An economic analysis of repositioning for the prevention of pressure ulcers

Aims and objectivesTo compare pressure ulcer incidence and costs associated with repositioning older individuals in long-term care using two different repositioning regimes. BackgroundRepositioning has not always been integrated into pressure ulcer preventative methods, with arguments that it is an expensive procedure in terms of personnel and time. DesignParticipants were randomly allocated to the experimental group (n=99; repositioned every 3hours, using the 30 degrees tilt) and the control group (n=114 standard care, repositioned every 6hours, using the 90 degrees lateral rotation). The analysis explored the incidence of pressure ulcer development and the cost difference between the two repositioning schedules, over a 4-week period. ResultsThe mean daily nurse time for repositioning was 18<bold>5</bold>minutes (experimental) and 24<bold>5</bold>minutes (control). Nurse time cost per patient over the study period was Euro206<bold>6</bold> (experimental) and Euro253<bold>1</bold> (control), 96<bold>6</bold>% of participants (experimental) remained free of pressure ulcers, compared with 88<bold>1</bold>% (control). The cost per patient free of ulcer was Euro213<bold>9</bold> (experimental) and Euro287<bold>3</bold> (control). Projected annual costs were estimated for the 588 (53<bold>5</bold>%) residents in the 12 study sites requiring repositioning. The cost would be Euro1<bold>59</bold>m (experimental) and Euro2<bold>10</bold>m (control), a cost difference of Euro510,000. This represents a difference of 58<bold>8</bold>hours of nurse time, equivalent to approximately 12 full time nurses across the 12 sites. ConclusionRepositioning every 3hours, using 30 degrees tilt, has been shown to be more effective in less costly in terms of nurse time compared with standard care. Relevance to clinical practiceRepositioning individuals at risk of pressure ulcer development makes both economic and clinical sense, thereby supporting the EPUAP/NPUAP 2009 guidelines.