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The best of both worlds

Formulary management: Fawcett Memorial Hospital saves on costs and reduces waste with a hybrid underpad program

The insight

Our mission is to make healthcare run better by improving operating performance in four key areas. This is how we help bring down overall costs, as well as protect and grow revenue.

In this case study, we focus on reducing supply costs through more effective utilization. Healthcare providers need reliable and cost-effective incontinence products to protect patients from skin damage caused by excess moisture. Most hospitals take a one-size-fits-all approach, using a single category—for example, high-end disposable underpads—which can lead to overspending.

We helped Fawcett Memorial Hospital evaluate its moisture management needs against best practice benchmarks. Next, we created a blended, more cost-effective program of disposable and reusable underpads based on different levels of patient need. The result: better financial outcomes, without compromising patient care.

Fawcett Memorial
  • Full-service acute-care hospital
  • 238 beds
  • Overspending on moisture management program
  • Maintaining patient skin health
  • Assess spend/utilization against best practice benchmarks
  • Evaluate different products and determine clinical benefits
  • Develop hybrid product formulary customized to patient needs
  • Maintained skin health without compromising care
  • More than $50,000 a year in supply cost savings
  • Reduced waste
About Fawcett Memorial

Based in Port Charlotte, Florida, Fawcett Memorial is a 238-bed, full-service acute care hospital serving Charlotte County and the surrounding areas. Clinical specialties include emergency, heart, vascular, surgical and orthopedic care.


Healthcare providers encounter many different skin conditions every day. But among the most common are those caused by prolonged exposure to moisture, including incontinence associated dermatitis (IAD).

IAD is characterized by inflammation of the skin caused by exposure to urine or stool. Skin breakdown resulting from IAD and other moisture-associated skin damage is a common, costly and painful problem. Patients with both incontinence and impaired mobility are at a 37.5% greater risk of developing a pressure injury.1 Approximately 60,000 patients die from pressure injuries each year.2

Healthcare providers require reliable and cost-effective solutions to protect against IAD. Though available incontinence products vary in design and cost, most fall into one of two categories: disposable, fast-drying underpads or reusable, breathable underpads.


greater risk of developing a pressure injury for patients with both incontinence and impaired mobility 1

Comparing options

Both types of underpads offer benefits for healthcare facilities. Disposable, fast-drying underpads—or drypads—can be relatively expensive, but they contribute to better skin outcomes when used for high-moisture, high-fluid-output incontinence care. By drawing in moisture and locking it away from the skin, drypads maintain skin integrity in patients and reduce the risk of hospital-acquired pressure injuries.

Key benefits of disposable underpads:

  • Dry to the touch in minutes
  • Air permeable for skin health and patient comfort
  • Lies flat when wet, without bunching, swelling or disintegrating
  • Maintaining proper pressure index
  • Managing multiple voids

greater risk of developing a pressure injury for patients with both incontinence and impaired mobility 1

In contrast, reusable underpads are often less expensive, helping decrease waste and costs. Though they don’t dry as quickly as disposable dry underpads, innovations are changing that. Reusable options are best for noncritical patients because they are less likely to have high-fluid incontinent episodes during their hospital stays.

Benefits of reusable underpads:

  • Tolerating multiple washings
  • Air permeable for skin health and patient comfort
  • Lying flat when wet, without bunching, swelling or disintegrating
  • Maintaining proper pressure index
  • Helping reduce waste and costs

Many US hospitals utilize one of these options exclusively to manage incontinence. Fawcett Memorial was using 100% disposable underpads and overspending on its moisture management program.


Finding the right mix

Brenda Sellers, RN, Clinical Resource Director at Fawcett Memorial, was interested in taking a hybrid approach to the hospital’s incontinence products, using disposable drypads for high-risk patients and reusable options for noncritical patients. This type of blended moisture management solution makes the best use of both underpad options: cost-effective reusable and fast-drying disposable.


Clinical and financial results

Sellers led a clinical trial to determine the correct ratio of reusable and disposable underpads Fawcett needed. Based on the findings, Fawcett switched to the hybrid approach, using 75% breathable, reusable underpads and 25% dry, disposable underpads.

The introduction of a reusable pad saved Fawcett more than $50,000 a year in supply costs and significantly reduced waste—all without any negative impact to patient skin health.

  1. Langemo D, Hanson D, Hunter S, et al. Advances in skin & wound care. The Journal for Prevention and Healing. 2011;24(3):126-140. Available at Accessed March 13, 2020.
  2. Preventing pressures ulcers in hospitals. Agency for Healthcare Research and Quality. Available at: Accessed March 13, 2020.

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