17th Annual Wound Care Conference November 3-6, 2011 Use … · An international pressure ulcer...
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Use of a Repositioning System in Postoperative Cardiovascular ICU Patients Results in a 63% Reduction in Facility-Acquired Sacral Pressure Ulcers METHODS * Prevalon™ Turn and Position System (Sage Products Inc, Cary, IL) An international pressure ulcer prevalence survey found that overall rates of facility- acquired pressure ulcers (FAPU) were highest in adult critical care patients in 2009 (8.8% to 10.3%), with the sacral/coccyx area being one of the most commonly effected anatomical areas. 1 Patients admitted to a surgical intensive care unit (ICU) are at high risk for pressure-related injury due to multiple risk factors, including but not limited to extended surgical procedures, immobility, increased friction and shear, and exposure to moisture or incontinence. 2-4 Financial analyses report each case of FAPU is estimated to represent an average of (US) $10,845 of direct economic costs based on Medicare data, with a substantial indirect economic impact. 5 The cost of treatment for pressure ulcers depends on the ulcer stage, with conservative estimates reporting a stage I pressure ulcer in Canada is estimated to cost approximately (Canadian) $2,450 per case. 6 A study was conducted in our hospital to evaluate the effectiveness of a turn and position system* in reducing the incidence rate of sacral FAPU in the cardiovascular ICU (CVICU). BACKGROUND 1. VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008- 2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage. 2009;55(11):39-45. 2. Jackson M, McKenney T, Drumm J, et al. Pressure ulcer prevention in high-risk postoperative cardiovascular patients. Critical Care Nurse. 2011;31(4):44-53. 3. Nijs N, Toppets A, Defloor T, et al. Incidence and risk factors for pressure ulcers in the intensive care unit. J Clin Nurs. 2009;18(9):1258- 1266. 4. Terekeci H, Kucukardali Y, Top C, et al. Risk assessment study of the pressure ulcers in intensive care unit patients. Eur J Intern Med. 2009;20:394-397. 5. The Sixth Annual HealthGrades Patient Safety in American Hospitals Study. April 2009. http:// www.healthgrades.com /media/ dms/pdf/PatientSafetyInAmerican HospitalsStudy2009.pdf. Accessed October 18, 2011. 6. Are you a health-care decision- maker? Pressure Ulcer Awareness and Prevention Program, Canadian Association of Wound Care. Available at: http://www. preventpressureulcers.ca/decision- maker/decision-maker.html. Accessed October 18, 2011. 7. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guidelines. Washington D.C.; 2009. REFERENCES Linda Flockhart RN BScN, Manager, Cardiovascular Intensive Care Unit and Clare Fielding RN BScN Clinical setting: University Health Network is a large teaching hospital of the University of Toronto in Canada. The clinical setting for this trial was a 22-bed CVICU and Vascular Stepdown unit. Metrics: A team of licensed and trained wound care resource nurses conducted weekly skin and chart audits on all patients in the CVICU to determine the prevalence and incidence of pressure ulcers utilizing National Pressure Ulcer Advisory Panel staging methodology. To determine the effectiveness of a 90-day trial intervention with a turn and position system, we reviewed the 11 months prior to trial implementation and calculated the average number of sacral FAPUs over this historical baseline. The average monthly number of sacral FAPUs was compared with the average monthly number of sacral FAPUs during the 90-day trial period. In order to further assess the effectiveness of the intervention, we assessed like time periods, comparing the number of sacral FAPUs that developed 90-days before with the number of sacral FAPUs that developed during the 90-day trial. A cost analysis was also conducted, using a conservative estimate of (Canadian)$2,450 per stage I ulcer, comparing before and after incidence rates, determining cost-savings, and considering the cost of the turn and position system to determine the cost-effectiveness of the intervention. DISCUSSION 17th Annual Wound Care Conference November 3-6, 2011 CONCLUSION Given the high-risk nature of this patient population and their propensity to pressure-related injury, additional research is warranted on the impact of a