The scope of the community wound burden and costs to care

ABSTRACTS & BIOGRAPHIES

Benchmarking time and costs of healing community wounds

Prof. Keryln Carville1,2, Ms Cate Maguire1, Ms Joanna Smith1

1Silver Chain , Osborne Park, Australia, 2Curtin University, Bentley, Australia

Aim:

To describe the client demographics, the number and types of wounds managed, and time and costs to healing community wounds.

Methods:

All nurses employed by a community organisation in Western Australia enter wound assessment and management data onto tablets or smart phones at point of care. Ongoing audits are conducted to ensure completeness and accuracy of data. Analysis allows for reporting of: types and numbers of wounds; length of stay; consumables used, nurse time taken to perform the procedures and time and costs to heal.  Data collected in 2017 provides the benchmark for ongoing analysis of wound healing outcomes and costs in 2018.

Results:

The 6-month project identified 16,925 wounds attributed to 8,789 clients and 80.3% (n=10,510) of wounds healed.  There were equal numbers of males (53%) and females and males were younger (63.4 versus 67.2 years; t(8787)=8.67, p <0.0001). The mean cost to heal females was $306 and males $288 with significant maximum variances amongst wound types. Comparisons with elderly and Indigenous wounded clients managed over 12-months demonstrated 79% of these wounds healed. This data was used to benchmark 2018 wounds and their outcomes.

Discussion:

On average 2,500-3,000 wounds are managed daily in the WA community service. Provision of products and best practice demonstrates reduced costs and time to healing, and affords national benchmarking opportunities. The benefits of which will be outlined.

Biography:

Keryln was awarded Life Membership of the AASTN in 2015. She is the Co-coordinator of the Curtin University postgraduate Wound, Ostomy and Continence Practice Program.  She is Chair of the Wounds Australia Wound Standards Committee and Chairs the Pan Pacific Pressure Injury Alliance. She is the Evidence Chair on the International Wound Infection Institute. Keryln was appointed a Fellow of the Australian Wound Management Association (now Wounds Australia) in 2006 and the inaugural award for Life Time

Achievement in Nursing in WA in 2010.


Efficacy of monofilament pad, microfibre pad and gauze debridement

Ms Anne  Capes1, Ms Jenny  Faithful1, Prof Keryln Carville1

1Silver Chain, Osborne Park, Australia

Aims:

To investigate the efficacy and cost-effectiveness of commercially available monofilament and microfibre debridement pads as compared to standard gauze for mechanical wound debridement.

Methods:

A quality improvement pilot study was conducted amongst a convenience sample of 150 clients with leg ulcers (50 each randomised group). Clients who meet the inclusion criteria presented with slough, necrosis or local infection (suspected biofilm) in their ulcer.  The wounds were randomised to either monofilament pad, microfibre pad or gauze debridement method.  Descriptive statistics will be undertaken using ComCare® Wound Module data to determine post-debridement outcomes.  Total cost of wound debridement and management interventions will be determined and compared with other mechanical debridement, methods, conservative sharp debridement and low frequency ultrasound debridement (LFUD).  Quantitative and qualitative questions in the satisfaction survey will be analysed to determine staff satisfaction with debridement methods.

Results:

The study will be completed in December 2018 and the results presented.

Discussion:

Debridement is an important component of wound bed preparation.  Mechanical debridement using the study devices is simple and can be performed by all nurses, and is relatively inexpensive as compared to LFUD.

Biography:

Anne Capes works as a Clinical Nurse Consultant Manager and STN for Silver Chain Group in Perth. Anne is Chair of the Wounds Interest Group, Silver Chain WA and a past vice president and current committee member of the AASTN WA Branch. Anne is committed to the advancement of nursing excellence and optimal patient outcomes.


NPWT: A cost and treatment analysis in acute wounds managed in the community

Mrs Gordana Petkovska1, Mrs Keryln Carville1, Mrs  Cate Maguire1, Mrs Joanna Smith1

1Silver Chain Group, Perth, Australia

Aims:

To determine the effectiveness and costs of NPWT in acute wounds in comparison to conventional therapies.

Methods:

Nurses employed by a community organisation in Perth enter wound assessment and care plan data onto tablets or smart phones, which is uploaded at point of care the ComCare® Wound Module database.  Rigour is ensured by daily monitoring of data and follow up should discrepancies occur.  A 6-month study with data collected 1 January to 30 June 2018 is used to determine the prevalence, type of acute wounds, healing times, consumables used and costs to heal.  Acute wounds with NPWT as part of the treatment regime was compared to wound without the advanced therapy.

Results:

A 6-month study found 18,482 wounds of all types and acute wounds comprised 7229 or 39% of the total. Males comprised 55% with females being significantly older (58.2 versus 56.7; t(4316)=2.3956; p=0.0166).  The length of stay for acute wounds was 44 days.  The mean cost to heal an acute wound was $328 with the total spent for the 6-month period was $1,642,624.  NPWT was used in only 189 acute wounds with a mean cost of $1323. The total cost of acute wounds with NPWT was $311,563 and accounted for 18% of the acute budget.

Discussion:

Shorter hospital length of stay has led to increased numbers of acute wounds being managed in the community.  Wound healing outcomes and data on costs to heal has informed organisational protocols, practice and resourcing.

Biography:

Bio to come


Scoping the burden of lower extremity ulcers in the community

Ms Margaret Edmondson1, Dr Keryln  Carville1, Mrs Cate  Maguire1

1Silver Chain, Osborne Park, Australia

Aims:

To determine the effectiveness of treatment and costs to heal lower extremity ulcers in the community.

