Included inside: Pressure ulcer classification tool from HARTMANN

Zetuvit Plus - A patients view

Case study - Identifying cost saving potential in wound care

ISSUE 14 Autumn 12

Save the date: HARTMANN National Congress 23rd - 24th April 2013

Did You Know?

Zetuvit Plus has the fastest growing sales of any super absorbent in the community market1Zetuvit Plus Super absorbent wound dressing pad

For the treatment of heavily exuding wounds

Rapid absorption of wound exudate

Soft and conformable

Cost effective

For more information go to www.hartmann.co.uk or contact your local HARTMANN representative.

1. IMS Data July 2012Allclaimscanbereferenced.Dataonfile.

www.hartmann.co.uk

Welcome to Issue 14 of WoundFORUM

Dare I say, the nights are drawing in and it will soon be Christmas welcome to the Autumn edition of WoundForum, the free subscription publication from the Wound Management division of HARTMANN.

The ambitious target for the NHS to save 20 billion by 2015, means that many trusts are looking to make efficiency savings across all areas of clinical practice. The HARTMANN Wound Management product portfolio is perfectly positioned to provide the right product, at the right time, at the right price. To see how one community service saved 42,000 by switching to HARTMANN products, turn to page 5.

How often do we take a step back and take time to reflect on a patients experience with wound dressings? Take five minutes to turn to page 4 where you can read a patient testimonial, from Scott McKay about living with leg ulcers and treatment with Zetuvit Plus, the super absorbent wound dressing pad from HARTMANN.

Finally, on page 8 we take a look at pressure ulcer classification and degrees of severity according to the EPUAP guidelines and highlight which HARTMANN products you might choose to create the optimum wound healing environment for pressure ulcers. See the insideback cover for your free pullout and keep guide.

WoundForum is distributed free of charge twice a year, if you would like to subscribe or if you have any suggestion for topics for future issues please do not hesitate to contact me.

Enjoy reading and see you in the spring.

Sally Nestasally.nesta@uk.hartmann.info

Congratulations to Alison Goodson, Case Manager from Sussex Community NHS Trust. She wins a bright and colourful tourniquet by successfully completing the word wheel competition in the Spring edition.

Here at HARTMANN we are continually striving to reduce our impact on the environment, if you would prefer to receive Wound Forum via email, please do not hesitate to contact me with your email address details.

3

Life BeforeScott was an active individual who played football twice a week and had achieved Blue belt with Red Tag in Tai Kwando. One day on thefootballfieldhenoticedaninsectstuckto his leg, which he knocked away to reveal a small amount of blood. When he got home he cleaned the bite with antiseptic and went about his normal daily life. A professional hard working family man with 2 small children, Scottenjoyed an active life and generally looked after his health that was 8 years ago.

Scott now lives with chronic leg ulcers, which have caused Scott to gain weight due to inactivity leading to type II diabetes and many other problems. Scotts average hospital stay varied between 4 and 5 weeks due to wound infections and he was admitted to hospital at least 3 times

per year. In terms of dressing changes, Scott attended his GP surgery 4 times per day due to the amount of exudate from his wounds. As Scott has had a large amount of time off work his career progression has been threatened. Scott decided to study for a second degree; however this has been put on hold until early 2013 due to the amount of time he has had to spend in hospital.

The Best decision I ever made!After several referrals with no real solution from his consultant or GP, Scott contacted David Gray, his local Tissue Viability Specialist. He has been under Davids treatment for one and a half years now and explained that this was One of the best decisions I have ever made!.

David introduced Zetuvit Plus as part of Scotts care regime in order to deal with the high volumes of exudate from Scotts leg wounds. Somedaysthereisover1.5litresoffluid.Mywoodenfloorshavebeenruinedanditgottothe stage that I had to sleep upright in a chair in the living room, to save having to replace the mattress and bedding so often

Scott describes Zetuvit Plus as a soft effective dressing that provides comfort and treatment. It is easier to apply than my previous dressings due to the sizes available. Scott also commented that his previous dressings caused more problems than solutions. Zetuvit Plus does not cause any friction or rubbing as it has soft edges. I endured quite severe pain from the rough edges from my previous dressing.

