Overview of Pressure Care Management and Pressure Ulcers
Pressure ulcers, also known as decubitis ulcers, are painful skin and tissue injuries caused by prolonged pressure on the skin. Commonly caused by extended periods in bed, the most often affected areas are the heels, ankles and hips.
During a study by G. Bennet et al. (2004), it was found that the cost of pressure care amounted to 4% of total NHS expenditure, and yet with suitable procedures in place all pressure ulcers are in theory preventable.
The Royal College of Nursing highlight the importance of pressure care with their recommendation that, “all healthcare professionals should be educated about:
- Pressure ulcer risk assessment and prevention,
- Selection, use and maintenance of pressure relieving devices
- Patient education and information-giving” (Clinical Practice Guidelines, p.42. 2005).
The Impact of Pressure Ulcers on the Individual
Anyone who spends extended periods in bed is at risk of developing pressure ulcers, but those at the most risk are individuals with poor circulation, obesity, incontinence, malnourishment or previous tissue damage.
Pressure ulcers can have severe effects on the individual, and the worst scenarios can lead to disability, amputation and even a threat to life. The risk of infection is heightened and the length of stay in hospital often extends, but above all pressure ulcers can be extremely painful and cause avoidable suffering.
Impact of Pressure Ulcers on the Care Industry
The financial implications of pressure ulcers are significant cause for concern for both the NHS and private care facilities.
The NHS reports that “treating pressure damage costs the NHS more than £3.8 million every day” (Improvement.nhs.uk, 2019). In cases where patients are in hospital or long-term care for a reason not originally related to pressure ulcers, the cost of pressure care equates to between £43 - £374 per patient, per day (Dealey, Posnett and Walker, 2012).
When a patient develops a pressure ulcer whilst in hospital, their stay is extended on average by 5-8 additional days (Costing statement: Pressure ulcers, 2014), taking up beds that would otherwise become free.
In addition to increased cost of care, litigation costs relating to pressure ulcers were at an all-time high of £20m in the year 2017-18, an increase of 43% in just three years (Stephenson, 2019). Cases of nursing homes being liable for pressure ulcers developing have resulted in compensation pay-outs of up to £11,000 (Accidentspecialistsolicitors.co.uk, 2019).
- The cost of pressure ulcer care is 4% of total NHS expenditure 1
- More than 90% of pressure care treatment cost is nurse time1
- A pressure sore worsening from grade 1 to grade 2 increases costs by 300%1
As is often the case with most health-related issues, prevention is the most effective cure. If the necessary guidelines and practices are followed, then almost all pressure ulcers are preventable.
The National Institute for Health and Care Excellence recommend that a risk assessment by GP’s could effectively reduce the worsening of existing pressure sores and help to prevent new pressure sores from developing. (Costing statement: Pressure ulcers, 2014)
Although it’s impractical to perform a full risk assessment on every individual who will be spending extended periods in bed, implementing an initial screening programme, such as the Anderson Pressure Ulcer Risk Assessment screening tool used by NHS Midlands and East (Nhs.stopthepressure.co.uk, 2019), should highlight those at the greatest risk. These will often be:
- Individuals with an existing or historical pressure ulcer
- Individuals with significantly limited mobility
- Individuals with an inability to reposition themselves
Performing a more in-depth risk assessment on the individuals identified, such as the Braden Scale (Braden and Bergstrom, 1988) or using technology such as the FDA authorised SEM Scanner as used by the NHS Isle of Wight (SEM Scanner, 2019), will allow care providers to adapt their care provision. This may include providing specialist equipment, such as mattresses or cushions, or following a repositioning cycle to reduce pressure levels.
Recommendations for Improving Pressure Care
Until 2018/19, there was no agreed definition as to what constitutes a pressure ulcer within the NHS. The following definition has now been standardised and rolled out in education curriculums and care providers,
“A pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can be present as intact skin or an open ulcer and may be painful” (Improvement.nhs.uk, 2019).
This standardised definition should increase understanding in healthcare professionals to help both during the identification process and in everyday care, reducing the number of cases where at risk individuals are missed.
With a more robust screening process in place, the next focus is on procedures to prevent new ulcers from developing and existing ulcers from worsening.
Mattresses | Foam or Pressure Care Technology
High specification pressure care mattresses, such as the Opera Impulse, are designed to automatically redistribute the user’s weight to reduce the pressure levels whilst in bed.
In a recent comparison study between a standard hospital foam mattress and Opera Care’s Impulse Mattress, a reduction in pressure of up to 81% was measured.
The test was performed to assess the level of pressure that an identical user would experience on both mattress types. The results would then be used to identify a user’s risk of developing, or worsening, a pressure ulcer from spending extended periods on a mattress.
The same user was measured laying on both mattresses in the same body position and measurements were simultaneously taken at 1,024 points, recording the pressure between the body and the mattress.
Pressure reductions of 81% were experienced at the head, an average of 56% in the shoulders and an average of 54% in the buttocks.
Pressure Care Mattresses | A cost assessment
Studies have shown that the suitability of pressure care equipment and it’s effect on the occurrence of pressure sores has been difficult to prove with a degree of accuracy (Gray, Cooper and Stringfellowe, 2013).
According to G Bennet et al. (2004), the mean incidence rate of pressure ulcers forming stands at 4% of hospital inpatients. The average cost of treating a pressure ulcer stands at £208.50 per patient per day and on average hospital stays are extended by 6.5 days. This results in a total avg. cost of treating pressure care at £1355.25 per affected patient.
With an incident rate of 4%, we can average this cost between 100 patients to calculate daily cost for every patient admitted into hospital.
