Executive Summary

1 January 2017

Pressure ulcer prevention (PUP) in surgical patients has become a major interest in acute care hospitals with the increased focus on patient safety and quality of care. A pressure ulcer is any area of skin or underlying tissue that has been damaged by unrelieved pressure or pressure in combination with friction and shear. Pressure ulcers are caused due to diminished blood supply which in turn leads to decreased oxygen and nutrient delivery to the affected tissues (Tschannen, Bates, Talsma, &Guo, 2012).

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Pressure ulcers can cause extreme discomfort and often lead to serious, life threatening infections, which substantially increase the length of stay and total costs of care and compromise quality of care. The main purpose of this paper is to provide an executive summary of a project that is introduction of pressure relieving surfaces to reduce the occurrences of pressure sores in surgical patients to the Board for approval of funding of the project.

Indeed prevention and management of pressure ulcers is a priority for all health care settings, the purpose of this project is to emphasize the importance of using gel filled overlays in operating tables and use of high specification foam surfaces for post operative patients and allow funding for the project. The main concept behind the project is to provide the surgical patients with mattresses that are pressure reducing, pressure redistributing or pressure relieving. The high specification foam mattress moulds or contours to the body, helping to relieve pressure and stop ulcers from developing.

Our target population includes all surgical patients undergoing prolonged surgeries and the post operative patients. Surgical patients are particularly at high risk. Patients undergoing surgical procedures who are immobile for long periods are unable to change positions are at greater risks than patients who are mobile. Because of sedation and anesthesia, surgical patients cannot sense the numbness or pain that prolonged pressure causes and subsequently are unable to change position to relieve the pressure. The vulnerable bony areas prone to pressure ulcer are back, heels, hip, spine, elbows, shoulders and back of head.

Studies have proved that total operating time and overall number of surgical procedures are significant predictors of pressure ulcers. A research conducted by Lindgren et al found that 14. 3 % of surgical patients acquired a pressure ulcer during the time from surgery to twelve weeks after surgery. For every thirty minutes the surgery went beyond four hours, the risk for a pressure ulcer increased by approximately thirty three percent. As we are all aware that there is no reimbursement for a hospital acquired pressure ulcer and the cost for each pressure ulcer has to be absorbed by the facility.

A patient’s development of a pressure ulcer while under the care of health care provider or facility is viewed as grounds of a professional liability law suit. The mere existence of pressure ulcer is often viewed as a physical evidence of medical negligence. The cost to treat pressure ulcers are expensive, the United Sates (US) health care system spends more than one billion dollars annually to treat pressure ulcers. It has been estimated that the cost of treating pressure ulcers is 2. 5 times the cost of preventing them (Whitehead &Trueman, 2010).

In order to reduce the strain on hospital budgets caused by pressure ulcers, we need to implement a planned approach to PUP and management by incorporating a range of pressure relieving surfaces leading to improvements in health care and patient’s quality of life. Studies show that the uses of high specification foam mattress are likely to cost less overall and more effective than standard hospital mattress. For my budget justification I will be using an example from a research conducted in the University of Oxford, United Kingdom (UK) on four different patient groups.

A standard hospital mattress range from ? 39 to ? 62 and high specification foam mattresses range from ? 97 to ? 422 and overlay cost for operating tables range from ? 100 to ? 300. The pooled estimate of the four studies yielded a relative risk of 0. 29 (95% CI 0. 19–0. 43), or a relative reduction in pressure ulcer incidence of 71% (95% CI 57–81%). Calculations were based on the total costs and total number of pressure ulcers that would develop using high- specification foam mattress and standard hospital mattress.

The cost of providing a standard hospital mattress for a100 patient episodes was only ? 11, whereas the cost of providing a high specification foam mattress was higher at ? 57. However the incidence of pressure ulcers and the treatment cost are lower with high-specification foam mattress. In a group 100 patients where 20 developed a pressure ulcer only six would do so with a high-specification hospital mattress.

For example in a group of 100 patients, where 20 developed pressure ulcers the cost of treating them was ? 750 x 20 = ? 5,000, in patients cared for on a standard hospital mattress, whereas for patients cared on high-specification mattresses the cost was ? 750 x 6 =? 4500, as more pressure ulcers were prevented (Legood &McInnes, 2005). Therefore even though the high-specification foam pressure relieving mattress cost more to purchase, the treatment savings accruing through the reduced number of pressure ulcer outweigh the increased costs. Pressure ulcers continue to affect the lives of patients and are have a significant impact on patients and health service resources.

In light of current financial constraints it is highly acknowledged that high specification surfaces are more expensive than the standard surfaces, however the budget analysis reveals pressure relieving surfaces can reduce the number of pressure ulcers and the associated costs of treatment. Furthermore avoiding an adverse event during a hospital stay, such as pressure ulcer not only produces financial efficiencies but also prevents loss of quality of life and pain and suffering which patients may experience.

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