Keys To Effective Wound Dressing Selection

Volume 24 - Issue 8 - August 2011
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Insights On Ordering Dressings And Collaborating With Ancillary Services

Determining the needs of the served population and establishing a cost-effective and efficient product inventory is important. Chronic wounds may take months to heal so one may consider referral to wound care specialty practices. Carrying a large variety of dressings in the office setting may be unrealistic. A small stock of basic dressings is usually adequate. There are multiple medical supply companies that deliver ordered supplies to the home and bill insurance directly. While there is no one-size-fits-all answer, most wound care lines consist of both baseline and advanced products. Remember that many product indications overlap and that several products may support the same goal.

Achieving a positive outcome often requires collaboration with community, family and ancillary services such as physical therapy or home care. When home care is in place, the agencies may have a wound care consultant available to assist with development of an optimal dressing plan. Be aware that home care agencies and rehab facilities may operate out of one specific product formulary so it is best to order wound care products by category (i.e. hydrocolloid, calcium alginate, etc.) rather than by product name. If the patient or family is expected to change the bandage at home, one should ensure the patient or family’s ability to understand instructions for dressing changes, including attention to infection control. Many areas have private home wound care consulting companies as additional resources.

Author(s):

Nancy Slone Rivera, MS, ANP-C, CWON, CFCN, and Stephanie C. Wu, DPM, MSc

Navigating the different stages of chronic wound healing can be quite challenging. Accordingly, these authors review the role of proper wound dressing selection and pros and cons of dressings ranging from gauze and hydrocolloid dressings to calcium alginate dressings and foams.

Chronic skin ulcerations affect millions of people in the United States with an attributable annual cost of at least $3.6 billion.¹ In addition to the tremendous financial burden, the prolonged and sometimes interrupted healing process associated with chronic wounds can affect the patient’s quality of life due to impaired mobility and substantial loss of productivity.

Chronic wounds also pose a significant management challenge to healthcare professionals.² Technical advances along with better understanding of the complex cellular and biochemical mechanisms of the wound healing process have led to the development of a plethora of wound dressings over the past decade. It is often difficult to navigate through the extensive array of dressing choices.

Wound healing is an orchestra of highly integrated cellular events as opposed to a defined single event. Successful wound management requires an understanding of the healing process along with knowledge of the properties of the various available dressings. While the ultimate goal in most cases is prompt healing, one must remember that this is a dynamic process requiring a series of adaptive smaller goals as the wound progresses through the repair trajectory. One should select dressings to best suit the various stages of wound healing.

Most challenges arise with chronic wounds where healing fails to proceed through an orderly and timely process. When this occurs, wounds stagnate and may deteriorate. While a topical dressing may be part of the solution, one should investigate reasons for the relapse. To heal, wound beds must have balanced hydration, an advancing wound edge and be free of necrotic tissue and critical colonization.^3-5 Other factors that can impair wound healing include repeated trauma and compromised host or vascular status.^6-8

The most advanced dressing will be ineffective if one does not address factors that impede healing. Arbitrary dressing selection can result in unnecessary cost with an increased risk of complications associated with delayed wound healing.

Wound care is a holistic practice. Consider multiple factors prior to initiating therapy including the ability, accessibility and resources of the patient and care provider. What is labeled as non-adherence may be instead an inability to follow through with the plan of care due to physical, social and/or community barriers.⁹ Dressing cost may be another deterring factor. Prescribing a dressing that is not reimbursed or is too costly for the patient may lead to inadequate follow through.