What is life like now?Scott has been receiving treatment with Zetuvit Plus for 7 months now and commented that historically he would have been in hospital at least twice during this time. Instead of having 4 dressing changes per day, which are problematic due to work and family commitments, my legs can now be dressed twice a day: once early morning and once late evening. Scott has managed to return to a more steady work routine, Using Zetuvit Plus has had a huge effect on work, my previous dressing did not control the odour.

Scotts quality of life has improved, I can do otherthings;thereisnopuddleonthefloorand no smell! There is nothing worse when you are in the supermarket and people around you are commenting on the awful smell when you know full well that it is coming from you.

4

www.hartmann.co.ukA patients view - Zetuvit Plus

Using Zetuvit PlusA patients view - Scott Mckay

If someone else with my condition, or similar, could have told me about how effective Zetuvit Plus is at controlling exudate; controlling smell

and how comfortable it was, I would have changed to the dressing straight away

Left leg with venous disease of the lower limbs

Whats important?Keeping me out of hospital, improved my quality of life it ticks all the boxes for everyone. Its not just the cost of the dressing; I must have saved the hospital

money by not being there as often!

Whats important?Staying out of hospital to spend time

with my family! My partner doesnt drive and so when Im in hospital I

dont tend to see her or my children, so it is a very lonely experience.

Whats important?Provide an environment where Im

not embarrassed, where I can be professional with no soaking trousers;

no smell!

Patient interview, August 2012

BackgroundThe serviceOuter North East London Community Services (ONEL CS, formerly Havering PCT) headquarters is based at St. Georges Hospital in Hornchurch, Essex. It employs over 1500 staff, the majority of whom provide care directly to patients inthe community, located across multiple sites within the London boroughs of Havering, Redbridge and Waltham Forest.

ONEL CS provides a diverse range of services to a population of approximately 750,000. The borough of Havering has the highest proportion ofpensionersinLondon,witharoundafifthofthe population in Havering being of retirementage. Since 2007, the population in Havering has been growing at a faster rate than the England average, with the population predicted to rise by 8.3% by 2020. This requires ONEL CS to prepare for large increased demand for olderpeoples services, particularly those for the very elderly (90+)1.

Outer North East London Community ServicesThe ONEL CS (Havering area) tissue viability (TV) service aims to promote the equitable provision of excellent wound care for all Havering residents and to improve wound healing and prevention, thereby contributing to a better patient experience, improved quality of life and reduced costs associated with complex wounds.

One of the main objectives of the TV service is to assess, plan and deliver high quality, clinically effective, individualised care whilst at the same time reduce dressing costs associated with chronic wounds, through the increased support of specialist advice and updated evidence based Wound Care Formulary .2

Many different types of wounds exist, both chronic and acute including leg ulcers (venous, arterial and vasculitic), pressure ulcers, surgical wounds,diabeticfootulcers,fistulas,sinuses,burns, fungating wounds, skin cancers, lacerations, haematomas and lesions secondary to lymphoedema. In the community, wound care is a core element of the district nursing and practice nursing role. Where complex tissue needsareidentified,areferralismadetotheTVservice for specialist advice.

The TV service provides a specialist complex wound service for patients registered with a Havering GP who have a complex TV problem or non-healing deteriorating wound. The service is provided in a clinical setting for patients that are able to attend or a domiciliary setting for household patients. The TV service aim to prevent inappropriate admissions to hospital by facilitating and providing specialist wound management within the community and if appropriate to facilitate early discharge from hospital.

The Havering area team is made up of Jane Stevens, Clinical Nurse Specialist and Team Leader; Theresa Mitchell, Tissue Viability Specialist Nurse; Joanna England, Tissue Viability Nurse; Beryl Wilson, Secretary and Dawn Howe, TBM admin. Jane commenced her post with the service in October 1999 and has

5

CaseSTUDY Identifying Cost Saving Potential in Wound Care

Identifying Cost Saving Potential in Wound Care A case study undertaken within Outer North EastLondon Community Services (Havering Area)

We were really impressed with the clinical performance of the product and the cost

effectiveness. I made contact with HARTMANN and asked what else do you do?

www.hartmann.co.uk

Outer North East London Community Services

6www.hartmann.co.ukwww.hartmann.co.uk

since been working hard along with hercolleagues to ensure the service delivers:

specialist evidence based assessment, support and advice to all healthcare professionals support and advice to patients, families and carers education programmes clinical audit to support practice developments clinical guidelines standard setting ink nurse system procurement advice to the PCT link between primary and secondary care.

