Balancing clinical and operational priorities for optimal skin health


Skin health is critical to whole-patient wellness, and healthcare systems must align their clinical and operational goals to create optimal skin health outcomes. 

In a Dec.11 webinar hosted by Becker's Hospital Reviewand sponsored by Cardinal Health, industry experts discussed the importance of proper skin health product selection and use, how science is contributing to innovation in skin care and how staff education can improve clinical and financial outcomes.

Cardinal Health presenters included:

  • Cathy Milne, APRN, MSN, ANP/ACNS-BC, CWOCN-AP, outside clinical consultant to the Skin Health team 
  • Beth Hawkins-Bradley, RN, MN, CWOCN, Principal Education Specialist
  • Harish Patel, a Research and Development Director and research fellow with more than 22 product patents

Prevention and product selection

In the U.S., chronic wounds affect approximately 6.5 million patients and lead to $25 billion in treatment costs each year. Skin health encompasses a wide continuum, and unhealthy skin along with pressure or incontinence can lead to a pressure injury adverse event, non-healing skin tear or friction injury. "By maintaining skin health, we prevent many adverse events," Ms. Milne said. "To prevent wounds — and extra costs — from occurring, you have to take intentional action."

"To save the organization money, many systems will create a formulary based on price alone, rather than looking at clinical outcomes and preventing potential risks," Ms. Hawkins-Bradley said. "Of course, you can't spend everything on prevention — which is not reimbursed — or you'd go out of business. Reimbursements incentivize treatment, not prevention. However, the total cost, wasted time and reputational risk can be costlier than the savings gained from switching to inferior products."

Product quality selection is key. For example, antimicrobial dressings, also known as AMD, aren't a treatment for the wound but rather a broad-spectrum agent providing an antimicrobial defense. Cardinal Health's AMD products are designed to prevent bacteria from contaminating the wound. "Different brands and products are preferred for different uses. With an infected wound, they also prevent the spread of bacteria," said Mr. Patel. "Silver is another antimicrobial agent that is used. However, it can be much harsher to the skin. Silver is not selective — it will kill the good cells and the bad cells."

The importance of staff education

An effective skin health program must result from building strong operational and clinical collaboration. Wound care nurses are pulled in many directions. They are asked to consult at bedside, update the skin health evidence-based guidelines, train staff, review protocols and products, recommend formularies and drive savings at the same time. They're also seriously outnumbered.

"I've seen ratios as high as one wound care nurse for every 150 to 350 patients," Ms. Milne said. “Despite new employee orientation with skin health and pressure injury prevention protocols, a number of studies have shown that most bedside nurses cannot stage pressure injuries accurately," Ms. Milne said. "That means the pressure injury data being reported and acted upon by the organization is also inaccurate."

A lack of appropriate staff education can cost the facility money, reimbursement and reputation in the form of star ratings.

Cardinal Health developed a new approach to improve staff education and patient skin care and reconcile tensions between clinical and financial priorities.

I.C.E.: A new approach to cross-category thinking

I: Invite an inclusive group of stakeholders to the conversation

The responsibility for skin health encompasses many departments. If a manager's success in the organization is measured only by financial benchmarks and does not include clinical outcomes — even if the outcome cannot be determined until after the patient has left — it may cost the organization more overall. Unless leadership takes a broad view, budget tradeoffs occur to the detriment of clinical quality.

C: Establish aligned success criteria at the start of the evaluation or initiative

"It's important to establish the decision criteria for product evaluations up front, with an impartial, blinded evaluation and clear decision criteria that each stakeholder aligns to," Ms. Hawkins-Bradley said. "When you can show at least clinical equivalence or get the balance between clinical and financial priorities to improve patient outcomes, operational costs decrease."

An effective skin health program requires strong operational and clinical collaboration. The healthcare facility or system formulary must be objectively reviewed by both sides to identify redundant products, low-utilization products, off-contract products, and excessive SKU's within a category. 

The clinical team should review skin protection-related protocols to ensure they're up-to-date and list products by categories required to implement protocols. 

E: Evaluate the results afterwards

Healthcare organizations should conduct a deep-dive analysis after initiating a product, looking at the entire continuum of care. Leadership should encourage wound care teams and stakeholders to collect data to help come up with solutions, such as re-evaluating the total formulary to ensure it is cost-conscious and effective.  

Access the recording here.

To learn more about Cardinal Health, click here

If you’d like to connect with a representative or express interest in a Cardinal Health product formulary analysis, visit here.

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