Pressure ulcer dressings in critical patients: a cost analysis

Silva, Dinara Raquel Araújo; Bezerra, Sandra Marina Gonçalves; Costa, Jéssica Pereira; Luz, Maria Helena Barros Araújo; Lopes, Vanessa Caminha Aguiar; Nogueira, Lidya Tolstenko

doi:10.1590/S1980-220X2016014803231

Brasil

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 51 • 2017 • https://doi.org/10.1590/S1980-220X2016014803231 linkcopy

Pressure ulcer dressings in critical patients: a cost analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE To assess the direct cost of dressings in pressure ulcer treatment.

METHOD This was a descriptive observational study conducted at an intensive care unit in the Northeast region of Brazil, between November and December 2015. Data were gathered using the Pressure Ulcer Scale for Healing and a form to characterize and assess costs. Values in Brazilian reais (BRL) were converted into U.S. dollars at the exchange rate of USD 0.26/BRL. Univariate and bivariate analyses were conducted.

RESULTS The sample consisted of 15 patients with at least stage 2 ulcers. There was a significant reduction in costs with dressing materials between the initial and final assessments (p=0.002), with a mean of USD 11.9 (±7.4). The most common topical treatments used were essential fatty acids and papain.

CONCLUSION Cost reduction was proportional to the stage of pressure ulcer. The role of nurses in creating evidence-based care plans is crucial to improve care management.

Descriptors Pressure Ulcer; Costs and Cost Analysis; Bandages; Nursing Care

Materials			Quantity		Total cost (USD)
	Unit	n (%)^* * Used on all of the observed patients;	Min-Max	M (±SD)	Min-Max	M (±SD)
Needle	-	59 (100)	0.0-13.0	4.0 (2.8)	0.0-1.1	0.3 (0.2)
0.9% saline solution	100 ml	48 (100)	0.0-5.0	3.2 (1.2)	0.0-1.9	1.2 (0.4)
0.9% saline solution ampoule	10 ml	70 (100)	0.0-15.0	4.7 (3.6)	0.0-1.9	1.2 (0.5)
Scalpel and safety handle	-	21 (100)	1.0-2.0	1.4 (0.5)	0.8-1.6	1.1 (0.4)
Procedure gloves	Pair	77 (100)	5.0-6.0	5.1 (0.4)	0.5-0.5	0.4 (0.0)
Surgical gloves	Pair	75 (100)	5.0-5.0	5.0 (-)	1.2-1.2	1.2 (-)
Sterile gauze	20-unit pack	121 (100)	5.0-12	8.0 (2.8)	1.0-2.3	1.6 (0.5)
Micropore tape	cm	5265 (100)	175.0-460.0	351.0 (76.6)	0.2-0.3	0.3 (0.5)
EFA	ml	280 (100)	0.0-81.00	18.7 (20.7)	0.0-0.6	0.2 (0.2)
Papain 8%	g	83 (100)	0.0-26.0	5.5 (8.6)	0.0-2.3	0.5 (0.8)
Papain 10%	g	165 (100)	0.0-31.0	11.0 (10.6)	0.0-2.5	0.9 (0.8)
Silver Sulfadiazine	g	43 (100)	0.0-30.0	2.9 (8.2)	0.0-0.5	0.1 (0.1)
Sterile gauze compresses	5-unit pack	22 (100)	0.0-7.0	1.5 (2.4)	0.0-19.1	4.0 (6.5)
Total	-	75 (100)^ total dressing procedures performed.	-	-	5.2-27.7	11.9 (7.4)

		Total cost (USD)
Stage of pressure ulcer	n(%)	Min-Max	M(±SD)
Stage 2	6 (40.0)	6.5-13.1	8.2 (2.4)
Stage 3	6 (40.0)	5.2-24.2	14.1 (8.4)
Stage 4	1 (6.7)	27.7-27.7	27.7 (-)
Unstageable	2 (13.3)	7.8-9.0	8.4 (0.9)
Total	15 (100)	5.2-27.7	11.9 (7.4)

