Development of a wound care formulary using clinical evidence and ensuring effective change management

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Clinical guidance, Editor's Pick, Formulary, Service delivery, Wound care

Development of a wound care formulary using clinical evidence and ensuring effective change management

Supported by Urgo Medical

Andrew Sharpe, Caroline Dowsett, David Wylie, Dawn Douglas, Graham Bowen, Hollie Robinson, Jacqui Fletcher, Joy Tickle, Kelly Phillips, Leanne Atkin, Michelle Goodeve, Nina Murphy, Rebecca Elwell, Sian Fumarola

24 October 2023

With an increasing number of chronic wounds, growing availability of wound care products and rising costs (Guest et al, 2020), selecting a cost-effective product remains a significant aspect of wound care. Although wounds present a substantial burden to healthcare systems, evidence-based wound care lacks priority (House of Lords, 2017). There has been recognition within the National Health Service (NHS) that there is a need for national recommendations such as the establishment of the National Wound Care Strategy Programme (NWCSP) in the United Kingdom (UK); however, in comparison to other health conditions, wound care remains a relatively low priority. Wounds can be prevalent in all patients, and they often become more difficult to manage in those with comorbidities and long-term health conditions.

Evidence shows that there is unwarranted variation in wound care across the UK, with an underuse of evidence-based practices and overuse of interventions supported by little to no evidence (Gray et al, 2019; NHS Digital, 2019). It is crucial that clinicians avoid isolated and uncoordinated practices that prevent information or evidence from being shared or implemented, which often leads to decisions that are varied and affect patient care. Evidence-based person-centred care is a priority in clinical practice, with a focus on individual choice and shared decision-making, and although in recent years there has been a move away from more paternalistic care, in some organisations there may be a culture of ‘professional exceptionalism’ among some clinicians (Scraggs et al, 2012). When developing a formulary, it is therefore vital to consider clinical and leadership behaviours with particular reference to change management and the mindset needed from staff to standardise practice.

Evidence shows that inappropriate and unnecessary dressing changes can have a negative impact on both patient wellbeing and healthcare resources (Lindholm and Searle, 2016). Local wound care formularies can streamline and guide the process of appropriate dressing selection, support clinicians to make cost- and clinically effective decisions and promote evidence-based practice. Amid unprecedented challenges and mounting pressures on the NHS, guidance on how to build and implement a formulary is especially relevant at the moment. In addition, there is a need to simplify processes while improving experiences for both clinicians and patients.

A multidisciplinary group of experts convened for a meeting in Birmingham in June 2023 to develop this Best Practice Statement, focusing on best practice for developing a formulary, use of evidence and change management processes. The group included experts within tissue viability, lymphoedema, wound and vascular care, podiatry, operational management, procurement and education. The aim of this meeting and the resulting document was to learn from shared experiences and provide guidance on best practice, to increase awareness of local wound care formularies and ensure that all patients receive safe, evidence-based and cost-effective care.

This document was developed with the following overall objectives:

Establish requirements of a formulary
Provide support to those who are developing or updating a formulary
Explore the importance of an evidence-based approach to decision-making, including consideration of national recommendations and guidance
Consider overall costs and the wider health economy
Discuss the need to change mindsets
Explore how to evaluate and measure success and effectiveness
Identify the challenges to be addressed.

Due to the multiplication of formularies, a substantial amount of time and effort is wasted on producing local documents. As a result, this statement includes a template to provide practical guidance on how best to develop and use a formulary to achieve best practice. This also provides an opportunity to challenge historical ways of developing a formulary, ensuring evidence is used in the best way to support clinicians and patients.

Jacqui Fletcher, Chair

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Disclaimer: This document has been developed by Wounds UK and is supported by an unrestricted educational grant from Urgo Medical. This publication was coordinated by Wounds UK with the Expert Working Group and Review Panel. The views presented in this document are the work of the authors and do not necessarily reflect the views of Urgo Medical.

