Why set up and/or optimize your Institution’s Formulary?
The goal of a wound care product formulary is to help all healthcare professionals who care and treat patients with wounds select the most appropriate dressings and bandages for each patient.
Without a formulary, choosing among thousands of wound care products can be overwhelming and time-consuming. Furthermore, clinicians frequently order products by brand name, not realizing the clinic already has similar products in stock, under a different brand name. As a result, stock rooms may be filled with stacks of unused products, many past their expiration dates, resulting in financial loss.
We have previously shown that implementation of a local wound care formulary may result in more than 38% savings in inventory costs and increased staff efficiency.
Setting up and/or optimizing a good wound care product formulary will save financial and human resources, decrease waste and reduce total treatment cost per episode of care for the following reasons.[1]
- By having products that are clinically proven and cost-effective in the formulary, ad-hoc dressing orders will be can be decreased.
- Having a formulary can save time in clinician’s decision making and aid in continuity, as whenever different staff members perform or order dressing changes, the same regime is used. Additionally, the patient perceives the wound team as a cohesive unit and is less confused about current treatment.
- Standardization ensures only proven cost-effective products are used
- A formulary reinforces consistency of product utilization, leading to maximized clinicians’ application skills. As a result, expected dressings outcomes will be achieved, with less product waste.
This article provides steps and tips on how to set up a formulary for your institution and how to optimize an existing formulary.
My facility does not have a formulary yet. How can we set it up?
Setting up a wound care formulary may seem like a daunting task. Decisions on which products will be in the formulary should be made locally and tactfully, involving other clinicians in the decision process to obtain their input and agreement. Here we outline steps to be taken in the process, along with pro tips for engagement.
Questions to be answered before choosing products for your formulary:
Is your facility restricted to a certain manufacturer or distributor?
Find out if your facility or hospital has a binding purchasing contract with specific manufacturers or distributors. Many institutions have binding contracts to obtain tiered discounts on the amount of products purchased, which incentivizes the institution to purchase solely from a specific supplier. If your institution does have such a contract, you will need to limit your choices to products the supplier carries.
Is your facility part of a single setting or does it interact with other settings?
Are your patients only seen at your facility or do they get referred to other settings, such as skilled nursing facilities, home health, community health clinics, etc? If your patients are referred across the continuum of care, try to obtain formularies of the other settings you work with, and consider incorporating product brands they use into your formulary. In that way, you can ensure that when you refer a patient, your wound care orders will be carried out at the receiving facility. To facilitate the collaboration, share this article with the institution you work with - it will walk them through how to set up their own formulary within WoundReference and how to share their formulary with you, so that you always have real-time access to the most current version of their formulary within WoundReference.
What is your patient mix and what interventions are offered by your service?
Your formulary will need specific product types, depending on factors such as type of conditions seen at your facility and interventions offered. The table below illustrates examples of product types needed in each case:
| Examples of types of conditions |
Examples of product types to include in formulary |
| Venous ulcers |
Absorptive dressings (e.g., specialty absorptive, alginate and hydrofiber), compression bandages
|
| Arterial ulcers |
Vascular assessment devices (ABI, toe pressure, dopplers, etc)
|
| Pressure ulcer/ injuries |
Barrier creams, support surfaces, dressing to prevent developing of pressure injuries
|
| Diabetic foot ulcers |
Offloading devices (total contact cast, removable walkers, etc)
|
| Lymphedema ulcers |
Compression bandages
|
| Surgical wounds |
Incisional negative pressure wound therapy devices
|
| Skin tears |
Non-adherent dressings
|
Do clinicians at your facility have preferences? What are their usage patterns?
Clinician preferences and usage patterns can help you determine baseline usage and costs before implementation of a formulary, and can provide ideas of what products clinicians might be more inclined to accept as being part of the Institution’s formulary. To answer this question, you can ask the clinicians as a team to evaluate what they are currently using. Factors to consider are:
- Evidence based data associated with product usage
- Costs associated with certain brands, usage patterns etc.
- High use/low use products
- Standard practices versus “custom” practices that drive costs up
Are there any clinicians at your facility who are considered “experts” by their peers?
