AMG is a top-five, post-acute hospital system with 11 hospitals, some of which are embedded in larger, full-service hospitals. With a reputation for providing expert wound care, they often take on difficult cases that other hospitals turn away. The AMG staff had relied on a particular negative-pressure wound therapy (NPWT) system for years. The product was adequate, and the vendor was reasonably reliable; so, when Keri Mullins, BSN, RN, and chief clinical officer for North Alabama Specialty Hospital, was approached by corporate management to evaluate switching to the Medela Invia NPWT System (see Figure 1),1 her initial reaction was "No way."
A reluctant evaluator
Keri had good reason to be hesitant. A few years prior, she had an opportunity to use a different NPWT device, and "it was a disaster for patients," she said. "I was worried that when I switched this time, I'd have the same negative outcomes." Keri didn't want to risk trying a new device, and she wondered why she was being pushed to "fix" something that wasn't broken. Management listened to Keri's concerns but finally persuaded her to try the device because brief experiments at their hospitals in Albuquerque, New Mexico, and Lafayette, Louisiana, seemed promising. She agreed to a 3-month evaluation.
Training the staff
Before anyone at AMG could begin using the Medela system, the staff needed training. Representatives from Medela came to the hospital and trained the nurses on both the day and night shifts. The representatives stayed at the Alabama hospital, providing guidance until every nurse felt fully confident using the new devices. The Medela representatives also let the nurses know that they were available for support 24/7.
Evaluation produced surprising benefits
As AMG began using the Medela Invia pumps, they soon noticed multiple advantages over their current NPWT devices from another vendor. Many of them were completely unexpected:
* The pumps were quieter.
* They were easier to place on the patient.
* They stayed in place longer without the need for adjustment.
* They maintained pressure without the tube clogging for better exudate removal.
* The dressings stayed in place longer.
* Nurses didn't need to log device use, allowing them to spend more time helping patients.
One of the unforeseen benefits that Keri noticed was the attitude of the nurses. "They felt empowered using the Medela pumps," she said. "They had confidence they could develop care plans for patients, handle any issues that arose and troubleshoot any problems on their own. They didn't have to keep asking their nurse supervisors for help."
Accessing additional pumps when needed also proved to be an improvement. "When we needed more pumps from our previous vendor, there was usually a 48- to 72-hour delay," Keri said. "With Medela, they'd get us more pumps usually same day!"
It soon became clear that staff preferred the Medela Invia devices as well as Medela's customer service and support. How the staff felt was important to Keri, but it wasn't her chief priority. For her, what mattered most were patient outcomes.
The patients chose Medela too
The enthusiasm of the AMG staff regarding the Medela system was soon bolstered by favorable reviews from their patients. Because the pumps were easier to apply and adhered better, patients experienced less pain. With the improved exudate removal, dressings stayed on longer, and patients didn't have to endure dressing changes as frequently. Patients also liked that the Medela pumps were quieter. The noise from the previous devices was a constant annoyance. Patients complained of difficulty sleeping and the difficulty of having conversations over the noisy devices. The quiet from the Medela pumps was a welcome change.
Transitioning patients from hospital to home
One of the concerns AMG had initially about switching to Medela was how patients released from the hospital would continue their wound care at home. "Medela connected us with a home health company that also uses the Invia pumps, so our patients could have continuity of care," Keri said. "Representatives from the home health company meet with patients at our hospital prior to release. They've been wonderful, helping us to ensure our patients have a smooth transition."
Treating the most complex patients
AMG is known for taking on the most challenging cases: "We specialize in wound care," explained Keri. "We take on really sick patients with very complex wounds; the cases that any skilled nursing facility would likely turn away. Most patients stay with us for 18 to 25 days."
One patient from a hospital in Tennessee was referred to AMG. "Nobody had been able to get a vac to adhere to this patient's wound, and she'd been dealing with it for 2 years," Keri said. "With the Medela pump, we got the dressing to adhere. After 4 weeks the wound could be closed by a plastic surgeon, and the patient was able to go home!"
Hospital Consumer Assessment of Healthcare Providers and Systems scores improved
Like most hospitals, AMG has its patients complete surveys around patient satisfaction. One of the questions refers specifically to wound care. "We're always looking for ways to increase patient satisfaction," Keri said. "Once AMG began using Medela devices, the scores shot up. That's important for our employees, who take great pride in their work, and HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] scores also affect how our hospital gets paid."
Significant cost savings
Although cost savings wasn't AMG's priority, it certainly was a factor in the decision to switch to Medela. The hospital was pleasantly surprised when the year's costs were tallied. "From a cost perspective, the savings over the past 2 years have been exponential. But I would do this again even without the cost savings to improve our patient outcomes and staff satisfaction."
Keri admitted to having come full circle from reluctant evaluator to enthusiastic fan. "Our patient results are beautiful. There's not a single negative thing I can say. We made zero compromises on clinical outcomes, and the support we receive from Medela is outstanding. Our team spends less time problem solving, which has led to higher staff and patient satisfaction."
REFERENCE