References

Abu-Baker NN, AbuAlrub S, Obeidat RF, Assmairan K (2021) Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students. BMC Nurs 20(1): 13

Atkin L, Tickle J (2018) Best practice statement leg ulceration pathway: revision required to reflect new evidence. Wounds UK 14(4): 58-62

Atkin L, Bućko Z, Conde Montero E et al (2019) Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 23(Sup3a): S1-S50

Bussey-Jones J, Genao I (2003) Impact of culture on health care. J Natl Med Assoc 95(8): 732-5

Chapman N, Hudson K (2021) Making the case for nurses’ increased involvement in NHS procurement. Nursing Times 117: 25-7

Connor L, Dean J, McNett M et al (2023) Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews Evid Based Nurs 20(1): 6-15

Dabiri G, Damstetter E, Phillips T (2016) Choosing a Wound Dressing Based on Common Wound Characteristics. Adv Wound Care (New Rochelle) 5(1): 32-41

Department of Health (2015) Culture change in the NHS: applying the lessons of the Francis Inquiries. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/403010/culture-change-nhs.pdf (accessed 12.07.2023)

Department of Health and Social Care (2012) Review of local formulary processes to support Innovation Health and Wealth. Available at: https://www.gov.uk/government/publications/review-of-local-formulary-processes-to-support-innovation-health-and-wealth (accessed 15.05.2023)

Dissemond J, Malone M, Ryan H et al (2022) Implementation of the M.O.I.S.T. concept for the local treatment of chronic wounds into clinical practice. Wounds International 13(4): 34-43

Dowsett C, Nichols J (2021) 3D: a new educational framework to improve care for patients with leg ulcers. Wounds UK 17(1): 78-83

Dreier L, Nabarro D, Nelson J (2019) Systems Leadership for Sustainable Development: Strategies for Achieving Systemic Change. Available at: https://www.hks.harvard.edu/sites/default/files/centers/mrcbg/files/Systems%20Leadership.pdf (accessed 03.10.2023)

English M, Ogola M, Aluvaala J et al (2021) First do no harm: practitioners’ ability to ‘diagnose’ system weaknesses and improve safety is a critical initial step in improving care quality. Arch Dis Child 106(4): 326-32

Falanga V (2000) Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen 8(5): 347-52

Gray MJ, Wholey W-Y, Jakob U (2013) Bacterial responses to reactive chlorine species. Annu Rev Microbiol 67: 141-60

Gray TA, Wilson P, Dumville JC, Cullum NA (2019) What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework. BMJ Open 9(7): e024859

Grothier L (2018) What are the challenges for community nurses in implementing evidence-based wound care practice? (part 1). Wounds UK 14(4): 18-23

Guest JF, Ayoub N, McIlwraith T et al (2017) Health economic burden that different wound types impose on the UK’s National Health Service. Int Wound J 14(2): 322-30

Guest JF, Fuller GW, Vowden P (2020) Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open 10(12): e045253

House of Lords (2017) NHS: Wound Care. Available at: https://hansard.parliament.uk/lords/2017-11-22/debates/6C57E65A-A04D-449B-82E9-C836F088A696/NHSWoundCare (accessed 12.07.2023)

Jani A, Pitini E, Jungmann S et al (2019) A social prescriptions formulary: bringing social prescribing on par with pharmaceutical prescribing. J R Soc Med 112(12): 498-502

Kaini BK (2013) Healthcare governance for accountability and transparency. J Nepal Health Res Counc 11(23): 109-11

Kamper SJ (2020) Generalizability: Linking Evidence to Practice. J Orthop Sports Phys Ther 50(1): 45-6

Kendall M, Enright D (2012) Provision of medicines information: the example of the British National Formulary. Br J Clin Pharmacol 73: 934-8

LeBlanc K, Campbell K, Beeckman D et al (2018) Best practice recommendations for the prevention and management of skin tears in aged skin. Wounds International

Lindholm C, Searle R (2016) Wound management for the 21st century: combining effectiveness and efficiency. Int Wound J 13: 5-15.

