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Pressure Ulcer Prevention Program Study: A Randomized, Controlled Prospective Comparative Value Evaluation of 2 Pressure Ulcer Prevention Strategies in Nursing and Rehabilitation Centers

Shannon, Ronald J. MPH, BS; Brown, Lynne MBA, BSN, RN; Chakravarthy, Debashish PhD

doi: 10.1097/01.ASW.0000421461.21773.32

OBJECTIVE: This article assesses the comparative prevention-effectiveness and economic implications of a Pressure Ulcer Prevention Program (PUPP) against standard practice of prevention using Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality [AHRQ]) guidelines and a mixture of commercial products.

DESIGN: The study is a randomized, controlled, prospective cohort study with an accompanying economic evaluation. The economic evaluation is performed from the perspective of the nursing and rehabilitation centers.

SETTINGS: Two nursing and rehabilitation centers under the same quality and safety support organization. Both institutions are experiencing high nursing staff turnover and incidence of pressure ulcers (PrUs).

PARTICIPANTS: 133 residents at risk of developing PrUs (EQUIP-for-Quality Risk Score Moderate to Very High [MVH]). All are Medicare-eligible residents with Minimum Data Set (MDS) 2.0 evaluations.

INTERVENTIONS: The PUPP includes a strategic product bundle and decision algorithms driven by MDS 2.0 Resident Assessment Scores to assist in reducing or preventing PrUs and incontinence-associated skin conditions. The control group utilizes a different brand and assortment of commercial skin care products, briefs, pads, and mattresses, but without use of the decision algorithms driven by MDS 2.0 Resident Assessment Scores. Pressure ulcer prevention education was done for all nurses by a nurse certified in the PUPP program at the beginning and ad libitum by trained senior nursing staff at the end of the study.

MAIN OUTCOME MEASURES: Comparative reduction in the incidence of nosocomial PrUs and average 6-month net cost savings per MVH-risk resident.

METHODS: Residents were assessed for PrU risk using EQUIP-for-Quality risk assessment algorithm based on data from their Minimum Data Set (MDS 2.0), then assigned to either the PUPP program or control group (standard practice following AHRQ guidelines). Residents were followed until discharge, death, development of PrU, or a maximum time period of 6 months. Direct medical costs of prevention and PrU treatment were recorded using a modified activity-based costing method. A decision model was used to estimate the net cost savings attributed to the PUPP program over a 6-month period.

RESULTS: A 67% reduction in the incidence of nosocomial pressure ulcers is attributable to the PUPP strategy over a 6-month period for MVH residents. The average 6-month cost for a MVH Medicare resident is $1928 and $1130 for the control group and PUPP group respectively. Mean difference (net cost savings per resident at risk of pressure ulceration) is $798 per resident for PUPP.

CONCLUSIONS: PUPP assisted in reducing the incidence of PrUs by 67% in a 6-month period in nursing home facilities. The estimated annual net cost savings attributed to PUPP for 300 MVH residents is estimated at approximately $240,000

This study estimates the value of the Pressure Ulcer Prevention Program in preventing pressure ulcer occurrence in residents at moderate to very high risk in 2 nursing and rehabilitation centers exhibiting high staff turnover.

Ronald J. Shannon, MPH, BS, is President, Global Health Economic Projects LLC, Clifton Park, New York. Lynne Brown, MBA, BSN, RN, is President, LMS Brown Consulting LLC, Victor, New York. Debashish Chakravarthy, PhD, is Vice President, Technical and Clinical Affairs, Medline Industries, Inc, Mundelein, Illinois.

Mr Shannon has disclosed that he has no financial relationships related to this article. Ms Brown has disclosed that she was a consultant/advisor to Medline Industries. Dr Chakravarthy has disclosed that he is an employee of the company (Medline) whose products were tested.

Acknowledgments: The authors thank all the colleagues, facility administrators, and nursing staff at the nursing and rehabilitation facilities who contributed to this study, as well as the management team at corporate headquarters for their support and assistance through completion of this research. This study was funded and supported by Medline Industries, Inc, Mundelein, Illinois. All products for the experimental group were donated by Medline Industries, Inc. No external funding, apart from the support of the authors’ institutions, was available for this study. Submitted June 21, 2011; accepted in revised form May 8, 2012.

© 2012 Lippincott Williams & Wilkins, Inc.