Pressure ulcer prevention

Expensive wounds

By: Mölnlycke Health Care, November 1 2011Posted in: Pressure ulcer prevention

Pressure ulcers place a major burden on healthcare systems worldwide.
These painful wounds can severely affect patient’s quality of life, and healthcare practitioners need to consider how the implementation of prevention protocols may offer cost savings in the longer term. The cost of a dressing for example is minimal in comparison to the costs of treating an established pressure ulcer.

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Learn more about the consequences of the pressure ulcers

Pressure ulcers can have a major impact on both the individual and the healthcare system.

Patient suffering increases

  • Increased distress
  • Increased pain
  • Unable to return to normal life functions
  • Reduced quality of life
  • Increased risk of infections
  • Increased mortality risk

Cost of care increases

  • Increased length of stay
  • Increased nurse time
  • Increased cost of consumables
  • Increased cost of pharmaceuticals
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Pain Impact

Pressure ulcers are painful wounds which can severely affect patient’s quality of life. Pain levels in pressure ulcers have often been unrecognised however in recent surveys the following statistics on patient pain have been reported:

  • Up to 87.5% patients reporting pain at wound dressing change12
  • PU Pain prevalence reported 16.3% prevalence13


The recently published NPUAP/EPUAP guidelines comment that this pain can be both ’quantified’ and ’differentiated’ from other pain episodes and, importantly, occurs both during procedures and at rest. Additionally, the guidelines recommend that all patients with pressure ulcers should be assessed for pain using a validated scale and preventative/ management measures put in place.

Example of a Pain Assessment Tool


More recently the use of pain or altered sensation as a risk factor has also been identified, although further research is required.

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Financial Impact

Pressure ulcers place a major burden on healthcare systems worldwide, with an emerging additional cost of litigation increasing in importance over recent years.
Healthcare practitioners need to be aware of both the direct and indirect costs and consider how the implementation of prevention protocols may offer cost savings in the longer term. The cost of a dressing for example as a prevention tool is minimal in comparison to the costs of treating an establish pressure ulcer.

A few facts of the real financial cost of pressure ulceration:

Fact 1 the estimated cost to the US hospital sector is $11 billion per annum 14.
Fact 2 the estimated cost in the UK National Health Service is estimated at
£1.4–£2.1 billion annually (4% of total NHS expenditure)15.
Fact 3 lawsuits remain common in both acute and long term care – with high payments in certain cases16.
Fact 4 the average cost to treat an individual with an unstagable ulcer or a deep tissue injury estimated to be $43,18017,18.
Fact 5 US- One report highlighted that average length of stay in hospital is almost
3x longer19.
Fact 6 Mean hospital cost for pressure ulcers in US $14.260 in comparison the same cost in Korea is identified as $3000-$700011.
Fact 7 Cost to treat pressure ulcers in the community in Canada reported
as $900020.

 

References

  1. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009
  2. Bibliometric Analysis of Pressure Ulcer research. JWOCN; 37(6); 627-632; Hong-Lin Chen et al; 2010
  3. Medical Device related pressure ulcers in hospitalised patients. International Wound Journal; 7(5); 358-365; Black J M et al; 2010
  4. WOCN Society. Professional Practice Manual 3rd Edition, Appendix D Prevalence and Incidence: A Toolkit for Clinicians, Mt. Laurel NJ; 2005 3. Dressing related pain in patients with chronic wounds: an international patient perspective. Price P et al. International Wound Journal; 2008
  5. International Guidelines: Pressure ulcer prevention: prevalence and incidence in context. A consensus document. London: MEP Ltd, 2009
  6. Pressure Ulcer Prevalence Monitoring Project: Summary report on the Prevalence of Pressure Ulcers. EPUAP Review; Volume 4, Issue 2, 2002
  7. Results of nine international pressure ulcer surveys: 1989-2005. Ostomy Wound Management; 54(2). Vangilder C et al; 2008
  8. Prevalence of pressure ulcers in Canadian healthcare settings. Ostomy/Wound Management. 50(10):22-38. Woodbury MG, Houghton PE; 2004
  9. Prentice JL, Stacey MC. Pressure ulcers: the case for improving prevention and management in Australian health care settings. Primary Intention 2001; 9: 111-12027
  10. A Cross-sectional Descriptive Study of Pressure Ulcer Prevalence in a Teaching Hospital in China Zhao G, Ostomy Wound Manage. 2010 Feb;56(2):38-42
  11. Factors affecting healing of Pressure ulcers in Korean Acute Hospital. Sung Y.H et al. WOCN January 2011
  12. Description of pressure ulcers pain at rest and at dressing change. Szor JK. JWOCN. 26(3):115–120; 1999
  13. Pressure ulcer pain suffering; issues in a multi centre pain prevalence, Nixon J et al. Oral presentation at EPUAP Annual Conference, Birmingham, UK. 2010
  14. Reaching for the moon: achieving zero pressure ulcer prevalence. J Wound Care 18(4): 137–44 Bales I, Padwojski A ;2009
  15. The cost of pressure ulcers in the UK: Age and Ageing; 33: 230–235; Bennett G et al; 2004
  16. Legal Issues in the Care of Pressure Ulcer Patients: Ket Concepts for Healthcare Providers – A Consensus Paper from the International Expert Wound Care Advisory Panel. 23(11):493-507, November; Fife C et al; 2010
  17. Centers for Medicare & Medicaid Services. Proposed Fiscal Year 2009 Payment, Policy Changes for Inpatient Stays in General Acute Care Hospitals. Available at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3045&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500. Accessed May 13, 2008.
  18. Centers for Medicare & Medicaid Services. Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Proposed Collection of Information Regarding Financial Relationships Between Hospitals and Physicians; Proposed Rule. Federal Register. 2008;73(84):23550. Available at: http://edocket.access.gpo.gov/2008/pdf/08-1135.pdf
  19. Hospitalisation related to pressure ulcers among adults 18 years and over. Agency for Healthcare Research and Quality; Statistical Brief #64. 2006
  20. Interprofessional Management of Complex Continuing Care Patient Admitted with 18 Pressure Ulcers. Baker T et al. Ostomy Wound Management; Feb 2011
  21. Pressure Ulcer Classification; Differentiation between pressure ulcers and moisture lesions. EPUAP Review 6(3); Defloor T., et al ;2005
  22. Wound Dressing Shear Test Method (Bench) Providing Results Equivalent to Humans.Bill B et al. Poster Presentation at the EPUAP Congress, Oporto, 2011
  23. Wound Dressings, Measuring the Microclimate They Create, Call E. Oral Presentationat the EPUAP Congress, Oporto, 2011
  24. Dressings can prevent pressure ulcers :fact or fallacy? The problem of pressure ulcer prevention. Wounds UK;5(4) pg 61-64; Butcher M et al; 2009
  25. Journal of Wound, Ostomy and Continence Nursing: May/June 2007 - Volume 34 - Issue 3S - p S67 doi: 10.1097/01.WON.0000271036.00057.f8 Scientific and Clinical Abstracts From the 39th Annual Wound, Ostomy and Continence Nurses Annual Conference, Salt Lake City, Utah, June 9-13, 2007:Research Abstracts: Wound-Evidence-Based Interventions
  26. Shear A contributory factor in pressure ulceration. A presentation aimed at clinicians and associated professional. www.npuap.org; accessed 14/12/09
  27. Temperature-modulated pressure ulcers: a porcine model. Arch Phys Med Rehabil. 76(7):666-73; Kokate J.Y et al; 1995
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