubbing as it hassoft edges. I endured quite severe pain from therough edges from my previous dressing.”What’s important?“Provide an environment where I’mnot embarrassed, where I can beprofessional with no soaking trousers;no smell!”What is life like now?Scott has been receiving treatment withZetuvit ® Plus for 7 months now andcommented that historically he would havebeen in hospital at least twice during this time.“Instead of having 4 dressing changes per day,which are problematic due to work and familycommitments, my legs can now be dressedtwice a day: once early morning and once lateevening”. Scott has managed to return to amore steady work routine, “Using Zetuvit ® Plushas had a huge effect on work, my previousdressing did not control the odour.”Scott’s quality of life has improved, “I can doother things; there is no puddle on the floorand no smell! There is nothing worse when youare in the supermarket and people around youare commenting on the awful smell when youknow full well that it is coming from you”.What’s important?“Staying out of hospital to spend timewith my family! My partner doesn’tdrive and so when I’m in hospital Idon’t tend to see her or my children,so it is a very lonely experience.”4Left leg with venous disease of the lower limbsPatient interview, August 2012

CaseSTUDY Identifying Cost Saving Potential in Wound Carewww.hartmann.co.uk“We were really impressed with the clinicalperformance of the product and the costeffectiveness. I made contact with HARTMANNand asked what else do you do?”Identifying Cost Saving Potential in Wound CareA case study undertaken within Outer North EastLondon Community Services (Havering Area)BackgroundThe serviceOuter North East London Community Services(ONEL CS, formerly Havering PCT) headquartersis based at St. Georges Hospital in Hornchurch,Essex. It employs over 1500 staff, the majorityof whom provide care directly to patients inthe community, located across multiple siteswithin the London boroughs of Havering,Redbridge and Waltham Forest.ONEL CS provides a diverse range of servicesto a population of approximately 750,000. Theborough of Havering has the highest proportionof pensioners in London, with around a fifth ofthe population in Havering being of retirementage. Since 2007, the population in Haveringhas been growing at a faster rate than theEngland average, with the population predictedto rise by 8.3% by 2020. This requires ONEL CSto prepare for large increased demand for olderpeoples services, particularly those for the veryelderly (90+) 1 .Outer North East LondonCommunity ServicesThe ONEL CS (Havering area) tissue viability (TV)service aims to promote the equitable provisionof excellent wound care for all Haveringresidents and to improve wound healing andprevention, thereby contributing to a betterpatient experience, improved quality of life andreduced costs associated with complex wounds.Outer North East LondonCommunity ServicesOne of the main objectives of the TV serviceis to assess, plan and deliver high quality,clinically effective, individualised care whilst atthe same time reduce dressing costs associatedwith chronic wounds, through the increasedsupport of specialist advice and updatedevidence based Wound Care Formulary . 2Many different types of wounds exist, bothchronic and acute including leg ulcers (venous,arterial and vasculitic), pressure ulcers, surgicalwounds, diabetic foot ulcers, fistulas, sinuses,burns, fungating wounds, skin cancers,lacerations, haematomas and lesions secondaryto lymphoedema. In the community, woundcare is a core element of the district nursingand practice nursing role. Where complex tissueneeds are identified, a referral is made to the TVservice for specialist advice.The TV service provides a specialist complexwound service for patients registered with aHavering GP who have a complex TV problemor non-healing deteriorating wound. The serviceis provided in a clinical setting for patients thatare able to attend or a domiciliary setting forhousehold patients. The TV service aim to preventinappropriate admissions to hospital by facilitatingand providing specialist wound managementwithin the community and if appropriate tofacilitate early discharge from hospital.The Havering area team is made up of JaneStevens, Clinical Nurse Specialist and TeamLeader; Theresa Mitchell, Tissue ViabilitySpecialist Nurse; Joanna England, TissueViability Nurse; Beryl Wilson, Secretary andDawn Howe, TBM admin. Jane commenced herpost with the service in October 1999 and has5

