Development of nursing care bundle for the prevention of pressure injuries, the impact on the rate and cost of pressure injuries

Objective: The aim of this study was to evaluate the effect of the Pressure Injury Prevention Care Bundle (PIP-CB), developed for the prevention of hospital-acquired pressure injuries (HAPIs), on the rate of pressure injuries (PIs) development and cost. Methods: This randomized controlled experimental study was conducted in the General Intensive Care Unit of Koç University Hospital between December 1, 2023 and March 28, 2025. The sample size was determined according to power analysis and 90 patients were randomly assigned to the intervention (n=45) and control (n=45) groups. PIP-CB was applied to the intervention group in line with international guidelines. The control group received standard care applied in the institution. "Nurse Observation Form", "Patient Identifier Information Form", "Braden Risk Assessment Scale", "Hospital-Acquired Pressure Injury Cost Form" and "Care Bundle Follow-up Form" were used as data collection tools. Data were evaluated by descriptive statistics, Chi-Square test, Mann-Whitney U test, Correlation and Regression analysis. In cost analysis; The average cost was calculated by taking into account the usage quantities and unit prices for all cost items, including nursing labor, and the cost-effectiveness of the PIP-CB was evaluated based on the ICER value, which represents the additional cost per prevented PIs. Results: When the socio-demographic and health indicator characteristics of the intervention and control groups were compared, it was found that there was no statistically significant difference between the groups in general (p>0.05). However, significant differences were found between the groups in terms of some variables such as hospitalization time, rate of mechanical ventilation, glucose and serum albumin levels, and corticosteroid and vasopressor use (p<0.05). In the study, the PIs rate was determined as 17,8% in the intervention group and 46,7% in the control group and the difference was found to be statistically significant (p=0,003). The average PIs development period was 7 days in the intervention group and 3 days in the control group and the difference between the groups was statistically significant (p=0,002). Total costs were found to be significantly higher in the intervention group (X̄: ₺62,721.22±36,431.75) compared to the control group (X̄: ₺39,752.24±19,319.33) (p = 0,002). It was calculated that an additional cost of X̄ =₺74,467.44 was incurred for each additional PIs case prevented, and X̄ =₺3,074.44 was incurred for each additional PIs day prevented. These values are below the theoretical willingness to pay threshold range (approximately ₺454,000- 1,362,000) determined for Turkey based on the Gross Domestic Product per capita. Conclusion and Recommendations: The findings of the study showed that PIP-CB, which includes systematic and structured nursing practices, is effective in reducing the development of PIs and delaying the development of PIs. Although PIP-CB application increases the cost in the short term, it is a cost-effective intervention in the long term in terms of reducing the PIs rate. Based on these findings, it is recommended that care bundle interventions be disseminated, tested in multi-center studies, and that studies that include comparative analyses including treatment costs in addition to prevention costs be planned. Keywords: Pressure injury, Hospital-acquired pressure injury, Care bundle, Cost-effectiveness analysis, Randomized controlled trial