Lyder Courtney H, Shannon Ronald, Empleo-Frazier Ophelia, McGeHee Doreen, White Christopher
Adult Advanced Nursing Program, Specialty Care and Management Division, Yale University School of Nursing, New Haven, Conn., USA.
Ostomy Wound Manage. 2002 Apr;48(4):52-62.
With scrutiny from survey agencies (Centers for Medicare and Medicaid Services and state agencies) and potential litigation increasing, long-term care facilities must implement aggressive pressure ulcer prevention programs. However, cost-effective pressure ulcer prevention continues to be a challenge for most long-term care facilities, in part because limited research is available to guide their efforts. Two long-term care facilities (Facility A with 150 beds and Facility B with 110 beds) participated in a quasi-experimental study using retrospective and prospective study data to evaluate the effect of implementing a protocol of care to address the incidence of pressure ulcers. Retrospective study results showed a combined, cumulative, 5-month pressure ulcer incidence of 43% in Facilities A and B. Implementation of the comprehensive prevention program resulted in an 87% decrease in pressure ulcer incidence in Facility A (from 13.2% to 1.7% per month, P = 0.02) and a 76% decrease in Facility B (from 15% to 3.5% per month, P = 0.02). The average monthly cost of prevention for a high-risk resident was $519.73 (plus a one time cost of $277 for mattress and chair overlays). More than half ($277.15) of the monthly costs relates to labor; the most expensive item cost is for support surfaces. This study demonstrated that this comprehensive program resulted in a significant decrease in the incidence of pressure ulcers in two long-term care facilities. Because labor and support surface costs remain high, long-term care facilities are encouraged to use prevention intervention strategies based on risk stratification.
随着调查机构（医疗保险和医疗补助服务中心以及各州机构）的审查力度加大以及潜在诉讼的增加，长期护理机构必须实施积极的压疮预防计划。然而，对大多数长期护理机构来说，具有成本效益的压疮预防仍然是一项挑战，部分原因是可用于指导其工作的研究有限。两家长期护理机构（拥有150张床位的A机构和拥有110张床位的B机构）参与了一项准实验研究，该研究使用回顾性和前瞻性研究数据来评估实施一项护理方案对压疮发生率的影响。回顾性研究结果显示，A机构和B机构在5个月内的压疮累计发生率为43%。实施全面预防计划后，A机构的压疮发生率下降了87%（从每月13.2%降至1.7%，P = 0.02），B机构下降了76%（从每月15%降至3.5%，P = 0.02）。高危居民每月的预防平均成本为519.73美元（加上一次性的床垫和座椅衬垫费用277美元）。每月成本的一半以上（277.15美元）与劳动力有关；最昂贵的项目成本是支撑面。这项研究表明，这个全面的计划使两家长期护理机构的压疮发生率显著下降。由于劳动力和支撑面成本仍然很高，鼓励长期护理机构使用基于风险分层的预防干预策略。
