Best Way to Avoid Bedsores?

Stress Ulcer Prevention The subject up for study in this report shall be whether stress ulcers in hospital patients induced by being bedridden can be mitigated or even prevented by turning the patient to a new position at least once every two hours. The amount of research on this subject is not pervasive and voluminous. However, some material about the subject does exist. Thus, a conclusion should be possible regarding whether patient-turning is a solution to prevent stress ulcers from forming in the first place.

While it may not truly be a fix-all solution, the practice of turning patients at two hour intervals shows some promised based on evidence-based research and results. Stress ulcers, otherwise commonly referred to as deep tissue injury (DTI) is a pressing and persistent issue in the medical field. This is especially true when speaking of patients that are bedridden for any significant amount of time including those in nursing homes, those in hospitals for an extended amount of time and so forth.

It is generally held by professionals and scholars in the medical industry that repositioning of patients at certain intervals is a way to partially or fully offset this happenstance per the work of Demol (2013) and others. Demol did a study on precisely that subject and did patient repositioning at intervals of two, three, four and six hours. It was found through their modeling that size and severity of stress ulcers/DTI was markedly reduced through the use of these intervals.

As it relates to the needed interval time amount to get the best results, it was found that ulcers were further and further reduced as the time interval between patient position changes got smaller (Demol et al., 2013). Another study on the same subject found that bedsores, the way that they referred to DTI/stress ulcers, are an important problem to solve as people who have bedsores are two to six times more likely to die than those that do not experience any occurrences of this phenomenon.

This study was written back in 2008 but it follows the later Demol study in that they use intervals of a certain length to turnt he patient so as to prevent bedsores. Interestingly enough, this older study suggested using two hour intervals. However, it also suggested remedies and methods like different mattresses (e.g. specialized foam mattress, air-filled matress, low air-loss bed and air-fluidized bed) as well as pharmacological interventions (e.g. diazepam, baclofen, dantrolene sodum, mephensine carbonate, dimethothiazine and orciprenaline).

The study also noted that the proper intervention should be dictated by the stage classification (i.e. severity) of the sore. The score range is from one to four (Nayak et al., 2008). Another study that evidence for the two-hour interval theory can be gleaned from was published earlier this year in March. Robert Behrendt (2014) and a few colleagues made reference to the fact that critically ill patients have a strong propensity to develop bedsores due to their consistently still state.

This study used two different methods with one set of study patients receiving continuous bedside pressure mapping (CBPM) and the other group did not. A total of 422 patients were studied and all of them were repositioned at two hour intervals. The two groups were nearly identical in size with the pressure-mapped people numbering 213 and the non-pressure-mapped people numbering 209. In total, only ten people that were not being pressure-mapped developed any new bedsores while five times that, but still only ten out of the whole control group, did develop bedsores.

In short, a smidge less than five percent of all patients that were turned every two hours got bedsores. The same study noted that turning every two hours is the "most common consensus-based repositioning recommendation" but "it is still more dogma than an evidence-based recommendation" (Behrendt, 2014). When it comes to healthy patients, which means those that are much less likely to get stress ulcers/bedsores in the first place, were found to be nearly identical in terms of susceptibility to stress ulcers.

Indeed, the study notes that "standard turning by experienced intensive care unit nurses does not reliably unload all areas of high skin-bed interface pressures (Peterson et al., 2010). If there is a theme to be garnered form the research done for this report, it would be that forgoing turning of patients is not a good idea.

However, it is not a cure-all and should be supplemented to find out pressure-ridden areas of the body so as to prevent the creation or aggravation of pressure points that could lead to or increase the severity of stress ulcers. Conclusion All of the studies consulted reflect that turning the patient at two hour intervals is the generally accepted practice and should not change.

However, it is also clear from at least two of the studies consulted that the turning alone is not as efficacious as using pressure-diffusing mattress technology and/or pressure mapping in general so as to detect problem spots. Perhaps this pressure-mapping could be used to supplant turning if.