Medical Honey for Wound Care Barbara A. Bischoff Grand Canyon University: - PowerPoint Presentation

Medical Honey for Wound Care Barbara A. BischoffGrand Canyon University:NUR-699 Making the Case for Evidence-Based Practice15 October, 2014

Concept Model

Problem DescriptionAll wound types have the potential to become chronicPain is the greatest impairment with chronic wounds3-6 million patients incur $5-$10 billion annually in the United StatesThis study determined there is sufficient evidence to propose a practice change to incorporate medical grade honey for improved pain management and wound healing in patients with chronic wounds. (Rutterman et al, 2013; Werdin et al., 2009; Biglari et al., 2012)

Chronic WoundsA wound that fails to proceed through the normal temporal sequence of repair to produce anatomic functional integrity within 3 months.Social, psychological, physical and economic cost Consequences: Severe impairment of quality of life Restriction of daily activity Emotional distress Lengthy treatment High treatment expense (Frykberg, 2011; Werdin et al., 2009; Ruttermann et al.,2013)

Chronic diabetic foot ulcers (DFUs) Annual incidence – 2%Lifetime risk – 15-25%15% of DFUs lead to amputation85% of lower extremity amputations preceded by DFUCurrently 24 million people in US with Diabetes8% of Total Population Foot complications most common reason for hospitalization (Rogers, 2011)

Diabetes, Wounds and Mortality68% mortality rate in five years after amputationHistory of DFU significant predictor of mortality over age 6545% mortality rate in five years with a neuropathic ulcer ( Gethin & Cowman, 2009)

Healthcare BurdenLower extremity ulcers: one of the most common complications of diabetesleading cause for hospitalization of diabetic patients Risk factors: n europathy deformity high plantar pressure poor glycemic controllong duration of diabetesperipheral arterial disease male gender 33% of cost to treat diabetes complications spent on ulcer treatment ( Kamaratos et al., 2012)

Manuka Honey (Leptospermum scoparium) Monofloral honey produced from bees feeding on manuka plantEndemic in Australia and New ZealandExhibits broad spectrum antibiotic activity against:Staphylococcus aureus Methicillin-Resistant Staphylococcus aureus (MRSA) Pseudomonas aeruginosa Vancomycin -sensitive Vancomycinresistant enterococci (VRE) ( Kamaratos et al., 2012)

Manuka Honey Impregnated DressingProvides moist environment with antimicrobial propertiesAnti-inflammatory effectsReduces edema and exudates P romotes angiogenesis and granulation tissue formation Induces wound contraction S timulates collagen synthesis Facilitates debridement Accelerates wound epithelialization ( Kamaratos et al., 2012)

Effect of Manuka honey-impregnated dressings (MHID) on NDFU Study size 62 type 2 diabetic patients MHID [Group I ] vs conventional dressings (CD) [Group II] Weekly follow-up, 16 week duration Mean healing time 31 ± 4 days (GI) vs 43 ± 3 days (GII) = (P˂0.05) GI 78.13% became sterile in 1 week vs 35.5% in GII Weeks 2, 4, 6: 15.62 % vs 38.7 %, 6.25 % vs 12.9 % and 0% vs 12.9% Percent ulcers healed were 97% (GI) vs 90% (GII). ( Kamaratos et al., 2012)

Microbiological ActivityDilution of honey produces hydrogen peroxideEnzymatic activity of oxidasesH2O2 stimulates macrophage chemotaxis Induces Vascular Endothelial Growth Factor (VEGF) Promotes angiogenesis Stimulates fibroblast proliferation Possesses antioxidant action, protecting the local wound milieu from oxidative stress. ( Kamaratos et al., 2012)

Literature SupportTen patient studyMean duration of chronic wound prior to honey therapy 3.3 yearsSeven wounds healed in ˂ 7 monthsPerspective of effectiveness Six month pilot study should provide substantial clinical evidence of benefits. Fig 1. Patient 3. Ulcer pathology before honey gel treatment. Fig 2. Patient 3. Complete healing of the wound after 7 months of honey gel treatment. ( Tellechia , 2013)

Proposed SolutionIntroduce honey dressings into wound care program Provide information on medical honey to all stakeholdersTrain staff in accurate wound documentation processesDevelop a mentor program headed by the wound care specialist Establish champion users to promote EBP techniques Conduct pilot study with honey dressings for DFU Evaluate study through analysis of carefully documented data (Al Saeed, et al., 2013; Bittman, et al., 2010, Kwakman et al., 2011; Dermasciences, n.d.)