Study rationaleTodays economic climate dictates the requirement to provide quality of care whilst being cost effective, and this is a challenge faced by many trusts in the UK. Jane adds There has always been pressure from the NHS to spend the public pound as effectively as possible and so cost savings have always been a priority. However high quality patientcare is paramount and therefore we must be cost effective not cost driven.

After seeing an advertisement in 2007 in a wound care journal for Atrauman, Jane applied for a free sample pack in order to evaluate the product, We had such positive feedback from the District Nurses about the performance of Atrauman we added the product to our formulary within a few weeks of receiving the samples. The feedback from theleg ulcer clinics was the most encouraging; patients reported that they found Atrauman far more comfortable over the course of a week under compression, in comparison to the previous low adherent standard treatment.

This spurred Jane on to investigate the rest of the HARTMANN product portfolio, We were really impressed with the clinical performance of the product and the cost effectiveness. I made contact with HARTMANN and asked what else do you do?

What happened next?Jane and her team went on to evaluate Cosmopor E as an alternative adhesive island dressing. At the time of evaluation the District Nurses were facilitating the post op clinics and Cosmopor E was used extensively during the trial period. All patients discharged post op were seen by the post op clinics, those who wanted to shower would be provided with afilm-backeddressing,whichwaslaterswitchedtoHydrofilm Plus3.

Jane and the team went on to clinically evaluate Hydrosorb sheet hydrogel dressing; Zetuvit E absorbent wound pad andHydrofilmhighMVTRfilmdressing3. CommentssuchasHydrofilmissomucheasierto apply; it saves time at each dressing change were received from the DNs.

When it came to the range of bandages from HARTMANN, nurses love Hospilite Hospilite is not as bulky as other crepe bandages and patients report it to not be as hot to wear. The District Nurses fed back that the bandage has great conformability and ease of application.

Demonstrated Cost effectivenessOn an analysis of spend between the period of April 2010 April 2011, if ONEL CS had continued to purchase the competitor products highlighted within this report, the total spend across the twelve months would be over 62,000. There have been no negatives aboutchanging to the HARTMANN products. Cost savings do not only relate to unit cost. Cost savings equate to cost effectiveness. We have tried other products with a price tag 50% less but they have not stood up to clinicaltesting stated Jane.

By incorporating the HARTMANN product portfolio as part of the wound care formulary, ONELCSsavedover42,000(figure1).Thechartinfigure2highlightstheproductcategories that these savings were made across during the twelve month period.

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

HART

MANN

Comp

etitor

Figure 1: Cost analysis April 2010 - Mar 20114

7www.hartmann.co.ukCaseSTUDY Identifying Cost Saving Potential in Wound Care

By converting to Atrauman as the non-adherent primary contact layer, Jane and her team were able to save a total of 20,000. Savings of just under 8,000 were made on type I and type II bandages and 12,500 worth of savings were made by switching to Zetuvit E. Following successful clinical evaluation5 the latest addition to the formulary is Zetuvit

Plus; super absorbent wound dressing pad for thetreatmentofsuperficial,heavilyexudingwounds. Zetuvit Plus saves on average 80% per dressing.

In conclusionThe HARTMANN range of high performance advanced and traditional wound management products compy with British and European standards. Products are supported by extensive patient studies to demonstrate clinical effectiveness and HARTMANN advanced wound care products are independently tested.Working in partnership with HARTMANN, you can expect:

optimal product performance, clinically proven value for money, with a proactive approach to cost management a customer focused approach to developing innovative solutions comprehensive education and training support dedicated customer service support a streamlined logistics operation ensuring you receive the right product, at the right time, in the right place

From Janes perspective We have demonstrated that by looking at new products coming to the market, we have been ableto make considerable cost savings, without compromiseonproductquality,efficacyandultimately patient outcomes.

Ingeneral,changeisdifficulttointroduceandmanage. HARTMANN support this process with product training and the development of bespoke marketing materials in order to support the implementation of the wound management formulary.

This report details the work undertaken by the Outer

North East London Community Services (Havering Area),

Tissue Viability team. The formulary this study covers

relates to work completed prior to amalgamation and

will impact the catchment area of Havering Borough in

the future. All price calculations refer to the NHS Supply

Chain on-line catalogue and the NHS Drug Tariff

(May 2011). Full details available upon request.

