Pressure ulcer prevention: a randomized controlled trial of 2 risk-directed strategies for patient surface assignment.
OBJECTIVE
To compare the clinical utility, in terms of incidence of pressure ulcer (PU) development, and economic impact of 2 programs of patient surface assignment for PU prevention.


METHODS
Randomized controlled clinical trial with economic evaluation.


METHODS
30-bed multidisciplinary intensive care unit (ICU), serving as the regional trauma center.


METHODS
144 consecutive eligible patients at risk for the development of PUs.


METHODS
PU risk was assessed on admission using the Skin Ulcer Risk Evaluation (SURE) Score, and patients were randomized to either the experimental (purchase) or control group (purchase/rent). Based on their SURE Score, patients were assigned a specialty surface if needed. Patients received head-to-toe skin assessments twice weekly, new PUs were documented, a new SURE Score was calculated, and specialty surfaces were upgraded or downgraded as necessary.


RESULTS
The incidence of PUs by site and severity, and cost.


METHODS
Multivariate logistic regression and decision modeling.


RESULTS
No significant differences were detected between groups with respect to baseline population characteristics, nor in the development of PUs. Predictors of PU development were ICU length of stay and SURE Score. The experimental (purchase) group was the less costly strategy. Under baseline assumptions, surface costs per at-risk patient were $76 CDN and $171 CDN in the experimental and control groups, respectively. The savings of $95 CDN per at-risk patient translates into conservative annual savings of $47,500 CDN.


CONCLUSIONS
Using an objective, risk-based method of patient surface assignment, the authors compared the clinical and economic outcomes of 2 programs of PU prevention. In a direct comparison of alternatives, the strategy that emphasized purchased rather than rented products proved to be the more economical. Finally, this approach illustrates how by prospectively capturing data on both the costs and consequences of competing alternatives, a more objective and informed decision-making process can result.
D000368:Aged; D001513:Beds / Q000191:economics / Q000592:standards*; D017046:Cost Savings; D003663:Decision Trees; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods; D018579:Patient Selection; D003668:Pressure Ulcer / Q000191:economics / Q000451:nursing / Q000517:prevention & control*; D012307:Risk Factors