www.hartmann.co.uksince been working hard along with hercolleagues to ensure the service delivers:• specialist evidence based assessment,support and advice to all healthcareprofessionals• support and advice to patients, familiesand carers• education programmes• clinical audit to support practicedevelopments• clinical guidelines• standard setting• ink nurse system• procurement advice to the PCT• link between primary and secondary care.Study rationaleToday’s economic climate dictates therequirement to provide quality of care whilstbeing cost effective, and this is a challengefaced by many trusts in the UK. Jane adds“There has always been pressure from the NHSto spend the public pound as effectively aspossible and so cost savings have always beena priority. However high quality patientcare is paramount and therefore we must becost effective not cost driven”.After seeing an advertisement in 2007 ina wound care journal for Atrauman ® , Janeapplied for a free sample pack in order toevaluate the product, “We had such positivefeedback from the District Nurses about theperformance of Atrauman ® we added theproduct to our formulary within a few weeks ofreceiving the samples”. The feedback from theleg ulcer clinics was the most encouraging;patients reported that they found Atrauman ®far more comfortable over the course of aweek under compression, in comparison to theprevious low adherent standard treatment.This spurred Jane on to investigate the rest ofthe HARTMANN product portfolio, “We werereally impressed with the clinical performanceof the product and the cost effectiveness. Imade contact with HARTMANN and askedwhat else do you do?”What happened next?Jane and her team went on to evaluateCosmopor ® E as an alternative adhesive islanddressing. At the time of evaluation the DistrictNurses were facilitating the post op clinics andCosmopor ® E was used extensively during thetrial period. All patients discharged post opwere seen by the post op clinics, those whowanted to shower would be provided with afilm-backed dressing, which was later switchedto Hydrofilm ® Plus 3 .Jane and the team went on to clinicallyevaluate Hydrosorb ® sheet hydrogeldressing; Zetuvit ® E absorbent wound padand Hydrofilm ® high MVTR film dressing 3 .Comments such as “Hydrofilm is so much easierto apply; it saves time at each dressing change”were received from the DN’s.When it came to the range of bandages fromHARTMANN, nurses love Hospilite ® “Hospiliteis not as bulky as other crepe bandages andpatients report it to not be as hot to wear. TheDistrict Nurses fed back that the bandage hasgreat conformability and ease of application”.Demonstrated Cost effectivenessOn an analysis of spend between the periodof April 2010 – April 2011, if ONEL CS hadcontinued to purchase the competitor productshighlighted within this report, the total spendacross the twelve months would be over£62,000. “There have been no negatives aboutchanging to the HARTMANN products.Cost savings do not only relate to unit cost.Cost savings equate to cost effectiveness.We have tried other products with a price tag50% less but they have not stood up to clinicaltesting” stated Jane.By incorporating the HARTMANN productportfolio as part of the wound care formulary,ONEL CS saved over £42,000 (figure 1). Thechart in figure 2 highlights the productcategories that these savings were made acrossduring the twelve month period.Figure 1: Cost analysis April 2010 - Mar 2011 4£70,000£60,000£50,000£40,000£30,000£20,000£10,000£0HARTMANNCompetitor6