Clinicians who are respected leaders and possess command of product usage/costs can serve as clinician champions to lead the change and facilitate the meetings. These leaders are the ones who will create engagement, change practice and lead the team when creating the formulary and directly improve patient care by driving clinical practice decision making.
Setting up your formulary - save time with WoundReference
Once you answered the questions above and defined your resources, needs and limitations, follow the steps below:
- Set up a “Formulary User” within WoundReference (see Instructions)
- Find out what products your service currently has in stock
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- Go through the supply room and group all wound care products already available, by brand and size
- For formulary development, focus on more costly items (e.g., cellular and/or tissue products, dressings, etc) instead of relatively inexpensive items (e.g., syringes, gloves, etc).
- On WoundReference, log in as the Formulary User
- Go to the Product Navigator and search for the products available in your supply room
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- As you find them in the Product Navigator, click on the “heart” icon to add them to the Favorites list. As you add product brands to the Favorites list, they are automatically categorized according to their product types (e.g., alginates, foam, etc). This is a huge time saver since you don’t have to find out what categories they belong to.
- Go to the WoundReference "Formulary" (click on "Favorites", then "Products"):
-
- For each product type, check the number of brands you have. If you have more than 3, decide which ones to eliminate so you end up with 2-3 per product type. Having 2-3 products may come in handy so you have a fall back plan in case of product shortages.
- If you need to eliminate or add some brands to each product type, ask your team: What makes a product worth including in your formulary? What features are important for each product type? Is there a budget for each type of product? Can we add product brands that are used by other institutions we refer patients to?
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- To help decide which products to add/remove, use WoundReference interactive feature matrices for all products brands that have this icon . The feature matrix allows you to sort brands by features that are important to your service.
- Find pricing, coding, coverage and reimbursement information by visiting each product brand page within WoundReference
- If you need custom help deciding which products to include, send a question to WoundReference specialists panel through Curbside Consult
- For each product selected for your formulary, you can create and save custom notes with product instructions to serve as a staff educational platform and a quick-reference manual.
- If you are considering adding a product to your formulary that you have not used before, call the manufacturer sales rep and ask for samples and educational materials.
- If you would like to add a product to your formulary that is currently not featured on WoundReference, please contact editors@woundreference.com, so that our editorial team can do the research for you and add the product to the Product Navigator. We will continually update product clinical information and supporting documentation to each product brand topic on WoundReference.
- After your team agrees with the products in the formulary, run it by the Hospital Value Analysis Team or Improvement Team (or similar) for feedback and approvals.
- NOTE: to evaluate the financial impact of setting up a Digital Formulary, identify how much your program was spending on wound care supplies before and after implementation of the Digital Formulary. Make sure that the types of expenditures compared before and after are the same
Sharing your formulary
After you set up your formulary within WoundReference, all users under your Organization will automatically have access to it. This is important so that you can proceed to the next step below “Educate clinicians”.
To improve transition of care, it is also helpful if you are able to share your Institution’s formulary with other services you work with on the healthcare continuum. WoundReference allows you to easily share your formulary - share a link one time only and the other institutions would be able to always see the current version of your formulary within WoundReference.
Educating clinicians
- Set up usage guidelines with information on how and when to use the product. It will help clinicians use products from the formulary (see templates) [2]
- Educate clinicians to write orders by product type instead of brand name (e.g., alginate dressing as opposed to 3M Tegaderm Superabsorber dressing) and have a field to indicate which product brand the clinician should use. In that way, if you eventually change product brand in that product type, you don’t have to obtain a new order. [2]
- Train clinicians on how to use the formulary and guidelines.[2]
- Hold a product demonstration session to show clinicians how to use products on the formulary. The goal is for them to become familiar with the options and avoid ordering products that are not part of the formulary [2]
Establishing an approval system for ordering products that are not on formulary
- Establish an approval system for ordering products that are not on formulary If desired: make a copy of this Google Form "Request for Non-Formulary Wound Care Product" and share the link with your clinicians. Any request will be sent to you via email and automatically logged into a Google Sheet.
