Registed Nurses' Association of Ontario

Evidence Booster: Best Practice Guideline Implementation and Estimated Cost Savings

The annual direct health-care costs are estimated to be CAD $2 billion due to falls, with older adults accounting for nearly half of these costs. In 2012, the average cost for a serious injurious fall was estimated to be CAD $31,000  when compared to a patient with no falls treated for similar diagnosis. This reflected direct and indirect in-patient costs of 34 days in the hospital with nursing care and excluded physician billing.

The direct health-care costs of treating a single pressure injury ranges from CAD $26,800 to $231,000 [in 2017] and treating pressure injuries can increase nursing care hours by up to 50%. In 2004, a Canadian organization estimated the minimum cost per case to be CAD $9,000 related to direct patient care cost that excludes physician billing but includes nursing labour, dressing supplies, medications, etc.

Practice Changes

In 2012, this Ontario hospital BPSO began implementation of the guideline. Implementation activities included post-falls huddles, hourly rounding with signage at the doorway, no slip socks, a revised falls risk threshold to identify patients at risk for falls on admission, fall prevention pamphlets for patients and their families, an updated falls prevention policy, review of level III and IV falls by a Best Practice Champion Falls Team, and implementation of the BEEEACH model (Behaviour, Education, Environment, Equipment, Clothing, Health-management). Implementation of the RNAO BPG also contributed to the BPSO achieving national accreditation.

In 2015, this Ontario hospital BPSO conducted a gap analysis and established implementation strategies including:  a standardized approach for assessing wounds using the Bates-Jensen Wound Assessment Tool, use of the NERDS tool (Non-healing – Exudate – Red & Bleeding – Debris – Smell) to identify infected wounds, a therapeutic surface strategy to standardize pressure reducing surfaces for all patients, a nutrition tracking log, daily reports of overall nutrition status, collaboration with the interprofessional team to document specific pressure injuries, and standardization of all prevention and management interventions.