By Laurie Swezey RN, BSN, CWOCN, FACCWS

Making decisions in today’s wound care world must take several entities into account. The patient/client and the practitioner must work together to decide on a dressing protocol that meets the needs of both. Additionally, the needs of the practitioner’s employer, whether home care agency, hospital, or other facility, must also be considered (i.e. cost). Appropriate wound care product use must maintain a balance, satisfying the demands of all three entities.

The Patient

Why should the patient share in decision-making regarding wound care? Remember that patients must “buy in” to their particular care plan for maximum cooperation and compliance. A patient who finds a dressing uncomfortable or aesthetically displeasing is much less likely to cooperate than a patient whose dressing is comfortable, relatively inconspicuous, and requires less frequent changing.

Some patients will want more control than others over decision-making, but all patients deserve a say in how their wounds are managed, and should be allowed to make choices whenever possible. While the end point of treatment is the same for patients and practitioners (a fully healed wound), this is not always practical or possible, and some things may be more important to the patient than to the practitioner, such as odor control. Consider the following factors along with the patient when deciding on what wound care products will be used to manage a wound:

• Pain management
• Control of odor and drainage
• Patient’s willingness and ability to change their own dressings
• Cost to the patient
• Time frame for healing (personal goals for healing versus reality)
• Quality of life (ability of the patient to live their life as normally as possible while being treated for a wound)
• Consistency in care (practitioners should resist changing another practitioner’s protocol without good reason)
• Aesthetic acceptability (bulkiness, color)

The Practitioner

The practitioner must decide on a dressing protocol for their clients based on current evidence-based guidelines. They must also consider the needs and desires of their patients, as well as their employer. The following factors must be considered from the practitioner’s perspective:

• The evidence supporting a particular product’s use (safety and efficacy)
• Acceptability of the chosen product by the patient
• Availability of the chosen product (formulary)
• Cost of the desired product in terms of frequency of dressing changes, cost per dressing change and expected duration of treatment)
• Ability of practitioner to meet patient needs while considering all of the above

The Employer

In today’s economy, the employer has a responsibility to authorize the use of wound care products that are cost effective while also conforming to evidence-based practice. The employer may be an organization, a hospital, a home care agency, etc. Factors that must be considered include:

• Cost of total treatment versus cost per unit
• Reduced treatment time/reduced length of stay
• The suitability of certain products for use in and out of the hospital setting (some treatments may not be suitable for some settings)
• Prevention of infection/complications
• Acceptability of products to the practitioners
• Avoidance of litigation

The employer has responsibilities to the public, their employees (practitioners) and to the patients they serve.

Meeting the Needs of Everyone

The proper use of wound care products can be a delicate balancing act. While the ultimate goal is always to obtain the best possible outcome for patients, other factors must be considered. Patients, practitioners, and employers must all work together, within certain constraints, to choose and provide wound care that meets the needs of everyone involved.

References
Issues in wound care: Report from a wound academy expert forum. (2007). Downloaded from the web December 18, 2010.
Myers, B. (2008). Wound Management: Principles and Practice (2nd Ed). Pg. 205-207.

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.