Mannion R, Davies H (2018) Understanding organisational culture for healthcare quality improvement. BMJ 363: k4907

Melnyk BM, Fineout-Overholt E (2019) Evidence- based practice in nursing & healthcare: A guide to best practice (4th ed). Lippincott Williams & Wilkins

National Institute for Health and Care Excellence (2015) Developing and updating local formularies. Available at: https://www.nice.org.uk/guidance/mpg1/evidence/full-guideline-pdf-549570061 (accessed 15.05.2023)

National Institute for Health and Care Excellence (2023a) Technology appraisal guidance. Available at: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-technology-appraisal-guidance (accessed 15.05.2023)

National Institute for Health and Care Excellence (2023b) Medical Technologies Evaluation Programme. Available at: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-medical-technologies-evaluation-programme (accessed 04.10.2023)

NHS Digital (2019) National Diabetes Foot Care Audit Fourth Annual Report. Available at: https://www.hqip.org.uk/wp-content/uploads/2019/05/National-Diabetes-Foot-Care-Audit-fourth-annual-report-FINAL.pdf (accessed 03.10.2023)

NHS England (2017) The How-to guide for measurement for improvement. Available at: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/How-to-Guide-for-Measurement-for-Improvement.pdf (accessed 17.07.2023)

Raepsaet C, Alves P, Cullen B et al (2023) The development of a core outcome set for clinical effectiveness studies of bordered foam dressings in the treatment of complex wounds. J Tissue Viability 32(3): 430-36

Sackett DL, Rosenberg WM, Gray JA et al (1996) Evidence-based medicine: What it is and what it isn’t. BMJ 312: 71-2

Schultz GS, Sibbald RG, Falanga V et al (2003) Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 11 Suppl 1: S1-28

Scraggs E, Brereton L, Newbould J et al (2012) Factors that encourage or discourage doctors from acting in accordance with good practice. Available at: https://www.gmc-uk.org/-/media/gmc-site/about/barriersandenablersofgood-practicefinalresearchreportpdf50388604.pdf (accessed 03.10.2023)

Shafaghat T, Zarchi MKR, Nasab MHI et al (2021) Force field analysis of driving and restraining factors affecting the evidence-based decision-making in health systems; comparing two approaches. J Educ Health Promot 10: 419

Song EH, Milne CT, Hamm T et al (2020) A novel point-of-care solution to streamline local wound formulary development and promote cost-effective wound care. Advances in Skin and Wound Care 33(2): 91-7

Song EH, Milne CT, Kuplicki S et al (2019) Streamlining the development and maintenance of a local wound care formulary. Available at: https://s3.amazonaws.com/HMP/hmp_ln/imported/2019-06/14-18_TWC0619_Song.pdf (accessed 17.05.23)

Stephen-Haynes J (2013) Development of an algorithm as an implementation model for a wound management formulary across a UK health economy. J Wound Care 22(12): 692, 694-6, 698

Veenstra GL, Ahaus K, Welker GA et al (2017) Rethinking clinical governance: healthcare professionals’ views: a Delphi study. BMJ Open 7(1): e012591

Webster P (2016) Consensus mounts for national drug formulary. CMAJ 188: E180

World Health Organization (2023) Health innovation for impact. Available at: https://www.who.int/teams/digital-health-and-innovation/health-innovation-for-impact#:~:text=WHO%20defines%20health%20innovation%20as,to%20accelerate%20positive%20health%20impact (accessed 12.07.2023)

World Union of Wound Healing Societies (2020) Optimising wound care through patient engagement. Wounds International

Wounds UK (2016) Best Practice Statement: Holistic management of venous leg ulceration. Wounds UK

Wounds UK (2021) Wound bed preparation: Made Easy. Wounds UK

Yeung K, Basu A, Hansen RN et al (2017) Impact of a value-based formulary on medication utilization, health services utilization, and expenditures. Med Care 55(2): 191-8

Resources

Development of a wound care formulary using clinical evidence and ensuring effective change management

Development of a wound care formulary using clinical evidence and ensuring effective change management

Principles of wound management in paediatric patients (Second Edition)

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