COST OF PRESSURE ULCER PREVENTION IN LONG-TERM-CARE

OBJECTIVE: To describe the total cost of pressure ulcer prevention, co mponent costs of each intervention, and the relationship of costs to s ubjects' risk level. DESIGN: 3-month cohort trial. SETTING: A 600-bed, state-supported, long-term care facility. PATIENTS: A total of 539 wa r veterans, 83% of whom were male; mean age was 73 years. MAIN OUTCOME MEASURES: Cost to facility for using each of four preventive interven tions: turning, pressure-reducing mattresses, chair cushions, miscella neous preventive devices. RESULTS: Sixty-eight percent of subjects rec eived a preventive intervention. Total 3-month facility cost of preven tion was $132,114, and 97% of the cost was consumed by 30% of the subj ects. 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 i nstituted for lower risk subjects, whereas high cost interventions (tu rning) 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 subj ects. Turning was, by far, the most expensive intervention, and the nu rsing staff reserved it for highest risk subjects. Strategies that sub stitute moderately priced mattresses for frequent turning may decrease the cost of prevention, as long as mattress cost is less than the dai ly turning costs it replaces. Future research to define the optimum co mbinations of preventive interventions for patients of various risk le vels is needed.