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Currently, in many hospices, wound management
includes use of home remedies and the use of inappropriate
active treatment.1 There is inconsistent education among
hospice nurses about appropriate wound assessment, product
selection, and wound management at the end of life, as well
as a lack of knowledge of total costs to hospices for wound
care.
HP identified a need for standardization in the following
key areas of wound management in hospice: Assessment Process,
Wound Care Product Selection, The Inventory and Distribution
Process, and Monitoring and Outcomes Documentation.
HP conducted a 90-day pilot study, which employed the HPWoundCare
model for over 1,000 patients from four participating hospices—of
these patients, more than 25% had wounds upon admission.
The study revealed:
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Increased Wound Detection - due to a lack of under reporting and documentation prior to the pilot program
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Decreased Wound Severity - due to the earlier detection and prevention measures employed during the study.
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Increased Nurse, Patient, Administrator Satisfaction – due to care planning completed upon admission reduced wound care planning during routine nurse visits.
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Direct product costs remained the same, but overall costs
of care were reduced as a result of process standardization
(e.g., including assessment, prevention measures, documentation,
and direct product distribution to patients’ homes).
With HP’s per diem model, month-to-month cost variances
is reduced, enabling predictability and stabilizing the
rate of increase from year to year.
The HPWoundCare model mandates a thorough wound assessment
upon admission for early detection and management of wounds,
through HP’s Medication Management Support Center.
Once the assessment is completed, a wound management plan
of care is developed, implemented, and monitored.
For many hospice nurses, this type of collaborative assessment
helps to identify other issues of patient symptom management.
This results in improved planning and prevention of other
symptoms related to their hospice diagnosis, moving toward
an acuity-based scheduling system for the hospice nurse.
HPWoundCare Guidelines
Hospice Pharmacia recruited leaders in hospice and wound care to participate in the development of palliative protocols, the HP Wound Care Guidelines. These guidelines are annually updated, and continue to evolve as the evidence-base expands in quantity and scope. Standardization of care allows for precise quality assurance and performance improvement measurement and monitoring. |
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The HPWoundCare Guidelines address wounds that commonly
occur at the end-of-life, including:
- Pressure Ulcers
- Tumor Wounds
- Venus Ulcers
- Arterial Wounds
- Skin Tears
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Considerations for HPWoundCare’s product selection
include evidence in the literature, feedback from nurses
regarding actual usage, nursing time needed to administer/change
products, and patient/family acceptability and likelihood
of adherence to the regimen.
Efficient Product Distribution Enhances Access and
Saves Time
HP realizes that thousands of dollars in wound care products
are inventoried on-site at hospices—dollars that could
be working for the hospice in other ways. Through HP’s
medication and supply distribution centers, HP is able to
deliver wound care products directly to patients’ homes, minimizing the need for on-site inventory.
Xeris for Wound Assessment and Documentation Ensures
Regulatory Compliance
The assessment and wound care plan is documented in Xeris,
Hospice Pharmacia’s on-line system for patient care,
and is available using a secure Xeris login and password.
Reports are also available in Xeris for wound care.
For more information, email us at HPWoundCare@hospicepharmacia.com
1 Results of 2003 focus groups with nurses and medical directors conducted by HP
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