The project has redesigned the way wound care products are procured, in an attempt to reduce waste and unnecessary costs, as well as ensuring that patients receive the appropriate dressing for their condition in a timely manner. The project also aims to reduce the administrative burden for clinical staff when ordering wound care products.
As part of a scoping exercise we discovered a system called ONPOS (online non prescription ordering service). We explored what the process involved and presented an options paper to our Medicines Optimisation Group. A pilot of the project was approved.
In summary it took the supply of wound care products away from the prescription route. Products are available to order via a user friendly online service. We are able to restrict product choice so that only formulary choice products are available to order. The order request is sent electronically to participating community pharmacies who acknowledge the order and then source the dressings. The dressings are typically delivered to a nominated base within 36 hours of the order being placed. The pharmacy invoice the CCG directly for the cost of products supplied at the end of the month.
A stock cupboard of dressings are available at nominated bases which means nursing teams are able to assess and treat wounds with the appropriate dressing immediately rather than waiting for the product to be supplied via the prescription route.
Training is supplied to all stakeholders and support is provided to set up and manage stock cupboards.
As the dressings are owned by the CCG rather than individual patients a box of dressings can be split amongst multiple patients. This reduces waste and costs. Dressings are supplied much quicker and accuracy of orders has increased. It also prevents over ordering and stock piling.
We conducted survey monkeys to establish clinicians' opinion about the existing supply route before the change in process and six months after it was established.
We sought feedback from practice teams, including prescription clerks.
We also sought feedback from patients in an attempt to understand whether ONPOS has improved their experience.
We are working with the nursing teams in an attempt to draw a correlation between timely supply of products and healing rates.
Unannounced inspections of stock cupboards take place on a regular basis to check that stock isn't been ordered and stored unnecessarily.
We have regular reports about product usage and are able to conduct analysis about use of different product types.
An evaluation paper of the pilot project was presented to the Medicines Optimisation Group and it was decided that the project will be rolled out to the whole CCG.
Patients: The appropriate product is available in a timely manner. Do not have to keep a supply of dressings in their home.
Nursing teams: Less administrative burden. The ordering process is simplified. Dressings are supplied quickly and accurately. Do not have to chase orders or stock.
Practice teams: Do not have to process requests for dressings. Reduced administrative burden. GPs do not take clinical responsibility for signing scripts for wound care products over which they have no involvement. Positive impact on their prescribing spend.
Pharmacies: Reimbursement is easy and timely. Support on use of system is available. Become familiar with product choice and subsequent procurement.
CCG: Reduction in spend on wound care products, approximately £15k in 6 months. Timely and detailed reports. Increased adherence to formulary choice dressings.
The main achievement of this project is that patients are supplied with appropriate dressings in a timely manner. The prescription route was protracted and could take up to 2 weeks for a product to be supplied.
Other outcomes and achievements are described above.
Other CCGs have contacted us about the project and are subsequently replicating it locally so I believe this is testament to the impact and success of the project.
