Effect of a Patient-Repositioning Device in an Intensive Care Unit On Hospital-Acquired Pressure Injury Occurences and Cost: A Before-After Study

J Wound Ostomy Continence Nurs. 2017 May/Jun;44(3):236-240. doi: 10.1097/WON.0000000000000328.


Purpose: The principal aim of this study was to determine the hospital-acquired pressure injury (HAPI) rate before and after introduction of a repositioning device, measure staff-perceived level of exertion with device use, and assess return on investment.

Design: 1 group, before-and-after study.

Subjects and setting: The sample comprised 717 patients cared for in a 17-bed intensive care unit. The study setting was the neonatal intensive care unit at Bon Secours Maryview Medical Center located in the mid-Atlantic United States (Portsmouth, Virginia).

Methods: A safe patient-handling intervention was implemented as part of a quality improvement initiative. The effect of this system was measured using several outcome measures: (1) HAPI occurrences on the sacral area and buttocks, (2) perceived effort of use by staff, and (3) cost analysis. We used the validated Borg Scale to measure perceived exertion that was ranked on a scale from 6 to 20, where higher scores indicate greater exertion. Cost comparisons were completed before and after introduction of the patient-repositioning system. Cost analysis was determined using internal dollar amounts calculated for each stage of pressure injury. The return on investment was calculated by comparing the cost of HAPIs and the product after the intervention with the costs of HAPIs before the intervention.

Results: Analysis revealed a statistically significant reduction in HAPI occurrence from 1.3% to 0% (P = .004) when baseline manual repositioning (standard of care) was compared with use of the repositioning system. Caregivers reported significantly less exertion when using the repositioning device as compared with standard of care repositioning (P < .001). The return on investment was estimated to be $16,911.

Conclusion: Use of a repositioning device resulted in significantly reduced HAPIs. Perceived exertion for repositioning the patient with a repositioning device was significantly less than repositioning with standard of care. A cost analysis estimated a return on investment as a result of the intervention on HAPI prevention.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Controlled Before-After Studies
  • Cost-Benefit Analysis / methods*
  • Cost-Benefit Analysis / statistics & numerical data
  • Equipment Design / standards*
  • Equipment Safety / nursing
  • Equipment Safety / standards
  • Female
  • Humans
  • Iatrogenic Disease / prevention & control
  • Intensive Care Units / economics
  • Intensive Care Units / organization & administration
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Nurses / psychology
  • Occupational Injuries / nursing
  • Occupational Injuries / prevention & control
  • Patient Positioning / instrumentation*
  • Patient Positioning / methods
  • Pressure Ulcer / economics
  • Pressure Ulcer / prevention & control*
  • Prospective Studies
  • Quality Improvement
  • Risk Factors
  • Risk Management / methods
  • Risk Management / standards
  • Surveys and Questionnaires
  • Virginia