www.hartmann.co.ukPressure ulcer classification and degrees of severitySource: http://www.hartmann-medicaledition.comCategory/Stage I:Non-blanchableredness of intact skinIntact skin with non-blanchableerythema of a localized area usually overa bony prominence. Discoloration of theskin, warmth, edema, hardness or painmay also be present. Darkly pigmentedskin may not have visible blanching.Further description: The area may bepainful, firm, soft, warmer or cooler ascompared to adjacent tissue. Category/Stage I may be difficult to detect inindividuals with dark skin tones.May indicate “at risk” persons.Source: www.hartmanntraining.co.ukCategory/Stage II:Partial thickness skinloss or blisterPartial thickness loss of dermispresenting as a shallow open ulcer witha red pink wound bed, without slough.May also present as an intact or open/ruptured serum-filled or sero-sanginousfilled blister.Further description: Presents as a shinyor dry shallow ulcer without slough orbruising. This category/stage shouldnot be used to describe skin tears,tape burns, incontinence associateddermatitis, maceration or excoriation.Category/Stage III:Full thickness skin loss(fat visible)Full thickness tissue loss. Subcutaneousfat may be visible but bone, tendonor muscle are not exposed. Someslough may be present. May includeundermining and tunneling.Further description: The depth of aCategory/Stage III pressure ulcer variesby anatomical location. The bridge of thenose, ear, occiput and malleolus do nothave (adipose) subcutaneous tissue andCategory/Stage III ulcers can be shallow.In contrast, areas of significant adipositycan develop extremely deep Category/Stage III pressure ulcers. Bone/tendon isnot visible or directly palpable.Category/Stage IV:Full thickness tissue loss(muscle/bone visible)Full thickness tissue loss with exposedbone, tendon or muscle. Slough oreschar may be present. Often includeundermining and tunneling.Further description: The depth of aCategory/Stage IV pressure ulcer variesby anatomical location. The bridge of thenose, ear, occiput and malleolus do nothave (adipose) subcutaneous tissue andthese ulcers can be shallow. Category/StageIV ulcers can extend into muscle and/orsupporting structures (e.g., fascia, tendonor joint capsule) making osteomyelitisor osteitis likely to occur. Exposed bone/muscle is visible or directly palpable.8

Pressure ulcer classification - Product Guidewww.hartmann.co.ukHARTMANN Product GuideProfessional consensus (in the treatment of pressure ulcers) recommends to create theoptimum wound healing environment by using modern dressings –e.g. hydrocolloids,hydrogels, hydrofibres, foams, films, alginates, soft silicones, in preference to basicdressing types – e.g. gauze, paraffin gauze and simple dressing pads 1 .See insidebackcover for yourFREE pullout andkeep guideTo protect:To debride:Hydrocoll ® gelatin-freehydrocolloid wound dressingThe smooth slippery backing minimises thefriction coefficient of the patient-supportsurface. This means that the patient is ableto move more easily over the support surfaceand the area covered by the dressing is likelyto be exposed to lower levels of pressure,shear and friction 2 .Hydrocoll ® gelatin-freehydrocolloid wounddressingProvides the ideal environment for theformation of granulation tissue, particularlythe activity of fibroblasts, acceleratingthe wound healing process 3 . Hydrocoll ®facilitates debridement of necrotic tissue andslough by promoting autolysis.Hydrofilm ® high MVTRtransparent film dressingBy applying a film dressing to vulnerableareas, the risk of pressure ulcers may bereduced due to the low friction externalsurface of the film 4 . Also consider using filmdressings as a secondary dressing for ulcerstreated with alginates or other wound fillerthat will likely remain in the ulcer bed for anextended period of time (e.g. 3-5 days).Hydrosorb ® sheethydrogel dressingSupplies the wound with moisture from theoutset and facilitates autolytic debridement.Its transparency allows inspection of thewound at all times without dressing change(highly economical due to prolonged dressingchange intervals), ideal for keepinggranulation and epithelial tissue moist.To absorb:Zetuvit ® Plus superabsorbent wounddressing padThe blend of cellulose fluff and fluid retainingsuper absorbent particles (SAP) means thatZetuvit ® Plus is particularly suitable for thetreatment of heavily exuding pressure ulcers.The unique structure of the dressingprovides cushioning 3 .PermaFoam ® hydroactivefoam dressing andSorbalgon ® calciumalginate dressingAlso suitable for the management ofexuding pressure ulcers.1 Bazin, S. et al (2005) The management of pressure ulcers in primary and secondary care. A Clinical Practice Guideline. Royal College of Nursing2 Fletcher J. et al (2011) Pressure ulcers and hydrocolloids made easy. Wounds International, Volume 2, issue 43 Data on file4 Nakagami G. et al. Comparison of two pressure ulcer preventative dressings for reducing shear force on the heel. Journal of Wound Ostomy. Continence Nurse. 2006 May-Jun;33(3):267-729

