COST OF PRESSURE ULCER PREVENTION IN LONG-TERM-CARE

OBJECTIVE: To describe the total cost of pressure ulcer prevention, component costs of each intervention, and the relationship of costs to subjects' risk level. DESIGN: 3-month cohort trial. SETTING: A 600-bed, state-supported, long-term care facility. PATIENTS: A total of 539 war veterans, 83% of whom were male; mean age was 73 years. MAIN OUTCOME MEASURES: Cost to facility for using each of four preventive interventions: turning, pressure-reducing mattresses, chair cushions, miscellaneous preventive devices. RESULTS: Sixty-eight percent of subjects received a preventive intervention. Total 3-month facility cost of prevention was $132,114, and 97% of the cost was consumed by 30% of the subjects. Turning was the most expensive component, accounting for $99,567. The daily cost of turning for subjects who received it was $8.83 +/- 1.66. Cost increased with subject risk level. Low cost devices were instituted for lower risk subjects, whereas high cost interventions (turning) were reserved for the highest risk subjects. CONCLUSIONS: This long-term care facility expended substantial resources on prevention, and most resources (97%) were expended on less than half (30%) of subjects. Turning was, by far, the most expensive intervention, and the nursing staff reserved it for highest risk subjects. Strategies that substitute moderately priced mattresses for frequent turning may decrease the cost of prevention, as long as mattress cost is less than the daily turning costs it replaces. Future research to define the optimum combinations of preventive interventions for patients of various risk levels is needed.