Dressing wounds can be expensive, sometimes costing in excess of $100 for an individual dressing. Contingent on the severity of the wound and nature of treatment, this cost can extend over a period of months and may become a barrier to patients leaving hospital or maintaining the same level of care at home.

Many patients, however, are eligible for significant cost reductions through prescription subsidies. War veterans, their spouses, and their dependents can obtain dressings through the Repatriation Pharmaceutical Benefits Scheme (RPBS). These men and women total more than 350,000, and in fact nearly half of Australian men above 80 years of age are Department of Veteran’s Affairs (DVA) beneficiaries.

Dressings

An example is a four layer compression bandage such as Profore®, Comprilan®, Surepress®, and Tensopress®, used to treat varices and oedema associated with venous disease and lymphoedema. The RPBS allows for five bandages to be supplied on one prescription for $6.00, or at no cost to hospital or patient if the Safety Net has been achieved. Similarly, a heavily exuding cavity wound may be packed with a series of ten Sorbsan® or Kaltostat® ropes for an equal price.

The dressings may be prescribed using standard RPBS prescriptions, allowing for restrictions such as those described above. Dressings containing silver are reserved for “wounds where there is evidence of critical colonisation and chronic wounds that have not responded to conventional dressings” and require an authority prescription.

Additionally, authorities are useful to obtain a 30 day supply simultaneously when a large number of dressings are needed.

Dressing Selection

At present the technology of moist wound healing is regarded as best industry practice, and the RPBS offers a guide to assessing the wound, describing the aims of treatment, and selecting the dressing. Recommendations are based on wound type, colour of wound base, depth of wound, and amount of exudates.

Wounds fall into the following descriptive categories:

  • Pink Epithelialising Wound
  • Red Granulating Wound
  • Yellow Sloughy Wound
  • Black Necrotic Wound
  • Infected Wounds
  • Malodorous Wounds
  • Minor Skin Trauma

The particular dressings available, from simple gauze pads like Melolin® to complex matrix systems like Iodosorb®, can be found as described in Table 1 below.

Table 1. Dressings available on the RPBS. 

Dressings
Activated charcoal malodorous wound Hydroactive debridement
Alginate cavity wound Hydroactive superficial wound high
exudate semi-permeable absorbent foam
Alginate superficial wound Hydroactive superficial wound
light exudate
Film Hydroactive superficial wound
moderate exudate
Film island Hydrocolloid cavity wound
Foam heavy exudate Hydrocolloid superficial wound
light exudate
Foam moderate exudate Hydrocolloid superficial wound
moderate exudate
Foam with silicone Hydrofibre alternate to alginates
Foam with silicone and silver Hydrofibre gelling fibre
Foam with silicone heavy exudate Hydrogel
Foam with silicone light exudate Hydrogel amorphous
Foam with silicone moderate exudate Hydrogel foam
Foam with silver Hydrogel ribbon
Gauze absorbent Hydrogel sheet
Gauze eye Non adherent
Gauze paraffin Tulle non gauze paraffin
Gauze paraffin with chlorhexidine acetate With silver
Hydroactive cavity wound
Bandages
Absorbent wool Tubular
Calico Tubular finger
Compression Tubular light weight
Retention cohesive heavy Tubular long stocking
Retention cohesive light Tubular short stocking
Retention cotton crepe Zinc paste
Miscellaneous Items
Betaine + polyaminopropyl biguanide Tape plaster adhesive elastic
Cadexomer-iodine Tape plaster adhesive hypoallergenic
Gauze and cotton tissue combine roll Tape plaster adhesive with silicone
Tape non woven retention polyacrylate

 

Challenges

Changing practice can be difficult for both medical staff and patients, although the significant cost savings may be of substantial benefit to all parties.

It may be challenging to add yet another check that differentiates between patients, however a glance at the Bradma label for “DVA” will confirm the eligibility of individuals to access RPBS supplies.

Another challenge is to educate medical practitioners about writing prescriptions for dressings which may be unfamiliar. HPS Pharmacies are able to liaise directly with medical practitioners to request and guide the preparation of the necessary prescription, and are able to source these specialised dressings for ward use, or to assist patients to continue their care at home.

Conclusion

Achieving quality outcomes means considering the holistic care of the patient. To achieve this, we should ensure that the excellent care we offer is sustainable for hospital and patient alike, by accessing those government subsidies that enable full access to the best products.

Initiating these tactics within the hospital stay can only improve the likelihood of success going forward.

References:

  1. Department of Veterans’ Affairs. Repatriation schedule of pharmaceutical benefits. 1 February 2014. Canberra : Australian Government Publishing Service; 2014.

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