Dollars and Sense: Economic Value in HAPU/sDTI Prevention

Background:  The Centers for Medicare and Medicaid Services has stopped reimbursing for Stage III and IV hospital acquired pressure ulcers (HAPU’s).  In 2010, our facility had total of six HAPU’s. Three of these HAPU’s were suspected deep tissue injuries (sDTI’s) on patients following cardiovascular surgeries. Each HAPU could have potentially cost our facility $43,180¹.

Problem: Literature related to Health Economic Value and HAPU/sDTI prevention in the operating room and the critically ill patient population is lacking.

Objective:  

• Decrease HAPU’s/sDTI’s in Critical Care Unit (CCU), Intensive Care Unit (ICU), Cardiovascular Intensive Care Unit (CVICU) and the Cardiovascular Operating Room (CVOR) population.
• Initiate a prevention protocol to address friction, shear, and manage microclimate.
• Decrease hospital costs through reduction of HAPU’s/sDTI’s with the addition of application of a soft silicone sacral dressing (SSSD).

Setting:  CCU, ICU, CVICU and CVOR.

Participants:  CCU, ICU, CVICU patients meeting Bridle’s² inclusion criteria. CVOR patients with surgeries ≥ 4 hours.  

Method:  SSSD was applied to the sacrum, skin assessed daily.  SSSD’s were changed every 3 days.

Results:  58 enrolled in the study, 56 completed with a 0% incidence of HAPU/sDTI’s during the 3 month study period.  Two patients were dropped from the study because protocol was not followed.

Conclusion: The use of the SSSD, as part of a comprehensive Pressure Ulcer Prevention Program, played an integral part in the reduction of HAPU/sDTI’s in the population studied. Although a small sample, this case study validates the study performed by Cherry³ in 2011. Since adoption of the SSSD as “Best Practice”, our facility has maintained a 0% incidence of HAPU’s/sDTI’s  over  the past 18 Months.  The cost of SSSD’s for prevention, over 15 months, was $21,590; nearly half the cost of treating one HAPU/sDTI.  Further Health Economic research is warranted for Pressure Ulcer Prevention.