Managing wound care outcomes.

Chronic wounds increase home care costs, stressing an already overburdened system. To improve costs and wound outcomes of home care in Nova Scotia, dedicated home care professionals collaborated with the Nova Scotia Department of Health Clinical Issues Committee in a four-phase endeavor. In Phase I, a descriptive, retrospective chart review (1995-1999) was conducted using an Outcomes Management Model research framework to assess existing wound prevalence, costs, and outcomes of care in the Nova Scotia Home Care setting. In Phase II, using literature-based best available evidence, the Nova Scotia Standardized Prevention and Treatment Protocol was developed. In Phase III, the Protocol was disseminated to 20 Nova Scotia healthcare agencies educated on its use. Wound care outcomes and costs were measured in Phase IV using a prospective, quasi-experimental, descriptive study design. The study found that before 1999, Nova Scotia Home Care wound care practices were costly and outdated, yielding sporadically recorded, often inferior, outcomes--eg, 30% of patients had pressure ulcers, 42% received daily home care visits, and of the 115 (24.6%) clients with venous leg ulcers only 16 received compression therapy. The Protocol increased awareness of the principles of moist wound healing and reduced the prevalence of chronic wounds, dressing change frequency, healing time, and costs of care. Phase IV study results (n = 50) showed an average decline in labor and materials costs of dollar 946.64 per client per month after Protocol implementation. The Nova Scotia Protocol enables home care professionals to provide quality wound care and has since been issued as policy for Home Care in Nova Scotia.