Cost of Medical Nutrition Therapy in the Healing of Pressure Ulcers

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LEARNING OUTCOME: To determine the costs of dietary interventions and dietitian's time to assess, implement and evaluate the effectiveness of these interventions that bring about healing of pressure ulcers in long term care residents. Outcomes studies are needed to quantify the benefits and cost-effectiveness of the services of a dietitian in long term care. The cost of healing pressure ulcers is estimated between $2,000 and $30,000. These numbers are not broken down to describe the costs of medical nutrition therapy. Residents over 60 years of age in long term care who developed a pressure ulcer were studied. The clinical outcome monitored was the healing of the pressure ulcer. Healing is defined as the physician order to discontinue treatment per nursing judgment. The resident's weight status, lab status especially albumin and healing progress were assessed and monitored as evidenced by changes in pressure ulcer size, color and drainage. The costs of the added nutrition interventions and for dietitian monitoring were evaluated. The costs of nursing interventions and licensed nursing time were not part of this study. Nine women and four men were followed in this study. The dietitian was notified when a resident developed a pressure ulcer and at this point data was gathered, assessment and interventions, if needed, begun. A standard pressure ulcer protocol was followed that assessed for increased protein, calories, other nutrients and fluid needs. Interventions included adding high protein foods, supplements or no intervention if the resident ate adequately from the presented menu. Eight of these residents had high weight for height and two of these residents gained weight. Five residents had stable, low weight for height. Nine residents, average age 81.9 years, had Stage II treatment areas and four residents, average age 83.3 years, had Stage III treatment areas. The average healing time for Stage II pressure ulcers ranged from 10 to 45 days (20 ± 13, mean ± SD). For Stage III, the average healing time ranged from 49 to 138 days (82 ± 40, mean ± SD). The costs of medical nutrition therapy for each Stage II and Stage III pressure ulcers was $58.55 and $179.02 respectively. These costs reflect only one aspect of care for these residents with pressure ulcers. This information can help in quantifying data in the managed care environment. It is information that can be used by a long term care facility to implement interdisciplinary protocols for pressure ulcer treatment but more important, is the prevention of pressure ulcers and the money saved. In conclusion, this study was able to quantify the cost of nutrition assessment, monitoring and intervention in the healing of pressure ulcers in long term care residents.