References1 JSNA 2010 Topline Findings report Havering NHS2 ONEL CS Module B performance requirements specification, quality and productivity; Section 1 specification Tissue Viability Service Specification3 Palfreyman, S, Stevens, J (2010) Use of Hydrofilm and Hydrofilm Plus in the community: an assessment BJCN Vol 15 No 34 Wholesaler and EPACT consolidated data April 2010 March 20115 Benbow M, Stevens J, (2010) Exudate, infection and patient quality of life BJN (Tissue Viability Supplement) Vol 19, No 20

0

5,000

10,000

15,000

20,000

25,000

Prima

ry con

tact la

yer

Island

adhe

sive d

ressin

g

Band

ages

Film dr

essing

Hydro

gel d

ressin

g

Absor

bent

dressi

ng

HARTMANN

Competitor

Wound Management

Figure 2: Cost analysis per product category April 2010 Mar 20114

Other benefitsBy streamlining routes to supply other benefits include:

closer working partnership with the manufacturer

reduced number of sales people calling on district nurses

reduced logistic and distribution costs quality assurance

8www.hartmann.co.ukwww.hartmann.co.uk

Pressure ulcer classification and degrees of severity

Category/Stage I: Non-blanchable redness of intact skinIntact skin with non-blanchable erythema of a localized area usually over a bony prominence. Discoloration of the skin, warmth, edema, hardness or pain may also be present. Darkly pigmented skin may not have visible blanching. Further description: The area may be painful,firm,soft,warmerorcoolerascompared to adjacent tissue. Category/StageImaybedifficulttodetectinindividuals with dark skin tones. May indicate at risk persons.

Source: http://www.hartmann-medicaledition.com

Source: www.hartmanntraining.co.uk

Category/Stage II: Partial thickness skin loss or blisterPartial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/rupturedserum-filledorsero-sanginousfilledblister. Further description: Presents as a shiny or dry shallow ulcer without slough or bruising. This category/stage should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration or excoriation.

Category/Stage III: Full thickness skin loss (fat visible)Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Some slough may be present. May include undermining and tunneling.Further description: The depth of a Category/Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and Category/Stage III ulcers can be shallow. Incontrast,areasofsignificantadipositycan develop extremely deep Category/Stage III pressure ulcers. Bone/tendon is not visible or directly palpable.

Category/Stage IV: Full thickness tissue loss (muscle/bone visible)Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often include undermining and tunneling. Further description: The depth of a Category/Stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and these ulcers can be shallow. Category/Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis or osteitis likely to occur. Exposed bone/muscle is visible or directly palpable.

9www.hartmann.co.ukPressure ulcer classification - Product Guide

Professional consensus (in the treatment of pressure ulcers) recommends to create the

optimum wound healing environment by using modern dressings e.g. hydrocolloids,

hydrogels, hydrofibres, foams, films, alginates, soft silicones, in preference to basic

dressing types e.g. gauze, paraffin gauze and simple dressing pads1.

HARTMANN Product Guide

To protect:Hydrocoll gelatin-free hydrocolloid wound dressing The smooth slippery backing minimises the frictioncoefficientofthepatient-supportsurface. This means that the patient is able to move more easily over the support surface and the area covered by the dressing is likely to be exposed to lower levels of pressure, shear and friction2.

Hydrofilm high MVTR transparent film dressing Byapplyingafilmdressingtovulnerableareas, the risk of pressure ulcers may be reduced due to the low friction external surfaceofthefilm4.Alsoconsiderusingfilmdressings as a secondary dressing for ulcers treatedwithalginatesorotherwoundfillerthat will likely remain in the ulcer bed for an extended period of time (e.g. 3-5 days).

To debride:Hydrocoll gelatin-free hydrocolloid wound dressingProvides the ideal environment for the formation of granulation tissue, particularly theactivityoffibroblasts,acceleratingthe wound healing process3. Hydrocoll facilitates debridement of necrotic tissue and slough by promoting autolysis.

Hydrosorb sheet hydrogel dressing Supplies the wound with moisture from the outset and facilitates autolytic debridement. Its transparency allows inspection of the wound at all times without dressing change (highly economical due to prolonged dressingchange intervals), ideal for keeping granulation and epithelial tissue moist.

