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An economic analysis of repositioning for the prevention of pressure ulcers

Authors

  • Zena Moore PhD, MSc, FFNMRCSI, PG Dip, Dip Management, RGN,

    Lecturer in Wound Healing, Tissue Repair and Research Methodology, Corresponding author
    • Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
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  • Seamus Cowman PhD, MSc, FFNMRCSI, P.G Cert Ed, Dip N, RNT, RGN, RPN,

    Professor & Head of Department
    1. Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
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  • John Posnett BA, DPhil

    Senior Vice President
    1. Heron Evidence Development, Butterfield Technology and Business Park, Luton, UK
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Correspondence: Zena Moore, Lecturer in Wound Healing, Tissue Repair and Research Methodology, Faculty of Nursing & Midwifery, RCSI, 123 St Stephen's Green, Dublin 2, Ireland. Telephone: +353 1 4022414.

E-mail: zmoore@rcsi.ie

Abstract

Aims and objectives

To compare pressure ulcer incidence and costs associated with repositioning older individuals in long-term care using two different repositioning regimes.

Background

Repositioning has not always been integrated into pressure ulcer preventative methods, with arguments that it is an expensive procedure in terms of personnel and time.

Design

Participants were randomly allocated to the experimental group (n = 99; repositioned every 3 hours, using the 30° tilt) and the control group (n = 114 standard care, repositioned every 6 hours, using the 90° 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.

Results

The mean daily nurse time for repositioning was 18·5 minutes (experimental) and 24·5 minutes (control). Nurse time cost per patient over the study period was €206·6 (experimental) and €253·1 (control), 96·6% of participants (experimental) remained free of pressure ulcers, compared with 88·1% (control). The cost per patient free of ulcer was €213·9 (experimental) and €287·3 (control). Projected annual costs were estimated for the 588 (53·5%) residents in the 12 study sites requiring repositioning. The cost would be €1·59 m (experimental) and €2·10 m (control), a cost difference of €510,000. This represents a difference of 58·8 hours of nurse time, equivalent to approximately 12 full time nurses across the 12 sites.

Conclusion

Repositioning every 3 hours, using 30° tilt, has been shown to be more effective in less costly in terms of nurse time compared with standard care.

Relevance to clinical practice

Repositioning individuals at risk of pressure ulcer development makes both economic and clinical sense, thereby supporting the EPUAP/NPUAP 2009 guidelines.

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