EUROPEAN PRESSURE ULCER ADVISORY PANEL

ESTIMATING THE COST OF PRESSURE ULCER CARE IN THE UK

Prof John Posnett1, Prof G Bennett2 and Carol Dealey3
1. York Health Economics Consortium, University of York, England, 2. Healthcare for the Elderly, 3. Nursing and Therapy Research Unit, University Hospital, Birmingham NHS Trust, Birmingham, England

Objectives

The purpose of this study is to estimate the cost to the health care system associated with the care and treatment of patients with a pressure ulcer Existing information on the cost of pressure ulcer care and on the determinants of cost is poor. One of the objectives of this study is to provide better information.

Methods

A cost model has been developed which estimates the expected cost of caring for patients with a pressure ulcer according to: (a) the grade of ulcer and (b) the setting of care (hospital inpatient, long term care facility and home care). Costs will be estimated on the basis of good practice protocols and will include the costs of pressure relief, risk assessment, turning, dressings, diagnostic tests, antibiotics and other elements of treatment. Costs will be shown per day and per episode of care for each grade of ulcer and each setting of care.

Results

The paper will discuss the main determinants of differences between patients in the costs of pressure ulcer care. It will also present estimates of the total costs of pressure ulcer care in the UK and will identify the distribution of costs by type of resource (nurse/carer time, dressings, drugs, diagnostic tests, inpatient costs).

Costs per day vary by treatment setting but do not vary substantially by the grade of ulcer .The main determinant of differences in cost per day is the ulcer-related health state of the patient: in particular the presence of infection or other complications. The most important determinant of cost is the time required to heal an ulcer. Expected time to heal is related to the grade of ulcer and also to the presence of infection or other complications. The variation in cost can be substantial.

Costs to the health care system depend on the estimated prevalence by grade and by care setting. A range of estimates will be presented.

AN OPEN MULTI-CENTER RANDOMISED STUDY COMPARING MEPILEX® BORDER SAFETAC®, A SELF-ADHERENT SOFT SILICONE FOAM DRESSING, VERSUS TIELLE™, A HYDROPOLYMER DRESSING, IN PATIENTS WITH PRESSURE ULCER STAGE II ACCORDING TO THE EPUAP GUIDELINES

M. Romanelli1, D. Van De Looverbosch2, H. Heyman2, A. Ciangherotti3, S. Meaume4 and S. Charpin4
1. Dept. of Dermatology, University of Pisa, Italy. 2. Extra-Mural Geriatric Dept. O.C.M.W. Antwerp, Belgium. 3. Centro SAIS, Leghorn, Italy. 4. L'Orbe Hopital Charles Foix, Paris, France.

Introduction

The authors present the final results from a multi-center study involving patients with Stage II pressure ulcers according to the EPUAP guidelines and enrolled in Belgium (n = 21), France (n = 7) and Italy (n = 10) for a total of 38 patients.

Methods

Patients were included in the study if ~65 years old, male and female, with a total Modified Norton scale score ~11. The wound should be red and/or yellow according to the colour classification. Patients with black necrotic tissue and with a food and/or fluid intake $: 2 were to be excluded. After randomisation, patients were allocated to treatment with either Mepilex® Border (n = 18 MXB) or Tielle™ (n = 20 TLL) and evaluated at baseline and weekly up to complete healing or to a maximum of eight weeks. Dressing change was planned at least once a week or more frequent if needed according to healing progression.

Results

Among the different parameters evaluated during the study period, tissue damage (including edge, bed and surrounding skin) was the most reported with a total of two occasions in the MXB group compared to a total of 32 occasions in the TLL group excluding baseline. Maceration was also reported on six occasions, excluding baseline, in the MXB group compared to 20 occasions in the TLL group. Eight out of 18 patients were healed before or at week 8 in the MXB group, and 10 out of 20 in the TLL group.

Summary

Both dressings had a high healing rate approximately 50%, however the Mepilex® Border group showed better results about the control of tissue damage and maceration.

PRESSURE SORES IN CRITICALLY ILL PATIENTS: STATE OF AFFAIRS

H.E.W. de Laat and Th. van Achterberg
University Medical Centre, Nijmegen, The Netherlands

Introduction

We all 'know' that Pressure sores are frequently occurring, painful and dangerous complications in critically ill patients on intensive care unit (ICU's). The aim of this literature review, that was published in 1997 in the Dutch scientific journal Verpleegkunde, is to find out the current state of affairs and especially the scientific knowledge about pressure sores in IC-patients. For that purpose four aspects in the literature were studied:

• The epidemiological aspects: how often does it occur and to what extent;
• Risk factors;
• Risk assessment instruments;
• Preventative measures.
  

Methods

After studying general literature on pressure sores, we selected in MEDLINE and OPC articles on pressure sores in critically ill patients (1967-1995). For the 5th EPUAP the study is actualised up to mid 2000.

Results/Conclusion

Based on literature research we can roughly assume that:

• One in four IC-patients have pressure sores and one in six patients that are admitted to the IC without pressure sores will develop them later. This high incidence can partly be explained by specific factors such as the:
  • medical history before admission to the IC-unit,
  • severity of disease and duration of admission and
  • the possible risk of implementing preventative measures;
    
• There are certainly contradictions for repositioning present in advance, such as serious neurotrauma, bronchospasms and arrhythmia but literature and own research however does show that:
  • the implementation of preventative measures is very arbitrary,
  • depending highly on the individual nurse that looks after you as a patient, and
  • that there is a small chance that this nurse actually also takes the proper measures.
    

NORTON, WATERLOW, BRADEN, AND THE CARE DEPENDENCY SCALE: COMPARING THEIR VALIDITY PREDICTING PATIENTS' PRESSURE SORE RISK

K. Balzer1, C. Schrniedl2 and Th. Dassen2
1. Zikadenweg 22, 70439 Stuttgart, Germany;
2. Department of Nursing Science, Humboldt University of Berlin, Berlin, Germany

Introduction

In Germany the Norton, Waterlow, and Braden Scales are the most commonly used pressure sore risk calculators. Each one of these scales is claimed to have predictive value although their predictive validity has merely been investigated within large samples. Furthermore these scales represent risk factors which seem to be strongly associated with subscales of the Care Dependency Scale (CDS). For these reasons this study was objected to compare the sensitivity and specificity of Norton, Waterlow, and Braden Scales testing them in a large sample, and secondly to evaluate the sensitivity and specificity oft the CDS identifying patients at risk.

Methods

The investigation was part of a prevalence study including 754 patients of three Berlin hospitals. A questionnaire was used containing the subscaies of the three risk calculators and of the CDS additionally to the items with regard to the prevalence. At one day nurses filled in the questionnaires using the patients' charts and assessing the patients' skin.

Results

Of 754 patients 34 subjects had at least one pressure sore. Comparing the three risk calculators the highest sensitivity could be found both for the Waterlow and Braden Scales (85.7%), and the highest specificity for the Norton Scale (75.1 %). Subjects with pressure sore were more likely to be care dependent (t-test: p < .01), 27 of them had a CDS-Score lower than 55. Using the score of 55 as cut-off point the CDS had a sensitivity of 73.6 % and a specificity of 83.1 % in identifying patients at pressure sore risk. Calculating Pearson's r a strong relationship could be found between the CDS-scores and the scores of the three scales (p < .001).

Summary

Applying the Norton, Waterlow, and Braden Scale to a large convenient sample of hospital patients some remarkable differences could be identified between these scales regarding their sensitivity and specificity. Moreover, according to this study the Care Dependency Scale seems to have predictive value similar to the three risk calculators.