Driving the Case for Improving Hospital Wound Care

Problem: In our 250 bed, acute-care facility, the Wound Team observed that the bordered foam dressings in use required frequent dressing changes and exhibited poor absorption.  Patients and clinicians were also dissatisfied with peri-wound maceration, aggressive adhesion, tissue stripping and painful dressing changes.

Goal: We initiated an evidence-based evaluation of the current formulary bordered foam dressing to measure clinical performance, healing outcomes and the impact of dressing performance on the quality of patient care. 

Method: All patients with a wound appropriate to manage with a bordered foam dressing were eligible for inclusion.  The WOC nurse changed the dressings of enrolled patients every 3 days to assess the wound and it’s healing progress as well as evaluate the dressing’s ability to absorb and stay in place.  Instances of peri-wound maceration, medical-adhesive-related injury and silicone residue were documented. Patients rated pain at dressing changes from 1-5. When dressings needed to be changed outside of protocol, the reasons were documented by staff.

Results: 10 patients with 25 wounds were evaluated: 2 wounds enlarged with 1 increasing by 150%, 11 wounds showed no change in dimensions and 12 showed 18% reduction in area or volume.  A moderate to large amount of silicone residue assessed with each change required painful cleansing.  The average pain scale rating was 3.5 with 56% noting dressing change as painful or very painful.  Staff nurses cited saturation and/or leaking as reasons for extra dressing changes.  Data collection is on-going. 

Conclusion: The data collected indicates a trend of poor dressing performance showing that our empirical observations can be documented and quantified. This QIP data will be used as evidence of patient outcomes and product quality to present to Leadership and Purchasing in substantiating our request to change to superior wound management products.