Practice Innovations
Management of painful postoperative wounds is difficult and expensive.1 Medicare estimates the cost for treatment of acute and chronic wounds ranges from $28 to 97 billion annually, with surgical wounds accounting for the largest amount.2 Upwards of 82% of surgical patients report severe wound related pain, at times causing extended length of stay in the hospital. This pain can persist for weeks after discharge from the hospital, lowering a patient’s quality of life.3 Opioids are often prescribed for management of postoperative pain, and have accounted for more than 100,000 deaths in 2021.4,5 Traditional wound dressings must also be changed frequently.
Methods: Our team instituted a quality improvement project (QIP) to test the potential of a novel wound treatment technology, a transforming powder dressing (TPD), to improve the current standard of care (SOC) practices for the management of painful postoperative wounds. We hypothesized that with the utilization of TPD, an extended wear, moist wound dressing, routine dressing changes, pain scores, narcotics, and nursing time would be reduced. A prospective evaluation was initiated with a targeted sample size of 10 to 20 patients. Adult patients with postoperative wounds and pain scores > 5 (VAS 0-10) were eligible.
Results:
QIP Group
After treatment with TPD
Dressing changes can be painful, and increase the need for opioids and risk for dependence. There is a critical need for a multidisciplinary collaboration and quality initiatives to identify alternate modalities for the management of painful acute and chronic postoperative wounds.6
Both patient-reported pain scores and usage of pain medication was substantially reduced after TPD implementation. Overall wound assessments and nursing time were also reduced compared to SOC without any wound related complications. Accelerated granulation was noted. Analysis of this data suggests that TPD may provide a safe, efficient, and significantly less painful solution for the management of postoperative wounds.
Trademarked Items:
References: 1. Chetter IC, Oswald AV, et al. Patients with surgical wounds healing by secondary intention: A prospective, cohort study. International journal of nursing studies. 2019. 89, 62–71.
2. Sen CK. Human Wounds and Its Burden: An Updated Compendium of Estimates. Advances in wound care. 2019. 8(2), 39–48.
3. Shahriari M, Golshan A, et al. Effects of pain management program on the length of stay of patients with decreased level of consciousness: A clinical trial. Iranian journal of nursing and midwifery research. 2015. 20(4), 502–507.
4. Garimella V, Cellini C. Postoperative pain control. Clinics in colon and rectal surgery. 2013. 26(3), 191–196.
5. Lopez G. New York Times; Good morning. Overdoses are increasing at a troubling rate. 2022FEB13.
6. Becker’s Hospital Review. “Wound care by the numbers: Medicare cost and utilization of patients with chronic wounds” Healogics. White paper - 090717.