New App Improves Care and Reduces Cost of Wound Care in Wales

Wound care services account for a significant amount (6%) of NHS Wales’ budget, an annual cost of around £330m.

Historically, district nurses and the community wound clinic in Swansea Bay University Health Board (SBUHB) have used paper patient notes, filled out a paper assessment, and measured wounds with a disposable tape measure, which can result in inconsistent and inaccurate documentation and incomplete records.

If a wound required review by a senior or specialist nurse, this would require the nurse arranging an appointment and travelling to the patient’s home or clinic to undertake the review and provide specialist advice.

A New App

Life Science Hub Wales offered to pilot the Minuteful for Wound app, which was taken up by district nursing SBUHB.

This project was led and managed by the district nursing managers, with limited project management experience and prior knowledge of the new tech. The app was piloted within five teams in district nursing and was then rolled out across district nursing and community wound clinic. This was a very steep learning curve, especially in relation to data collection and key performance indicators. The project has been driven from the ground up, rather than a ‘top down’ approach: work is ongoing to drive service benefits, patient care and staff engagement.

Caring for wounds in the community requires multidisciplinary working between different healthcare professionals to monitor for and prevent infection, and to encourage timely healing. Improper assessment of wounds can lead to unnecessary suffering for patients and/or unnecessary follow up visits and outpatient appointments, causing capacity issues and delays for patients.

We wanted to explore how adopting a digital approach to monitoring and assessing chronic wounds could drive better patient outcomes and lead to health system efficiencies.

Environmentally Sustainable

Our ambition was better wound management, patient activation and wellbeing, and time and cost savings while reducing our environmental impact. The new initiative adheres to the Health Board’s sustainability strategy to ‘Go digital’, which includes paperless processes, remote appointments and accessible information.

Using the Minuteful for Wound app to record wound assessments and care plans has allowed community wound clinics to become paperless. While paper patient notes remain in district nursing, everything that was previously recorded on paper regarding wounds is now documented on the app. As such, paper usage has reduced.

The app allows remote reviewing of wounds by Caseload Holders, Team Leaders, Tissue Viability Nurses and the Pressure Ulcer Prevention and Intervention Service. Without this remote access this group of health care professionals would have to travel to the patient’s home or to the clinic to offer specialist advice. Staff members use their cars to travel to patients and covering the whole of SBUHB they use a significant amount of fuel, contributing to air pollution and carbon footprint. Online reviews also reduce the need for patients to travel to a clinic if they have a concern.

The app also reduces travel for Datix incident investigations. As paper patient notes are retained in patient homes, to obtain this information a staff member needs to drive to the home, collect the notes and then return them again later the same day. The app allows this information to be obtained remotely instead.

Service Efficiencies

The app prompts early detection of wounds that are slow to heal, allowing for earlier intervention and a reduction in unnecessary suffering for the patient. Clinicians are able to involve patients in their own wound healing journey, enabling them to see progress and encouraging them to engage in self-care. Digitising and sharing records reduces the administrative burden on district nurses and wound care staff and streamlines work through a simplified, consistent recording and assessment process.

Digitised record keeping has speeded up the time taken to gather and report data, as information can be recorded online immediately (for example Datix /serious incident forms for pressure ulcers). While initial assessments are still conducted in person by the tissue viability nurse, follow-up care can be provided by district nurses, with the tissue viability nurse reviewing care via the portal. Complex wounds can be cared for by non-registrant members of the multidisciplinary team, changing the skill mix needed.

Changes have also been made to the staffing of the wound clinic, traditionally run by a band 5 registered nurse. The portal has allowed for wider skill mix in the clinics and as a consequence an extra 1,872 appointments have been offered.

Team leaders and tissue viability nurses can oversee wound management remotely, and if wounds are not healing well, they can review scans on the portal and offer specialist input to improve healing and optimise patients’ care plans.

Microbiology consultants have read-only access to the app. When they receive a wound swab from a patient who is on the app, this allows them to review the latest scan of the wound and what it is being dressed with, allowing them to produce a more robust report for the GP, and having an impact on antibiotic stewardship.

The Patient View

Feedback from patients shows they are more positive about their healing progress, and clinicians say they often use the wound images and data to engage people in their own treatment. 100% of patients surveyed by the Swansea Bay district nursing team said using the tool helped them feel more involved in their care, more motivated to embrace their treatment plan and more positive about improving their overall health, to aid healing.

Facts and Figures

The values of the project to date are:

• 2,083 hours saved per year in senior nurse (Band 6 Caseload Holder) travelling time. Calculated as: time saving for Band 6 not travelling to a visit, based on 25 staff, each saving 20 minutes per day, Mon-Fri.
• £11,250 saved on travel expenses a year. Cost saving (non-lease expenses), based on 25 staff, saving 4 miles per day, Mon-Fri.
• 30% less time for tissue viability nurses on face-to-face reviews.
• 447,120 sheets of paper saved per year. Within district nursing and wound clinic the total number of sheets of paper used for wound documentation per year = 447,120 sheets. Cost of sheet 0.38p each, total cost saving per year =£1699.05. Total carbon saving: 10,283.76 kg CO2, equivalent to driving 29,618.9 miles. (Wound clinics are now paperless and district nursing has reduced usage relating to wound documentation).
• 36 extra appointments per week have been created in the wound clinic.
• Patients feel more motivated to improve their overall health to aid healing of the wound.
• Patients advised that viewing the images of the wound motivated them to embrace their treatment plan. Staff can view real-time images of the wound with the patient, encouraging patient compliance and making them feel more involved in their care.
• Online access gives reassurance to staff with different skill sets to deliver gold standard care, with 100% access to records at any time.
• Information governance standards are compliant, particularly relating to storage of wound images, which they were not prior to using the wound app.

Conclusion

The benefits of this pilot project have been realised within district nursing and community wound clinics and as such a two-year contract has been signed to procure the Minuteful for Wound app. Data will continue to be reviewed from the dashboard and the benefits will continue to be highlighted and recorded. We have been talking to interested Health Boards across Wales and presenting our findings in all Wales groups, e.g. All Wales TVN Forum and All Wales District Nursing Forum. The value of having this app across health boards, and indeed Wales, would be a great step forward in collaborative working and seamless patient care.

Catrin Codd, DN, Senior Professional Nurse Advocate, SBUHB

LINKS

Life Science Hub Wales: https://lshubwales.com/

Minuteful for Wound app: https://healthy.io/eu/services/wound/