The challenges of developing a city wide wound formulary
Welcome to the TVS February blog written by Kate Williams, Wound Clinical Nurse Specialist, Leeds Community Wound Prevention & Management Service and TVS Trustee
I am one of the Tissue Viability Nurses within Leeds Community Healthcare Trust. For the first time, thanks to a great team of professionals, we have developed a wound formulary that covers both acute and community. This blog shares some thoughts on the more human side of selecting wound products for formularies.
INFORMATION, EVIDENCE & RESEARCH
As specialists in wound care, knowledge of dressings is essential. All of us are research aware and some are research active. We all understand the hierarchy of evidence, and we understand that the evidence threshold to be CE marked as a dressing is low.
We have seen many case studies and cost comparisons. We understand that assessment and diagnosis are much more important than dressings. Yet, so often the words ‘I like …..’ or I don’t like….’ are muttered in relation to wound dressings and formulary choices.
NURSES ARE VERY PASSIONATE ABOUT THEIR OPINIONS AND DRESSING CHOICES
We have so much product information on absorption, MVTR, fluid handling capacity, wear time, adherence etc. There is a plethora of information on every wound dressing, yet choosing a product for a wound formulary can be challenging, balancing often poor evidence with clinician preference. Leaving price aside, choosing products for a formulary can be an area of much debate.
We are social creatures who despite all our education and training, sometimes place more value on personal feedback and individual experience than evaluations done elsewhere, lab data, and small studies. Personal, social accounts are way more interesting than statistical, impersonal accounts from strangers.
WE DID IT!
After 12 months of work we have agreed a city wide wound dressing formulary. This has been a great piece of work by numerous different specialities including TVN’s (acute and community), plastics, dermatology, vascular, podiatry, orthopaedics pharmacy, medicines management and procurement teams. We have considered available data, prices, and product evaluations. We have had honest discussions about the less tangible aspects of the selection process such as the impact of too much change at once. We of course discussed personal preferences, and experiences, but finally we have agreed a joint list.
We managed not to make it as long as the BNF too! IT is quite concise. We are all committed to joint product reviews/formulary changes going forward. There are products there which some of us would not have traditionally used, compromise has been key. When it comes to roll out we now have to navigate the thrills and disappointments of an entire city! Fingers Crossed!!
MY TAKE HOME MESSAGE
Collaboration and compromise are as important as the products themselves.