turn and position system on FAPU prevention. Use of a turn and position device on our CVICU resulted in a 63% reduction in sacral FAPUs over a 90-day period, and cost-savings of approximately (Canadian) $12,175. The effectiveness of the turn and position device trial may have been attributed to several factors: • Use of the device helped caregivers adhere to best practices in patient repositioning and pressure offloading; • The design of the device ensures ease of patient repositioning with integrated handles and a low-friction glide sheet; • The 30 degree foam body wedges help facilitate repositioning in the 30 degree position, as recommended by practice; guidelines; 7 • Disposable microclimate pads help prevent exposure of the patient’s skin to excess moisture. FIGURE 1. 90-DAY BEFORE/AFTER COMPARISON OF SACRAL FAPU ON CVICU The original comparison of sacral FAPUs revealed during the 11-month historical baseline, the average number of sacral FAPUs among the total of 517 patients was 7.2 per month (mean 0.15) compared to 2.3 per month (mean 0.042) during the 3-month trial (n=165). This represented a sacral FAPU incidence reduction of 68%. The comparison of like time periods revealed that over the 90-days before the turn and position system was implemented (February, March, April 2011), 19 sacral FAPUs developed in the sacral region. A total of 7 sacral FAPUs developed over the course of the 90-day turn and position trial (May, June, July 2011). This represented a 63% reduction in sacral FAPUs during the 90-day trial (Figure 1). The secondary cost analysis (reported in Canadian dollars) revealed the estimated cost of treatment for the 19 sacral FAPUs that developed over the 90 days before the trial was $46,550, and the estimated cost of treatment for the 7 sacral FAPUs that developed during the trial was $17,150, representing an estimated cost-savings of $29,400 (63% reduction in expenditures for treatment). The total cost of the devices was $17,225. When subtracting the cost of the preventive devices from the estimated cost- savings (12 sacral FAPUs prevented), there was an estimated cost-savings of $12,175. RESULTS Poster#21650 Flockhart_Poster_UHN_CAWC_2011_CS5.indd 1 10/30/11 7:14 PM
Transcript of 17th Annual Wound Care Conference November 3-6, 2011 Use … · An international pressure ulcer...
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Use of a Repositioning System in Postoperative Cardiovascular ICU PatientsResults in a 63% Reduction in Facility-Acquired Sacral Pressure Ulcers METHODS
* Prevalon™ Turn and Position System (Sage Products Inc, Cary, IL)
An international pressure ulcer prevalence survey found that overall rates of facility-acquired pressure ulcers (FAPU) were highest in adult critical care patients in 2009 (8.8% to 10.3%), with the sacral/coccyx area being one of the most commonly effected anatomical areas.1 Patients admitted to a surgical intensive care unit (ICU) are at high risk for pressure-related injury due to multiple risk factors, including but not limited to extended surgical procedures, immobility, increased friction and shear, and exposure to moisture or incontinence.2-4
Financial analyses report each case of FAPU is estimated to represent an average of (US) $10,845 of direct economic costs based on Medicare data, with a substantial indirect economic impact.5 The cost of treatment for pressure ulcers depends on the ulcer stage, with conservative estimates reporting a stage I pressure ulcer in Canada is estimated to cost approximately (Canadian) $2,450 per case.6
A study was conducted in our hospital to evaluate the effectiveness of a turn and position system* in reducing the incidence rate of sacral FAPU in the cardiovascular ICU (CVICU).
BACKGROUND
1. VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008- 2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage. 2009;55(11):39-45.
2. Jackson M, McKenney T, Drumm J, et al. Pressure ulcer prevention in high-risk postoperative cardiovascular patients. Critical Care Nurse. 2011;31(4):44-53.
3. Nijs N, Toppets A, Defloor T, et al. Incidence and risk factors for pressure ulcers in the intensive care unit. J Clin Nurs. 2009;18(9):1258- 1266.
4. Terekeci H, Kucukardali Y, Top C, et al. Risk assessment study of the pressure ulcers in intensive care unit patients. Eur J Intern Med. 2009;20:394-397.
