From Chaos to Consistency: The Implementation of Wound Treatment TIERS in Home Care

Abstract

The advent of the Prospective Payment System challenged Johns Hopkins Home Care Group (JHHCG) to develop a more effective way to care for patients with wounds while creating quality patient outcomes. A work group was organized to standardize the wound care procedures and products throughout the agency. This group facilitated the development of wound care pathways and TIERS. The pathway outlines the content for each skilled visit, and the TIERS produced initial dressing recommendations and suggested dressing change frequency based on wound condition. Although the TIERS were developed for pressure ulcers, venous status ulcers, and surgical wounds, only the surgical pathways and TIERS are discussed in detail in this article. Extensive inservice education was provided to all clinical staff members in conjunction with the implementation of this innovative approach to wound care. The development of the wound TEIRS and pathways has dramatically changed JHHCG's traditional approach to wound care.