HARTMANN newswww.hartmann.co.ukWounds UK awardsHARTMANN are proud to be sponsoring“The cost-effective management in wound healing award”at the Wounds UK awards 2012.The awards have always sought to publicise and celebrate the breadth of excellent work andinnovation that is demonstrated by the nation wounds community. To further increase the visibilityof the awards and to combine with this year’s theme of ‘sharing best practice’ at the annualconference, the awards will form part of the Wounds UK Harrogate programme, held on the 12-14November. The entrants have all been received and will be announced by Wounds UK very soon.The cost-effective management in wound healing award fits perfectly with theHARTMANN ethos and attitude towards wound healing, keep it simple and cost effective.Woundcare 4 HeroesA new charity, Woundcare 4 Heroes (Wc4H), hasbeen formed to develop a national network ofcomplex wound management services to supportthe NHS in providing lifelong support and care forthose discharged from the Armed Forces.The excellence of cutting-edge battlefield traumacare today has resulted in far higher survival ratesof service personnel, and far greater numbers ofmen and women who require long-term wound caredue to the severity and complexity of their injuries.With the increase in life expectancy, those injuredin their 20s and 30s today, may still be needingspecialist wound care for many years to come.www.woundcare4heroes.org.ukBy being ‘feet on the beat’ and actively treating andsupporting injured personnel, their families and carers,Wc4H can provide early detection of complications,consistency of care, and fast track service users throughrapid referral systems to medical consultant level.Educating healthcare professionals in complex woundmanagement and furthering research in this area is alsohigh on Wc4H’s agenda.10

WoundFORUM NEWSSAVE THE DATEThe HARTMANN National Congresswill be a day of education training anddiscussion for healthcare professionalsinvolved with Continence and Woundmanagement.Previous HARTMANN congresses have beena huge success and have been thoroughlyenjoyed by our customers and we have someexciting guest speakers lined up already.www.hartmann.co.ukHARTMANN National Congress23rd – 24th April 2013Partnership working with innovative solutionsTo register your interest please go to our website www.hartmann.co.uk and go to contact us and fill in therequired details stating that you would like to be part of the 2013 National Congress.Pressure ulcer classification handy guideTo protect:Hydrocoll ® gelatin-freehydrocolloid wounddressingHydrofilm ® high MVTRtransparent film dressingTo debride:Hydrocoll ® gelatin-freehydrocolloid wounddressingHydrosorb ® sheet hydrogeldressingTo absorb:Zetuvit ® Plus super absorbentwound dressing padPermaFoam ® hydroactive foamdressing andSorbalgon ® calcium alginatedressingProfessional consensus (in the treatment of pressure ulcers) recommends to create the optimum wound healing environment byusing modern dressings –e.g. hydrocolloids, hydrogels, hydrofibres, foams, films, alginates, soft silicones, in preference to basicdressing types – e.g. gauze, paraffin gauze and simple dressing pads.

HeLP is at handHARTMANN eLearning Programme Skin ModuleHARTMANN eLearning Programme Skin Module gives an introduction to the skinand advises how to diagnose, treat and prevent skin injuries that are prevalentin vulnerable skin. The Skin Module is ideal for care home staff, students andhealthcare professionals who want a greater understanding of how to maintainhealthy skin in vulnerable patients.The topics covered are:• The anatomy and physiology of the skin• Functions of the skin• Skin assessment• Primary and secondary lesions• Pressure ulcers• Moisture lesions• Differences between moisture lesions & pressure ulcers• Skin tearsNEW!www.hartmann.co.ukCreate your own training account for free at www.hartmanntraining.co.uk