Methods:

All nurses employed by a community organization in Perth enter wound assessment and care plan data onto tablets or smart phones, which is uploaded at point of care on the ComCare® database.  A 6-month study completed in 2017 forms the benchmark for determining ongoing prevalence, the type of lower extremity ulcers, healing times, consumables used and costs to heal.  This data is used t benchmark 12-month data  prospective data collected in 2018 to determine the efficacy and costs of treatment.

Results:

The 2017 study found 16,925 wounds of all types attributed to 8,789 clients and lower extremity ulcers comprised 20% overall. There were 1,688 leg ulcers (venous, arterial, mixed aetiology, atypical) from 1,109 individuals. Venous leg ulcers comprised the greatest number of these.  Females comprised 54% and they were significantly older than males (78.7 versus 72.8; t(1,107)=7.0679; p<0.001). There were 976 foot ulcers (neuropathic, ischaemic, neuro-ischaemic, unknown aetiology) from 665 individuals.  Males comprised 65% while females were significantly older (t(663)=3.2832); p=0.0011).Lower extremity ulcers had the greatest length of stay.  The mean cost to heal a leg ulcer was $372 and a foot ulcer $336.  This data will be used to benchmark the 2018 data.

Discussion:

Benchmarking of lower extremity wound healing outcomes and costs to heal has informed organisational protocols, practice and resourcing and is anticipated to inform national health agendas.

Biography:

Margaret is a Nurse Practitioner in wound/ostomy with Silver Chain Group WA. She has over 25 years’ experience caring for clients with wounds and stomas in the community setting holding clinical, management and educational roles. Margaret  has held both national and state positions with the AASTN and Wounds Australia.

 


Time and costs to heal skin tears

Ms Pam Morey1, Professor Keryln Carville1,2, Ms Cate Maguire1

1Silver Chain, Osborne Park, Australia, 2Curtin University, Bentley, Australia

Aims:

To determine the effectiveness of treatment and costs to heal skin tears.

Methods:

All nurses employed by a community organisation in Perth enter wound assessment and care plan data onto tablets or smart phones, which is uploaded at point of care on ComCare® Wound Module database.  A 6-month study completed in 2017 forms the benchmark for determining ongoing prevalence of skin tears, the STAR classification, healing times, consumables used and costs to heal.  A 12-month’s project benchmarks prospective data collected in 2018 to compare the efficacy and costs of treatment.

Results:

The 6-month study found 16,925 wounds of all types attributed to 8,789 clients and skin tears comprised 15% (n=2,497) of these wounds.  There were 2,247 skin tears from 1,230 individuals. Females comprised 52% and were significantly older than males (83 versus 80 years; t(1228)=5.7358; p <0.001).  Most skin tears occurred on the legs (75%) as compared to the arms for hospitalised patients¹.  STAR classifications were reported as 1a = 15%, 1b = 16%, 2a = 14%, 2b = 23% and 3 = 32%.  The mean length of stay was 25 days and the mean cost to treat was $171. This data will be used to benchmark the 12 month data collected in 2018.

Discussion:

Skin tears are a common wound amongst the elderly and they can convert to significant wounds.   Wound healing outcomes and costs to heal has informed organisational protocols, practice and resourcing of prevention and management strategies for skin tears.

Reference:

Mulligan S, Prentice J & Scott L. WoundsWest wound prevalence survey 2011 state-wide overview report. Perth WA, Australia: Ambulatory Care Services, Department of Health, 2011.

Biography:

Pam is a Wound/Ostomy Nurse Practitioner with extensive experience in acute and chronic wound care. Pam has contributed to the development of national and state guidelines related to pressure injury prevention and wound management; held executive positions for the Australian Wound Management Association, and was awarded an AWMA Fellowship in 2012.


The impact of pressure injuries in the community

Ms Jenny Faithful1, Ms Anne Capes1

1Silver Chain , Osborne Park, Australia

Aims:

To determine the client demographics, the number and types of wounds managed, and time and costs to healing community wounds.

Methods:

The significant wellbeing and fiscal impact of pressure injuries on individuals and health providers is well appreciated. Yet in the 21st century, pressure injuries continue to exert serious clinical and economic challenges irrespective of advances in knowledge, technology and clinical setting.   All nurses employed by a community nursing organisation in Western Australia enter pressure injury assessment and management data onto tablets or smart phones at point of care. Ongoing audits are conducted to ensure completeness and accuracy of data. Analysis allows for benchmarking pressure injury prevalence across teams and reporting of client outcomes.

Results:

A 6-month project conducted 1 November 2016 to 30 April 2017 identified pressure injuries comprised 7%  (n=1,257) of wounds, over 12 months in 2017 they comprised 8% (2,749) of wounds and during the 6-months 1 January – 30 June 2018, 7% (14,10) of wounds. The outcome of these wounds in regards to their complexity, treatments, care outcomes and time and cost to discharge will be reported in this presentation.

Discussion:

Pressure injuries are largely preventable wounds. However, in the community they pose additional challenges in regards to access and equity in service delivery and resourcing. They contribute to increased length of stay and impacts on wellbeing and the heath cost burden.  Accurate data on community pressure injuries informs best practice outcomes for prevention and management.

Biography:

Jenny Faithful works as a Clinical Nurse Consultant Manger and STN for Silver Chain Group in Perth.  She is the secretary of the AASTN WA Branch and is committed to the advancement of nursing excellence and optimal patient outcomes.

AASTN

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