Extract of article published in JCN Vol 29
Are your wound management choices costing you money?
With the government looking to cut costs across the healthcare landscape, identifying comparable but cheaper treatment options can help you make savings. Here, Tracey Morgan, clinical nurse specialist tissue viability, takes a look at the facts…
The challenges facing the NHS now and in the future are well publicised, as is the need for significant change if it is to avoid widespread overspend, or decline in the quality of care delivered (NHS England, 2014). The population is ageing and this, coupled with medical and technological advances, means that more people are living for longer with multiple comorbidities such as diabetes, putting increasing strain on NHS budgets (NHS England, 2014).
The prevalence of chronic wounds, including diabetic foot ulcers, pressure ulcers and leg ulcers, is strongly related to age and the development of disease, with forecasted UK population trends indicating that there will be a significant increase in the number of patients with chronic wounds and a corresponding rise in the costs of care (Posnett and Franks, 2008; Dowsett et al, 2014).
The shift of care into the community, with investment in primary care services intended over the next five years, means that clinical commissioning groups (CCGs) will be responsible for dealing with increasing numbers of patients with wounds. However, the workforce of nurses delivering care in a community setting is set to fall, creating a struggle to deliver wound care for a growing patient group, without an increase in budget and resource, or without compromising patient choice and clinical outcomes (Dowsett et al, 2014). There is clearly a need for a new approach in wound care to make the necessary cost savings.
COST OF WOUND CARE
There is little understanding of the true costs involved in wound management, despite hundreds of thousands of patients being prescribed products each year. Indeed, approaches to care and costs vary both regionally and nationally (Read, 2013). However, one thing is certain — costs are predicted to rise exponentially with time.
‘The shift of care into the community, with investment in primary care services intended over the next five years, means that clinical commissioning groups (CCGs) will be responsible for dealing with increasing numbers of patients with wounds.’
The annual cost of wound care services in 2014 was estimated at £2,165 million, which is predicted to rise by £212 million to £2,377 million by 2019 (Dowsett et al, 2014). The cost of wound dressings and other materials is expected to rise by £41 million from 2014 to 2019. In 2014, 86.7% of wound care was delivered by registered nurses in the community (Dowsett et al, 2014).
Many chronic wounds are preventable and, if diagnosed and managed appropriately, can be healed within 24 weeks (Posnett and Franks, 2008). However, ineffective clinical practice, including lack of proper diagnosis and inappropriate treatment mean that this is often not the case. Delayed healing increases the risk of complications such as infection, which carry an additional cost burden. These costs can be reduced by ensuring that primary care doctors, general practice and community nurses, and hospital staff are properly trained in wound View pointsd iagnosis and treatment, including the selection of cost and clinically effective services, care pathways and wound dressings (Posnett and Franks, 2008).
WHAT KIND OF WOUNDS ARE SEEN IN THE COMMUNITY?
Community nurses need a wide variety of skills to deal with the full range of clinical presentations they face in any given day and wound care presents a range of challenges, e.g. how to protect older people’s skin, which dressings to use on common wounds such as leg ulcers and pressure ulcers, and which dressings provide patient comfort without further damaging the periwound skin on removal.
Whereas the inpatient nurse has access to a whole range of colleagues to turn to for advice — such as infection control teams, tissue viability specialists, link nurses and various medical specialties — the community nurse often has to act alone. This means that community nurses need a range of products that can be used in a variety of clinical situations, but which are also cost-effective.
Wounds commonly seen in the community include leg ulcers, pressure ulcers and diabetic foot ulcers, particularly when these become chronic and non-healing, which can involve nurses having to manage infection and varying exudate volumes. Managing these non-healing wounds in the community can be expensive, not only in terms of resources such as nursing time and dressing costs, but, also on patients’ quality of life (Chandan et al, 2009). The rise of long-term conditions such as obesity and diabetes means that chronic…