An economic analysis of repositioning for the prevention of pressure ulcers

To compare pressure ulcer incidence and costs associated with repositioning older individuals in long-term care using two different repositioning regimes.

Repositioning has not always been integrated into pressure ulcer preventative methods, with arguments that it is an expensive procedure in terms of personnel and time.

Participants were randomly allocated to the experimental group (n = 99; repositioned every 3 hours, using the 30° tilt) and the control group (n = 114 standard care, repositioned every 6 hours, using the 90° lateral rotation). The analysis explored the incidence of pressure ulcer development and the cost difference between the two repositioning schedules, over a 4-week period.

The mean daily nurse time for repositioning was 18·5 minutes (experimental) and 24·5 minutes (control). Nurse time cost per patient over the study period was €206·6 (experimental) and €253·1 (control), 96·6% of participants (experimental) remained free of pressure ulcers, compared with 88·1% (control). The cost per patient free of ulcer was €213·9 (experimental) and €287·3 (control). Projected annual costs were estimated for the 588 (53·5%) residents in the 12 study sites requiring repositioning. The cost would be €1·59 m (experimental) and €2·10 m (control), a cost difference of €510,000. This represents a difference of 58·8 hours of nurse time, equivalent to approximately 12 full time nurses across the 12 sites.

Repositioning every 3 hours, using 30° tilt, has been shown to be more effective in less costly in terms of nurse time compared with standard care.

Repositioning individuals at risk of pressure ulcer development makes both economic and clinical sense, thereby supporting the EPUAP/NPUAP 2009 guidelines.