WOUND CARE FORUM
July 1, 1999 3 minutes read
WOUND CARE FORUM
Question: "In my new job as assistant director of a long-term care facility, I will have to make wound care product choices for our residents. What product benchmarking studies should I consult, and how do I evaluate the resulting clinical outcomes?"
— Submitted by Betsy Cleveland, RN, Greenville, SC
Answer provided by Samantha Morgan, BSN, RN, CRRN, CCM, ET, director of rehabilitation services for Laurel Health Care Corp. in Westerville, OH:
A typical wound care product company manufactures everything from A to Z. This makes it enormously difficult to judge each one of these products and then make a determination. There’s no big data out there. Benchmarking products is especially difficult because everything the patient faces environmentally and physically can affect the product’s performance. Something as simple as a 1-degree change in body temperature makes a difference.
What happens instead of benchmarking is that a company hires a consultant and asks them to evaluate its products. That person doesn’t do research on the products, but evaluates them based on their own clinical experience. The product may receive a great review because it’s convenient, or offered at the best price the specialist has seen.
What you should do in order to select the best products for your facility is evaluate the population’s specific needs, then set up criteria for products to fill them. For example, I would pick a hydrocolloid dressing based on how many cubic centimeters of drainage it absorbs and how long it holds up on the patient. Those two things would be my benchmarks, and from them I would develop my protocol for which dressings to choose. Some of the criteria we use in developing product protocols at Laurel are:
• User-friendliness of product. If it’s a product only a wound specialist can apply, it’s of no value to us. The products we choose must be able to work as well when applied by an LVN.
• Effectiveness. We review the companies’ own research and select those products that appear most clinically effective if used appropriately.
• Durability. The products have to last as well as work.
We then set the treatment protocols, saying, for example, that if a wound is a stage three wound and if it contaminates more than one 4x4 every four hours, then it should be covered by a hydrocolloid dressing. We have in our protocol how it should be adhered to the skin, how it should be taped and checked. I expect that with any of the products we choose, we will have a healed wound within 12 weeks. If I don’t see significant improvement within two weeks and continued improvement after that, the product is in trouble.
But here’s the difficulty: As long as I’m managing the wound, or supervising the people who are delivering the care, my benchmarks will work. If I’m not in control of that, my benchmarks won’t work, because how do I know that the dressing is being used appropriately? I have no guarantee the caregiver knows how to apply that dressing. We do inservices, we train and educate. We believe our protocols are much more effective than the random pattern of use we were doing before, but there’s still a lot of margin for error.
How do you benchmark clinical outcomes? First you have to decide when the clinical outcome happens. For example, your benchmarks might be that in three weeks, the diameter and drainage of the wound would decrease by X amount and inflammation would be absent. You’d also want to look at serum albumin level and the different nutritional laboratory values. Yet in the days of the prospective payment system, very few people can afford to do frequent nutritional status studies on Medicare patients because there’s no payment provision for that. So what we typically do is try to get baseline values while the patient is in the hospital before transfer to long-term care, then retest in 30 days.
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