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Clinical Research
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Quality improvement: reliable instructions that reduce the cost in delivering burn care Lidia Garner, MSM, BSN, RN, CWCN, COCN Objective: The most frequently prescribed burn care protocol, Silvadene BID gauze dressings, is both labor-intensive for staff and expensive in materials. The National Naval Medical Center identified this as an opportunity for cost-savings and an improvement in the quality-of-care. The key business drivers were the budget, staff efficiency and patient satisfaction. A Nursing Efficiency Study of 45 nurses, 33 reported wound care as being the most time-consuming nursing task. Standard protocols of care for burn wound care were requested. Our goal was to decrease the frequency of dressing changes by 50% and to decrease hospital costs (labor and supply) by 50% Analysis/Benchmarking: The former burn protocol was Silvadene BID gauze dressings (changed 2 times/day). A cause and effect analysis was completed and the protocol was found to be labor intensive and burdensome. A silver-impregnated foam, moist-wound-healing protocol was introduced. The silver foam was changed 1-2 times/week and was compared to the existing protocol Outcomes: Average savings/patient was $257.09/week and cost savings of the silver impregnated foam dressing versus the Silvadene dressing was $1,028.36/month. Time saved in 12 hour shifts equaled 23.5, which when projected to 100 patients seen for burn care equals 2,182 12-hour shifts further equaling 14 full-time nursing positions saved Conclusion: Changing the protocol for burn patients resulted in a 90% decrease in overall costs. Time saved by staff was also 94%. The recommendation of the assessment team is to continue benchmarking the standardized protocols for burn care as well as ongoing data collection. Structured, educational wound classes and the development of a wound care team are also suggested. As a result, Tools for Success were put into place, which included: . .-Wound & Burn Care Algorithms.-Pressure Ulcer Cheat Sheet.-Specialty Bed Selection Guide.-On Site In-Servicing.-Vendor Fair/Demonstration.-Regularly Scheduled Wound/Ostomy Courses.-VAC Certification offerings |
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