5. The Sixth Annual HealthGrades Patient Safety in American Hospitals Study. April 2009. http:// www.healthgrades.com /media/ dms/pdf/PatientSafetyInAmerican HospitalsStudy2009.pdf. Accessed October 18, 2011.
6. Are you a health-care decision- maker? Pressure Ulcer Awareness and Prevention Program, Canadian Association of Wound Care.
Available at: http://www. preventpressureulcers.ca/decision- maker/decision-maker.html. Accessed October 18, 2011.
7. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guidelines. Washington D.C.; 2009.
REFERENCES
Linda Flockhart RN BScN, Manager, Cardiovascular Intensive Care Unit and
Clare Fielding RN BScN
Clinical setting: University Health Network is a large teaching hospital of the University of Toronto in Canada. The clinical setting for this trial was a 22-bed CVICU and Vascular Stepdown unit.
Metrics: A team of licensed and trained wound care resource nurses conducted weekly skin and chart audits on all patients in the CVICU to determine the prevalence and incidence of pressure ulcers utilizing National Pressure Ulcer Advisory Panel staging methodology. To determine the effectiveness of a 90-day trial intervention with a turn and position system, we reviewed the 11 months prior to trial implementation and calculated the average number of sacral FAPUs over this historical baseline. The average monthly number of sacral FAPUs was compared with the average monthly number of sacral FAPUs during the 90-day trial period.
In order to further assess the effectiveness of the intervention, we assessed like time periods, comparing the number of sacral FAPUs that developed 90-days before with the number of sacral FAPUs that developed during the 90-day trial.
A cost analysis was also conducted, using a conservative estimate of (Canadian)$2,450 per stage I ulcer, comparing before and after incidence rates, determining cost-savings, and considering the cost of the turn and position system to determine the cost-effectiveness of the intervention.
DISCUSSION
17th Annual Wound Care Conference November 3-6, 2011
CONCLUSIONGiven the high-risk nature of this patient population and their propensity to pressure-related injury, additional research is warranted on the impact of a turn and position system on FAPU prevention.
Use of a turn and position device on our CVICU resulted in a 63% reduction in sacral FAPUs over a 90-day period, and cost-savings of approximately (Canadian) $12,175. The effectiveness of the turn and position device trial may have been attributed to several factors: • Useofthedevicehelpedcaregiversadheretobestpracticesin
patient repositioning and pressure offloading; • Thedesignofthedeviceensureseaseofpatientrepositioning
with integrated handles and a low-friction glide sheet; • The30degreefoambodywedgeshelpfacilitaterepositioning
in the 30 degree position, as recommended by practice; guidelines;7
• Disposablemicroclimatepadshelppreventexposureofthe
patient’s skin to excess moisture.
FIGURE 1. 90-DAY BEFORE/AFTER COMPARISON OF SACRAL FAPU ON CVICU
The original comparison of sacral FAPUs revealed during the 11-month historical baseline, the average number of sacral FAPUs among the total of 517 patients was 7.2 per month (mean 0.15) compared to 2.3 per month (mean 0.042) during the 3-month trial (n=165). This represented a sacral FAPU incidence reduction of 68%.
The comparison of like time periods revealed that over the 90-days before the turn and position system was implemented (February, March, April 2011), 19 sacral FAPUs developed in the sacral region. A total of 7 sacral FAPUs developed over the course of the 90-day turn and position trial (May, June, July 2011). This represented a 63% reduction in sacral FAPUs during the 90-day trial (Figure 1).
The secondary cost analysis (reported in Canadian dollars) revealed the estimated cost of treatment for the 19 sacral FAPUs that developed over the 90 days before the trial was $46,550, and the estimated cost of treatment for the 7 sacral FAPUs that developed during the trial was $17,150, representing an estimated cost-savings of $29,400 (63% reduction in expenditures for treatment). The total cost of the devices was $17,225. When subtracting the cost of the preventive devices from the estimated cost-savings (12 sacral FAPUs prevented), there was an estimated cost-savings of $12,175.
RESULTS
Poster#21650
Flockhart_Poster_UHN_CAWC_2011_CS5.indd 1 10/30/11 7:14 PM