1 Bazin, S. et al (2005) The management of pressure ulcers in primary and secondary care. A Clinical Practice Guideline. Royal College of Nursing2 Fletcher J. et al (2011) Pressure ulcers and hydrocolloids made easy. Wounds International, Volume 2, issue 43Dataonfile4 Nakagami G. et al. Comparison of two pressure ulcer preventative dressings for reducing shear force on the heel. Journal of Wound Ostomy. Continence Nurse. 2006 May-Jun;33(3):267-72

To absorb:Zetuvit Plus super absorbent wound dressing padTheblendofcellulosefluffandfluidretainingsuper absorbent particles (SAP) means that Zetuvit Plus is particularly suitable for the treatment of heavily exuding pressure ulcers. The unique structure of the dressingprovides cushioning3.

PermaFoam hydroactive foam dressing and Sorbalgon calcium alginate dressing Also suitable for the management of exuding pressure ulcers.

See insideback cover for your

FREE pullout and keep guide

10

www.hartmann.co.ukHARTMANN news

WOUNDCARE 4 HEROES

www.woundcare4heroes.org.uk

A new charity, Woundcare 4 Heroes (Wc4H), has been formed to develop a national network of complex wound management services to support the NHS in providing lifelong support and care for those discharged from the Armed Forces. The excellence of cutting-edge battlefield trauma care today has resulted in far higher survival rates of service personnel, and far greater numbers of men and women who require long-term wound care due to the severity and complexity of their injuries. With the increase in life expectancy, those injured in their 20s and 30s today, may still be needing specialist wound care for many years to come. By being feet on the beat and actively treating and supporting injured personnel, their families and carers, Wc4H can provide early detection of complications, consistency of care, and fast track service users through rapid referral systems to medical consultant level. Educating healthcare professionals in complex wound management and furthering research in this area is also high on Wc4Hs agenda.

Wounds UK awardsHARTMANN are proud to be sponsoring The cost-effective management in wound healing award at the Wounds UK awards 2012.

The awards have always sought to publicise and celebrate the breadth of excellent work and innovation that is demonstrated by the nation wounds community. To further increase the visibility of the awards and to combine with this years theme of sharing best practice at the annual conference, the awards will form part of the Wounds UK Harrogate programme, held on the 12-14 November. The entrants have all been received and will be announced by Wounds UK very soon.

The cost-effective management in wound healing award fits perfectly with the HARTMANN ethos and attitude towards wound healing, keep it simple and cost effective.

www.hartmann.co.ukWoundFORUM NEWS

The HARTMANN National Congress will be a day of education training and discussion for healthcare professionals involved with Continence and Wound management.

Previous HARTMANN congresses have been a huge success and have been thoroughly enjoyed by our customers and we have some exciting guest speakers lined up already.

Wounds UK awards SAVE THE DATE

HARTMANN National Congress 23rd 24th April 2013 Partnership working with innovative solutions

To register your interest please go to our website www.hartmann.co.uk andgotocontactusandfillintherequired details stating that you would like to be part of the 2013 National Congress.

PressureulcerclassificationhandyguideTo protect:

To debride:

To absorb:

Professional consensus (in the treatment of pressure ulcers) recommends to create the optimum wound healing environment by using modern dressings e.g. hydrocolloids, hydrogels, hydrofibres, foams, films, alginates, soft silicones, in preference to basic dressing types e.g. gauze, paraffin gauze and simple dressing pads.

Hydrocoll gelatin-free hydrocolloid wound dressing

Hydrofilm high MVTR transparent film dressing

Hydrocoll gelatin-free hydrocolloid wound dressing

Hydrosorb sheet hydrogel dressing

Zetuvit Plus super absorbent wound dressing pad

PermaFoam hydroactive foam dressing and

Sorbalgon calcium alginate dressing

HeLP is at handHARTMANN eLearning Programme Skin Module

www.hartmann.co.uk

Create your own training account for free at www.hartmanntraining.co.uk

HARTMANN eLearning Programme Skin Module gives an introduction to the skin and advises how to diagnose, treat and prevent skin injuries that are prevalent in vulnerable skin. The Skin Module is ideal for care home staff, students and healthcare professionals who want a greater understanding of how to maintain healthy skin in vulnerable patients.

The topics covered are: The anatomy and physiology of the skin Functions of the skin Skin assessment Primary and secondary lesions Pressure ulcers Moisture lesions Differences between moisture lesions & pressure ulcers Skin tears

NEW!