- Work with your product supplier or distributor. Ask the distributor to monitor and keep track of products being ordered so that reports can be shared with you. [2]
My facility already has a formulary, how can we optimize it?
If you already have an existing formulary, you can replicate it within WoundReference so that you can confirm your products are serving your facility well. To replicate your formulary within WoundReference and confirm optimal product choice, follow steps described in Setting up your formulary
How can I access the WoundReference Digital Formulary Module?
The WoundReference Digital Formulary Module is available in all WoundReference plans, including the Free Basic Plan (see Plans). While Free Basic members can follow the steps described in this topic to set up and manage their formularies, PRO+HBO and PRO members benefit from full hands-on guidance from our specialists and advisory panel on creation, implementation and maintenance of their digital formularies. For a personalized demo, contact us.
References
- Wales NHS, UK Wound Dressing Formulary [Online]. Available at: http://www.wales.nhs.uk/sitesplus/documents/862/FOI-101b.pdf [Accessed: 5 April 2018].
- How to set up an effective wound care formulary and guideline - Wound Care Advisor [Online]. Available at: https://woundcareadvisor.com/how-to-set-up-an-effective-wound-care-formulary-and-guideline_vol2-no4/ [Accessed: 10 April 2018].
About the Authors
Elaine Horibe Song, MD, PhD, MBA
Dr. Song is a Co-Founder and Chief Executive Officer of WoundReference, Inc., a clinical and reimbursement decision support & telemedicine platform for wound care and hyperbaric clinicians. With a medical, science and business background, Dr. Song previously served as medical director for a regenerative medicine-focused biotech company in California, and for a Joint Commission International-accredited hospital network. Dr. Song also served as a management consultant for Kaiser Permanente, practiced as a plastic surgeon in private practice and academia, and conducted bench and clinical research in wound healing, microsurgery and transplant immunology. Dr. Song holds a position as Affiliate Professor, Division of Plastic Surgery, Federal University of Sao Paulo, and is a volunteer, Committee Chair of the Association for the Advancement of Wound Care. She has authored more than 100 scientific publications, book chapters, software registrations and patents.
Amy Smith, JD, RN, PHN
Amy Smith, RN, JD is a principal and founder of the Bay Area Lean Institute, an organization dedicated to helping health care companies improve operations. Her primary area of expertise is transforming front line clinical departments to highly efficient and reliable teams.
Prior to forming the Bay Area Lean Institute, Amy spent 21 years with Kaiser Permanente. Most recently she managed the Surgery and Reconstructive Plastic Surgery clinics in Walnut Creek, California. The department serves over 351,000 members. Amy worked with surgeons and staff to run the day-to-day operations of the outpatient clinics. She transformed the department from one of the lowest performers in the Northern California Region to one of the best by implementing lean management principles over a three-year period. Amy also coached and mentored managers and physician leaders throughout Kaiser Permanente to implement performance improvement projects and manage using lean techniques. Amy had major clinical accomplishments including implementing video visits for wound care with community skilled nursing facilities and implementing care pathways for Colectomy, Gallbladder and Small Bowel Obstruction patients. Amy attended Kaiser’s Improvement Institute and is a certified Improvement Advisor.
Amy served three years as the Healthcare Ombudsman-Mediator for Kaiser Permanente at the Oakland and Richmond Medical Centers. She has worked in Kaiser Foundation Hospitals and Medical Groups in both the Northern and Southern California Regions. Her nursing background includes pediatrics, home health, and general medical-surgical nursing.
As an attorney Amy was Associate General Counsel/Compliance Advocate for Kaweah Delta Health Care District. She also served three years as the felony domestic violence prosecutor for Tulare County. Amy has a BSN from Mount Saint Mary’s College in Los Angeles (holding a public health certificate) and a JD from the University of La Verne College of Law in La Verne, CA. She is licensed with the California State Bar as an Attorney and the California Board of Registered Nursing.
Cathy Milne, APRN, MSN, CWOCN-AP
Advanced Practice Wound, Ostomy Continence Nurse at Connecticut Clinical Nursing Associates
Connecticut Clinical Nursing Associates American University
