What are the potential cost savings of effective pressure injury prevention?
Prevention of pressure injuries is critically important in order to avoid the clinical, quality of life and economic challenges that they present. Assessment is based on clinical judgement and Risk Assessment Tools (RATs), examples of which include the Waterlow, Norton and Braden scales1,2.
The assessments use semi-quantitative, judgement based observations to score the extent of risk factors, with the outcomes intended to influence how a patient is managed to prevent a presure injury. The use of RATs are supplemented by Skin and Tissue Assessments (STAs) – visible and palpation tests intended to identify a pressure injury. STAs appraise skin colour, blanchability, temperature, hardness and other palpable indicators of injury.
This current standard of care in risk assessment processes, is often complicated and dependent upon the subjective judgement of the clinician. RATs provide a universal whole body focus to pressure injury risk; such injuries however do not develop universally, but at specific anatomies such as the sacrum and heel. Pressure injury prevention programmes can be effective3,4 but the predictive value of RATs may be low5–12. RATs can also be particularly challenging in patients with dark skin tones which can mask any visible changes13. Furthermore the outcomes from RATs may lead to pressure injury prevention strategies14, but this is not always the case15. The results of RATs may even lead to unnecessary interventions in patients who are not at risk15 and hence this may not reduce the incidence of pressure injury8.
Prevention strategies may therefore be inappropriately or ineffectively used since such interventions may lag the time between when the damage actually begins and the time under the current standard of care at which it is detected and diagnosed. STAs for example may trigger the need for anatomy specific interventions, but this may only happen once the wound has become visible at the skin surface and at this point significant tissue damage may have already occurred.
”When effective prevention is implemented it is highly likely to be cost saving”16,17
When effective prevention is implemented it is highly likely to be cost saving16,17 compared with the cost for the treatment and management of a pressure injury. There is a clear need for an objective risk assessment method to help increase the likelihood of early identification of PI risk and early prevention strategies.
The Science of Sub-epidermal Moisture (SEM) clinical evidence summary
Elevated levels of SEM is a biomarker of early tissue damage that can lead to pressure injury development. SEM can be identified by assessing the biocapacitance of tissue. This non-invasive technology enables early and objective assessment of increased pressure injury (PI) risk, empowering you to take decisive action to minimize PI incidence and to help reduce overall cost and time to care.
Download our Science of SEM clinical evidence summary and learn about:
- The challenge of preventing pressure injuries
- Effects of prolonged pressure on tissue
- The Provzio SEM Scanner hand-held wireless, non-invasive device
- Foundational clinical studies
Talk to an Arjo Expert
Learn more about the Provizio SEM Scanner by speaking with an Arjo Expert, who will respond to your request in a timely manner.
- Moore ZEH, Cowman S. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews 2014, Issue 2. Art,No:CD006471
- O’Tuathail C, Taqi R. Evaluation of three commonly used pressure ulcer risk assessment scales. Br J Nurs. 2011;20(6):S27-8, S30, S32 Passi
- Santamaria N, McCann, J, O’Keefe S, Rakis S, Sage S, Tudor H, NG AW, Morrow F. Clinical innovation:results of a 5 year pressure ulcer prevention project in an Australian University. Wounds International 2015;6(3):12-1
- Liv Kaitani T, Nakagami G, Sugama J, Tachi M, Matsuyama Y, Miyachi Y, Nagase T, Takemura Y, Sanada H. Evaluation of an advanced pressure ulcer management protocol followed by trained ostomy and continence nurses: a non-randomised controlled trial. Chronic Wound Care Manage Rese 2015;2:39-51
- Griswold LH, Griffin RL, Swain T, Kerby JD. Validity of the Braden scale in grading pressure ulcers in trauma and burn patients. J Surg Res. 2017;219:151-157
- Chen HL, Cao YJ, Wang J, Huai BS. Calibration power of the Braden Scale in predicting pressure ulcer development. J Wound Care 2016; 25(11):655-659
- Fletcher J. An overview of pressure ulcer risk assessment tools. Wounds Uk 2017;13:18-26
- Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs.2006;54(1):94-110
- Kottner J, Dassen T. Pressure ulcer risk assessment in critical care: Interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. Int J Nurs Stud. 2010;47(6):671-7
- Gould D, Goldstone L, Kelly D, Gammon J, Examining the validity of pressure ulcer risk assessment scales: a replication study. Int J Nurs Stud. 2004;41(3)331-9
- Walsh B, Dempsey L. investigating the reliability and validity of the Waterlow risk assessment scale: a literature review. Clin Nurse Res. 2011; 20(2):197-208
- Ranzani OT, Simpson ES, Japiassu AM, Noritomi DT, Amil Critical Care Group. The challenge of predicting pressure ulcers in critically ill patients. A multicenter cohort study. Ann Am Thorac Soc. 2016;13(10):1775-1783
- Thomas DR. Issues and dilemmas in managing pressure ulcers. J Gerontol Med Sci, 2001:56:238-340
- Magnan MA, Maklebust J. Braden scale risk assessments and pressure ulcer prevention planning: whats the connection? J Wound Ostomy Continence Nurs. 2009:36(6):622-34
- Lovegrove J, Fulbrook P, Miles S. Prescription of pressure injury prevention interventions following risk assessment: A exploratory descriptive study. Int Wound J. 2018;15(6):985-992
- Padula WV, Mishra MK, Makic MB, Sullivan PW. Improving the quality of pressure ulcer care with prevention a cost effectiveness analysis. Med Care. 2011;49(4):385-92
- Padula WV, Pronovost PJ, Makic MBF, Wald HL, Moran D, Mishra MK, Meltzer DO. Value of hospital resources for effective pressure injury prevention: a cost effectiveness analysis. BMJ Qual Saf.2019 Feb;28(2):132-141