Based on these figures, we can also calculate an average across all hospital inpatients to see how a change in incident rate would affect the total costs of pressure care treatment.
Avg. Daily Cost Analysis
By averaging the pressure care costs across all hospital inpatients, because all inpatients are at risk of being affected by pressure ulcers, allows us to calculate how an improvement in incident rate would affect treatment costs.
At the current 4% incident rate we can see that the daily cost per hospital inpatient is £8.34. Over the course of a year, the cost per occupied bed is £3,044.10.
Improving the incident rate to 1% would reduce the daily cost per hospital inpatient by £6.25 to £2.09. Over the course of a year, the cost per occupied bed would reduce by £2,281.25 to £762.85.
Based on these costs and savings, and assuming pressure care technology would be effective in reducing the incident rate, we can assess the cost effectiveness of investment in pressure care mattress technology.
Cost Analysis of Opera Impulse Hybrid Mattress System – Example Study
The Opera® Impulse Hybrid Mattress System offers wound care therapy designed specifically to take care of patients who are at risk of developing pressure ulcers, or already enduring distress and discomfort from pressure ulcers. The Impulse Mattress System costs £1495.00 exc. VAT. at retail and is covered by a 2 Year Warranty.
The table below shows a scenario of a care facility with 20 beds, currently operating at a 4% incident rate. As part of their programme to improve pressure care, the facility invested in 20 Opera Impulse Hybrid Mattress Systems to replace their existing foam mattresses as an effort to reduce the incident rate.
The statistics below demonstrate a cost analysis of the investment, savings and ROI over three years.
3% Incident Rate – Annual saving per bed of £762.50
2% Incident Rate – Annual saving per bed of £1,522.05
1% Incident Rate – Annual saving per bed of £2,281.25
- At a 3% incident rate the investment is recouped by the end of year 2
- At a 2% or 1% incident rate the investment is recouped by the end of year 1
- At a 2% incident rate there is a saving of over £61,000 after three years
- At a 1% incident rate there is a saving of over £100,000 after three years
Care facilities with pressure care equipment are likely to experience:
- a reduction in healthcare and nursing costs for repositioning residents
- decreased risk of litigation for pressure care issues
- reduced patient durations – not applicable for long term care facilities
The Opera® Impulse Pressure Care Mattresses System
The Opera® Impulse is a dynamic replacement mattress system, combining both high performance static foam, and active alternating air cell technology for exceptional patient comfort and healing. Alternating therapy can be quickly and easily applied by connecting the ultra-quiet pump, whilst still providing a peaceful sleeping environment.
Opera® Impulse Mattress
The Opera® Impulse mattress has a high-performance foam layer which features a zonal area design, which are channels for hose and cell connections to avoid pressure points on the surface to provide effective redistribution of pressure on the sacrum, head, shoulder blades and heel areas and supports patients up to 250kgs.
Opera® Impulse Air Pump
The Opera® Impulse air pump uses auto weigh technology that responds to patient movements on the mattress by automatically adjusting internal mattress pressure. This allows the Impulse power unit to regulate the interface pressure between the patient and the mattress, continuously providing total envelopment.
Call now to speak with a sales advisor to find out more about the Opera range of pressure care mattresses on 0333 222 8584.
- Costing statement: Pressure ulcers. (2014). Pressure ulcers: prevention and management. [online] Available at: https://www.nice.org.uk/guidance/cg179/resources/costing-statement-pdf-248688109 [Accessed 18 Dec. 2019].
- Dealey, C., Posnett, J. and Walker, A. (2012). The cost of pressure ulcers in the United Kingdom. Journal of Wound Care, 6, pp.230-5, 264, 261-2, 266.
- Nhs.stopthepressure.co.uk. (2019). Andersen Pressure Ulcer Risk Assessment. [online] Available at: https://nhs.stopthepressure.co.uk/path/docs/andersen%20Pressure%20Ulcer%20Risk%20Assessment.pdf [Accessed 18 Dec. 2019].
- Braden, B. and Bergstrom, N. (1988). [online] Bradenscale.com. Available at: http://www.bradenscale.com/images/bradenscale.pdf [Accessed 18 Dec. 2019].
- Stephenson, J. (2019). NHS litigation bill for pressure ulcers soars 53% in three years | Nursing Times. [online] Nursing Times. Available at: https://www.nursingtimes.net/news/technology/nhs-litigation-bill-for-pressure-ulcers-soars-53-in-three-years-08-05-2019/ [Accessed 18 Dec. 2019].
- SEM Scanner. (2019). Improved Patient Safety | Reducing Pressure Ulcers in NHS | Case Study. [online] Available at: https://sem-scanner.com/improved-patient-safety/ [Accessed 18 Dec. 2019].
- 1 Bennett, G. (2004). The cost of pressure ulcers in the UK. Age and Ageing, 33(3), pp.230-235.
- Accidentspecialistsolicitors.co.uk. (2019). [online] Available at: https://www.accidentspecialistsolicitors.co.uk/nursing-home-serious-pressure-sore/ [Accessed 18 Dec. 2019].
- Improvement.nhs.uk. (2019). [online] Available at: https://improvement.nhs.uk/documents/2932/NSTPP_summary__recommendations_2.pdf [Accessed 18 Dec. 2019].
- Improvement.nhs.uk. (2019). Pressure ulcers: revised definition and measurement. [online] Available at: https://improvement.nhs.uk/documents/2932/NSTPP_summary__recommendations_2.pdf [Accessed 18 Dec. 2019].
- The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. (2005). Clinical Practice Guidelines, p.42.
- Gray, D., Cooper, P. and Stringfellowe, S. (2013). Evaluating pressure - reducing foam mattresses and electric bed frames. British Journal of Nursing, 10(5).