Change ModelARCC designed to:utilize mentorship build EBP relationshipssustain EBP Quality Management Services committee – evidence analysis Clinical Resource Management committee – product availability Performance Improvement committee – mentor development plan ( Wallen , et al., 2010)

Budget Plan and FeasibilityPrincipal Investigator =$3800.00.Assessment Committee $3600.00.Staff Education = $2050.00. Presentation Materials = $ 200.00. Print Cost for Handouts = $348.00. Dressing Product = $ 28,800.00 Total Budget: $297,998.00 (Rogers, 2010; Wallen et al., 2010)

ImplementationPresentation to key stakeholdersCommittee meetingsMentor and staff educationResource acquisitionInform patients of evidence for use of alternative dressing option Carefully document all wound measurement and qualitative data

EvaluationWound documentationPatient and nursing satisfaction questionnairesSoftware utilization to manage and control dataData collection and analysis committee Rate the following statements: Never Rarely Some times Often Always Staff were courteous and polite.           Staff understood my problem         . Staff explained care options clearly.           Staff treated me with dignity and respect.           Staff listened to what I had to say.           Staff gave me the opportunity to ask questions about my care.           Staff answered my questions clearly.           Staff involved me in decisions about my care.           Overall, I was happy with the outcome of the wound care.           (Adapted from Oxleas , n.d. )

ConclusionDecreased painIncreased wound healingBetter quality of lifeFuture patient populations will benefit from medical honey treatmentPediatricsAcute woundsCatheter prophylaxis

ReferencesAl Saeed, M. (2013). Therapeutic efficacy of conventional treatment combined with manuka honey in the treatment of patients with diabetic foot ulcers: A randomized controlled study. The Egyptian Journal of Hospital Medicine, 53(10), 1064– 1071.Biglari , B., Moghadden , A., Santos, K., Blaser , G., Buchler , A., Jansen, G., Langler, A., Graf, N. Weiler , U., Licht, /v., Strolin, A., Kack, B., Lauf , V., Bode, U., Swing, T., Hanano , R., Swatz , N.T. & Simon, A. (2012). Multicenter prospective observational study on professional wound care using honey ( Medihoney ). International Wound Care Journal. ISSN 1742-4801, 252-259. Dermasciences Inc. (n.d.). MEDIHONEY Wound and Burn Dressing with Active Leptospermum Honey. Princeton, NJ.

References (Cont)Frykberg, R.G. (2011). The science of advanced wound care: What should you be using in your office? Podiatry Today Supplement: Emerging evidence on advanced wound care for diabetic foot ulcerations. HMP Communications, LLC (HMP), 1-3, 8-15 . Gethin G, Cowman S (2009) Manuka honey vs. hydrogel – a prospective, open label, multicentre , randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. Journal of Clinical Nursing; Vol 18(3):466-474 Kamaratos , A. V., Tzirogiannis , K. N., Iraklianou , S. A., Panoutsopoulos, G. I., Kanellos, I. E. & Melidonis, A. I. (2012). Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. International Wound Journal, 1-7. doi : 10.1111/j.1742-481X.2012.01082.x

References (Cont) Kwakman , P.H.S, teVelde , A.A., deBoer , L., Vandenbroucke-Grauls , C.M.J.E. & Zaat, S.A.J. (2011). Two major medicinal honeys have different mechanisms of bactericidal activity. PLoS One, 6 (3) PMC3048876 Oxleas . ( n.d. ). Integrated complex wound care team patient satisfaction survey. National Health Service. Retrieved from http://www.oxleas.nhs.uk/your-views/patient-experience-programme/who-are-our-patient-experience/adult-community-services/integrated-complex-wound-ca-1/ )Rogers. (2011). Key concepts from the 2010 consensus statement on diabetic foot ulcerations. Podiatry Today Supplement: Emerging evidence on advanced wound care for diabetic foot Ruttermann M., Maier- Hasselmann , A., Nink -Grebe, B. & Burckhardt, M. (2013). Clinical practice guideline: Local treatment of chronic wounds in patients with peripheral vascular disease, chronic venous insufficiency, and diabetes. Dtsch Arztebl Int ; 110 (3): 25–31. DOI: 10.3238/arztebl.2013.0025

References (Cont) Tellechea , O. (2013). Efficacy of honey gel in the treatment of chronic lower leg ulcers: A prospective study European Wound Management Association Journal 13 (2), 35-39. Wallen , G. R., Mitchell, S. A., Melnyk , B., Fineout-Overholt, E., Miller-Davis, C., Yates, J. & Hastings, C. (2010). Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship program. Journal of Advanced Nursing 66 (12), 2761–2771. doi : 10.1111/j.1365-2648.2010.05442.x Werdin , F., Tennenhaus , M.,  Schaller, H.E. &  Rennekampff , H.O. (2009). Evidence-based Management Strategies for Treatment of Chronic Wounds. Open Access Journal of Plastic Surgery, 9 (19), 169-179.