Economic Evaluations of Strategies to Prevent Hospital-Acquired Pressure Injuries

Abstract

GENERAL PURPOSE:To provide information from a review of literature about economic evaluations of preventive strategies for pressure injuries (PIs).TARGET AUDIENCE:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.LEARNING OBJECTIVES/OUTCOMES:After participating in this educational activity, the participant should be better able to:1. Identify the purpose and methods used for this study.2. Compare costs and effectiveness related to preventative strategies for PIs.ABSTRACTBACKGROUND: Pressure injuries (PIs) are a common and resource-intensive challenge for acute care hospitals worldwide. While a number of preventive strategies have the potential to reduce the cost of hospital-acquired PIs, it is unclear what approach is the most effective.OBJECTIVE: The authors performed a narrative review of the literature on economic evaluations of preventive strategies to survey current findings and identify important factors in economic assessments.DATA SOURCES: Ovid, MEDLINE, NHS Economic Evaluation Databases, and the Cochrane Database of Systematic ReviewsSELECTION CRITERIA: Potentially relevant original research articles and systematic reviews were considered.DATA EXTRACTION: Selection criteria included articles that were written in English, provided data on cost or economic evaluations of preventive strategies of PIs in acute care, and published between January 2004 and September 2015. Data were abstracted from the articles using a standardized approach to evaluate how the items on the Consolidated Health Economic Evaluation Reporting Standards checklist were addressed.DATA SYNTHESIS: The searches identified 192 references. Thirty-three original articles were chosen for full-text reviews. Nineteen of these articles provided clear descriptions of interventions, study methods, and outcomes considered.CONCLUSIONS: Limitations in the available literature prevent firm conclusions from being reached about the relative economic merits of the various approaches to the prevention of PIs. The authors’ review revealed a need for additional high-quality studies that adhere to commonly used standards of both currently utilized and emerging ways to prevent hospital-acquired PIs.

Patient expectations of pressure ulcer prevention in the NHS, healthcare demands and national policy: a critical commentary

“…The healthcare demands of pressure ulcer prevention Economic evaluations of the cost of PU prevention have been conducted in a variety of healthcare settings however, they are limited in guiding priorities due to methodological challenges undermining the value of results (Ocampo et al 2017). Specifically, evaluations of preventative interventions and associated costs are often evaluated in combination making the relative cost-effectiveness of individual interventions challenging to measure (Ocampo et al 2017).…”

Utilizing a Comprehensive Wound Care Team to Lower Hospital-Acquired Pressure Injuries in an Academic Public Hospital

“…5 Prevention measures include minimizing excessive moisture, treating and caring for fecal and urinary incontinence, frequent turning and repositioning, using specialized equipment such as mattresses, maximizing nutritional well-being, and providing staff education. 5,16,17 For prevention specific to medical devices, choosing the correct size of medical device, cushioning the skin with dressings, assessing the skin daily, and educating staff members on proper use of the device are crucial to limiting these injuries. 18 Despite insurance incentives, nursing-driven interventions, and preventative measures initiated by healthcare institutions, the risk of developing a pressure injury ranges from 2.8% to 9% in cumulative incidence based on patient length of stay.…”

“…With greater knowledge surrounding the process of how pressure injuries develop, as well as the CMS citing pressure injuries as a preventable event, prevention of and halting progression of these injuries is a necessity 5. Prevention measures include minimizing excessive moisture, treating and caring for fecal and urinary incontinence, frequent turning and repositioning, using specialized equipment such as mattresses, maximizing nutritional well-being, and providing staff education 5,16,17. For prevention specific to medical devices, choosing the correct size of medical device, cushioning the skin with dressings, assessing the skin daily, and educating staff members on proper use of the device are crucial to limiting these injuries 18.…”

Assessment of nurses’ and assistants’ knowledge on the prevention and management of pressure ulcers

“…Future evaluations should use a specific methodology so that they can compare alternative modes of action. 7 Nurses have the most predominant role in the prevention and care of pressure ulcers. They need to be able to assess which patients and when are at risk of developing pressure ulcers, and always offer the appropriate care.…”