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

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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 

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.

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