Cath Lab Digest

Studies conducted at healthcare institutions across the US show that pressure ulcers can increase patient length of stay, patient care costs, and patient pain and suffering.¹ Annual prevalence studies conducted at Holmes Regional Medical Center, Melbourne, Fla, a 580-bed regional medical facility, found that pressure ulcers were occurring, but due to the infrequency of data collection, trends were difficult to see. Responding to a need to improve documentation and develop best practice standards for patients at risk for developing pressure ulcers, the Wound Care Team at Holmes (comprised of Certified Wound Ostomy Continence Nurses [CWOCN], an Advanced Registered Nurse Practitioner [ARNP], and the department manager) implemented a team approach to performance improvement and developed an education plan for the clinical staff to better prevent and treat pressure ulcers.

Literature Review: Prevalence, Incidence, and Cost of Pressure Ulcers

One of the first team activities included a review of the literature for evidence-based treatment and best practices for prevention and treatment of pressure ulcers using the keywords pressure ulcer prevention, protocols, and research. The literature underscores the fact that pressure ulcers are a serious problem in the US and across the globe.² Overall prevalence of pressure ulcers in the US ranges from 3.5% to 29.5% in acute care and long-term care facilities.^3,4 Incidence ranges from 5% to 10% for all hospitalized patients,^5,6 from 3% to 9% in acute care facilities, from 2% to 28% in long-term care facilities,⁴ and up to 40% among patients with spinal cord injuries.⁷ A report by the Agency for Healthcare Research and Quality noted that of the 1.4 million patient safety incidents in US hospitals reported during 37 million hospital admissions from 2000 to 2002, pressure ulcers were one of the three most common (failure to rescue and postoperative sepsis are the other most commonly occurring incidents).^8,9 The prevalence of pressure ulcers does not seem to be declining. The results of the International Pressure Ulcer Prevalence™ Survey (IPUP) of 533 acute care facilities, conducted annually by Hill-Rom® (Batesville, Ind), indicate the annual prevalence of facility-acquired pressure ulcers (APUs) in the US increased from 7.1% in 1999 to 7.7% in 2004, with patients in Intensive Care Units (ICU) the most commonly affected. Nationally, prevalence in Medical Intensive Care Units (MICU) is 29.1%; Surgical Intensive Care Units (SICU), 21.0%; general Intensive Care Units (ICUs), 23.0%; and transitional care units, 24.8%.¹⁰

The cost of treating pressure ulcers places a great burden on healthcare facilities, increasing expenses in areas such as supplies, specialty beds, nutritional support, labs, and extra staff time required as the severity of the ulcer increases.¹¹ The annual direct cost of treating pressure ulcers in US hospitals is estimated by the Advisory Board Company in 2004 to range from $400,000 to $700,000 per year⁶ for direct treatment costs for hospital-acquired pressure ulcers. In a review of 218 research articles, Lyder¹² reports the cost of treatment to range from $500 to $40,000 per ulcer. Brem and Lyder⁵ report that a single hospital stay due to a pressure ulcer often exceeds $200,000 in costs. These financial considerations fail to take into account the additional pain and suffering experienced by the patients. The Advisory Board Company estimated that 60,000 deaths each year are associated with complications from pressure ulcers.⁵