The Mölnlycke O.R. blog
Under pressure - Pressure ulcer prevention: Justifying treatment for a non-existent wound
Professor Nick Santamaria, University of Melbourne & Royal Melbourne Hospital
Everyone who delivers clinical care is under pressure to prevent pressure ulcers, and everyone in the healthcare sector is equally under pressure to reduce costs. Pressure comes from all sides.
Pressure ulcer prevention is high on the agenda of hospitals and healthcare organisations, but scepticism about the efficacy and cost effectiveness of innovative preventive approaches is equally as high. How can the duelling pressures of showing the efficacy of prophylactic treatment and the cost of doing so be balanced? That is, how can you justify the cost of a treatment for a wound that does not yet exist?
Key to addressing the challenge of justifying treatment for as-yet-non-existent wounds is twofold: timely clinical risk assessment and economic and resource utilisation. With appropriate clinical protocols in place and in practice, and knowing how extensive the multiple economic challenges of treating pressure ulcer wounds can be, we have a basis for building a case for prophylactic treatment. Heel pressure ulceration, for example, is one of the most frequent wounds, and can increase length of patient stay and sometimes even require O.R. time, microbiology, antibiotics. These are calculable costs, without even mentioning the incalculable cost of reduced quality of life for patients who do suffer from pressure ulcer wounds.
The hurdle of paying for prophylactic dressings to prevent pressure ulcers becomes much less significant when these costs are broken down and understood and when the evidence supporting prophylactic treatment is presented. Trials are being conducted frequently to bolster this growing body of evidence; for example, Santamaria et al1 found that prophylactic treatment (soft silicone multilayered foam dressings) to prevent sacral and heel pressure ulcers in critically ill patients in a randomized controlled trial yielded cost savings. There was a significant reduction of pressure ulcer incidence in those who received preventive treatment with an intervention cost estimated to be AUD 36.61 per person based on an intention-to-treat analysis, which was offset by lower downstream costs associated with PU treatment (AUD 1103.52). The average net cost of the intervention was lower than that of the control (AUD 70.82 versus AUD 144.56). Another recently published study2 estimated that within the high-risk population of acute Australian hospitals, more than 71,000 patients could be expected to develop a pressure ulcer annually, costing AUD 77,800,000 (GBP 43,000,000). But implementing a national pressure ulcer prevention initiative based on the use of prophylactic multilayer silicone foam dressings for high-risk patients could yield an annual saving of AUD 34,800,000 (GBP 19,700,000), which equals a cost benefit of 55 percent to the Australian healthcare system.
As yet unpublished research, which aligns with results from previous studies, has also shown that in 150 ICU patients, the pressure ulceration rate went from 9.2 percent of patients to zero in five months using preventive dressings with high-risk patients.
Pressure-filled administrative and cost conditions have facilitated creative clinical solutions that led to evidence-based wound management strategies. Preventive pressure ulcer treatment does require more careful risk assessment (which is easily managed by having a protocol in place) but the efficacy shown indicates that prophylactic treatment warrants inclusion in establishing a hospital’s intervention policy.
How does your hospital approach pressure ulcer prevention and care?
- Santamaria N, Liu W, Gerdtz M, Sage S, McCann J, Freeman A, Vassiliou T, Devincentis S, Ng AW, Manias E, Knott J, Liew D. “The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.” Int Wound J. 2013 Oct 6. doi: 10.1111/iwj.12160
- Santamaria N, Santamaria H. “An estimate of the potential budget impact of using prophylactic dressings to prevent hospital-acquired PUs in Australia” Journal of Wound Care 2014 Nov 6. 10.12968/jowc.2014.23.11.583