Pressure ulcer prevalence among nursing home residents lying on standard mattresses and foam overlays has been reported to be 12% to 24%. Relieving and redistributing pressure on salient body parts (the coccyx or sacrum, trochanter, and heel) helps to reduce the risk of pressure ulcers; two main strategies for relieving that pressure are the use of high-density foam mattresses and frequent repositioning. Repositioning every two hours is recommended, although that frequency is likely not achieved in practice. To determine whether turning patients less often is as effective, researchers evaluated three repositioning frequencies (two, three, and four hours) in residents at 27 nursing homes in the United States and Canada.
Certified nursing assistants received training in proper repositioning of patients (required within 30 minutes of the scheduled time), completing documentation, and reporting skin changes. Licensed nurses were trained to assess for pressure ulcer development at the salient sites and assessed each patient weekly; they were blinded to turning-frequency allocation. The researchers provided ongoing supervision to support protocol adherence, and site coordinators were responsible for project oversight. The study population comprised 942 residents 65 years of age or older without pressure ulcers at baseline but at moderate or high risk for ulcer development. They had limited mobility and slept on high-density foam mattresses.
Most participants were women (78%) and white (80%); the average age was 85 years. More patients at moderate than at high ulcer risk were enrolled (617 versus 325). According to the randomization scheme, 321, 326, and 295 participants were repositioned every two, three, and four hours, respectively.
A total of 21 stage 1 or 2 pressure ulcers occurred in 19 participants. No stage 3 or 4 ulcers occurred. The rates of occurrence didn't differ significantly across the three groups or between the high- and moderate-risk participants. Similarly, pressure ulcer incidence was comparable among all high-risk participants, regardless of repositioning frequency. The authors suggest that repositioning every three or four hours may be effective when participants also sleep on high-density foam mattresses and protocols for repositioning and documentation similar to those used in this study are implemented.
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