Characteristic	Initial			Final			p-value
		Total cost (USD)			Total cost (USD)
	n (%)	Min-Max	M (±SD)	n (%)	Min-Max	M (±SD)
Tissue type
Epithelial	-	-	-	1 (6.7)	0.7-0.7	0.7 (-)	-^* * Insufficient number of valid decimal places to conduct test.
Granulation	1 (6.7)	2.7-2.7	2.7 (-)	4 (26.6)	1.1-4.0	1.9 (1.4)	0.068^u
Slough	6 (40.0)	1.1-5.5	3.4 (2.0)	7 (46.7)	0.7-4.5	2.0 (1.7)	0.028^u
Necrotic	8 (53.3)	1.1-4.4	2.4 (1.3)	3 (20.0)	0.8-1.1	0.7 (0.2)	0.036^u
Exudate amount
None	7 (46.7)	1.4-5.5	2.4 (1.5)	1 (6.7)	0.7-0.7	0.7 (-)	0.018^u
Light	5 (33.3)	1.1-5.1	2.4 (1.6)	12 (80.0)	0.7-4.5	1.6 (1.4)	0.080^u
Moderate	3 (20.0)	4.3-5.0	4.6 (0.4)	2 (13.3)	1.4-4.0	2.7 (1.9)	0.280^u
Wound surface area	15 (100)	1.1-5.5	3.3 (1.6)	15 (100)	0.7-4.5	2.4 (1.7)	0.002^t
4.1-8.0 cm²	-	-	-	2 (13.3)	0.7-1.1	0.9 (0.3)	-^* * Insufficient number of valid decimal places to conduct test.
8.1-12.0 cm²	2 (13.3)	1.5-5.0	3.2 (2.5)	2 (13.3)	0.7-1.1	0.9 (0.3)	0.180^u
12.1-24 cm²	2 (13.3)	1.4-2.3	1.8 (0.6)	-	-	-	-^* * Insufficient number of valid decimal places to conduct test.
>24 cm²	11 (73.4)	1.1-5.5	2.9 (1.6)	11 (73.4)	0.8-4.5	1.9 (1.6)	0.008^u
PUSH	15 (100)	1.1-5.5	2.9 (1.5)	15 (100)	0.7-4.5	1.7 (1.4)	0.001^t
Exudate aspect
Absent	7 (46.7)	1.4-5.5	2.4 (1.5)	1 (6.7)	0.7-0.7	0.7 (-)	0.020^u
Serous	1 (6.7)	5.0-5.0	5.0 (-)	-	-	-	-^* * Insufficient number of valid decimal places to conduct test.
Sanguineous	2 (13.3)	1.1-4.6	2.7 (2.3)	3 (20.0)	0.7-4.0	1.3 (1.7)	0.180^u
Serosanguineous	5 (33.3)	1.1-5.0	3.0 (1.7)	11 (73.3)	0.8-4.5	1.1 (0.3)	0.043^u
Wound odor
Present	1 (6.7)	4.3-4.3	4.3 (-)	-	-	-	-^* * Insufficient number of valid decimal places to conduct test.
Absent	14 (93.3)	1.1-5.5	2.7 (1.6)	15 (100)	0.7-4.5	1.1 (0.6)	0.001^u
Change frequency
Once a day	11 (73.3)	1.1-5.5	2.7 (1.7)	12 (80.0)	0.7-4.5	1.1 (0.3)	0.004^u
Twice a day	4 (26.7)	1.4-4.4	3.2 (1.4)	3 (20.0)	0.7-4.0	0.8 (1.9)	0.140^u
Total	15 (100)	1.1-5.5	2.8 (1.6)	15 (100)	0.7-4.5	1.1 (0.5)	0.002^t

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[TFN1] ^Legend
M (±SD): mean and standard deviation; Min-Max: minimum and maximum costs;

[TFN2] ^*
Used on all of the observed patients;

[TFN3] ^**
total dressing procedures performed.

[TFN4] ^Note
(n=75)