Summary

A Clinical Practice Improvement study was conducted at six long-term care provider systems and 109 facilities throughout the US to determine areas of significant improvement in the prevention and healing of pressure ulcers (PUs). Data were collected on 2,490 residents who were either at risk of developing a PU or had an existing PU. Results show that nutritional, staffing, medication, and incontinence interventions are significant areas of improvement to prevent PUs.  Prevalence studies have indicated that, on average, 11% of long-term care facility residents develop two PUs.  Early identification of PU risk and clinicians' knowledge of what interventions to implement (and when) are critical to obtain optimal PU prevention.

Primary Questions

1. What interventions, including dressings, surfaces, and positioning devices, are associated with prevention and healing of PUs in long-term care facilities?

2. What resident characteristics are the greatest risk factors for developing PUs and for prolonging healing time of PUs?

3. To what extent do nutritional interventions contribute to prevention and healing of PUs?

Methods

Data were collected on 2,490 residents: average age 79.8 years (70% female, 39% male). Multivariate analyses were performed on all data.

Results

Significant areas of improvement based on interventions associated with preventing PUs:

1. Nutritional Interventions (with treatment time ³ 21 days)

   • Early and sufficient nutritional support, using standard medical nutritional supplements

   • Enteral supplements, including disease-specific and high calorie/high protein

   • Fluid orders
     

2. Staffing Interventions

   • RN time per patient day ³ 30 minutes

   • CNA time per patient day ³ 2.25 hours
     

3. Incontinence Interventions

   • Disposable briefs

   • Toileting programs
     

4. For residents with dementia, combination of SSRI and antianxiety medications

Impact

Pressure ulcers in long-term care facilities cost on average between $1,284 and $4,647 per ulcer, per resident, to treat. For example, in a 100-bed facility housing 500 residents per year, PU treatment costs can exceed $300,000 annually.

Implementing study protocols developed for nutritional, medication, staffing, and incontinence interventions could prevent 25-50% or more of all new pressure ulcers in a long-term care facility. The facility in the above example could save over $150,000 annually.