Prevention of Pressure Ulcers

¶ … Patient Turning Every Two Hours and Positioning Decreases the Development of New Pressure Ulcers The objective of this study is to determine whether turning and positioning of a patient every two hours decreases in the development of new pressure ulcers. Toward this end, this study will conduct a review of the literature in this area of inquiry. The work of Rich, et al.

(2011) entitled "Frequent Manual Repositioning and Incident of Pressure Ulcers Among Fracture Patients" reports that frequent manual repositioning "is an established part of pressure ulcer (PU) prevention, but there is little evidence for its effectiveness." (p.1) The study reported by Rich, et al. conducted an examination of the link between repositioning and incidence of pressure ulcers among elderly patients that were bedbound fracture patients. The study findings indicate that there was no link between patient repositioning and incidence of pressure ulcers. However, the work of Ostadabbas, et al.

(2011) reports "the most common prevention method is still periodic repositioning by the nursing staff. Some patients are at higher risk than others, and therefore should be repositioned and examined more frequently." (p. 159) Rich, et al. reports a scheduling algorithm that is successful in reducing the labor and time required to turn and position patients for the prevention of the development of pressure ulcers.

The National Clearinghouse conducted a synthesis of guidelines on prevention of pressure ulcers and reports that there is an agreement that chair or wheelchair bound patients should be repositioned every hour if possible and where the patient is capable that they should be encouraged to perform small weight shifts every fifteen minutes. In addition agreement was discovered on regular scheduling of repositioning and turning for bed bound patients although no specific interval is stated.

Specifically stated is "Currently there is limited evidence to suggest that repositioning every four hours when combined with any pressure redistributing mattress is just as effective for prevention of pressure ulcers as more frequent (every two hours) repositioning or turning. Evidence for the optimal frequency of repositioning is lacking." (National Clearing House, 2006, p.

1) The National Institutes of Health, National Institute of Nursing Research, National Institute on Aging among other agencies conducted a study in order to determine "the optimal frequency of repositioning nursing facility residents with limited mobility who are cared for on a high density foam mattress in order to prevent bed sores." (2008, p.1) The study has not yet reported any results to the public.

The work of Baldwin (nd) reports that there has been a new device created, and specifically the Prevalon® Turn and Position System which serves to assist nurses with repositioning patients in addition to "sacral off-loading, and skin microclimate control within a facility's established turning and PU prevention protocol." (Baldwin, nd, p.

1) Included in the system are the following components: (1) One Low-Friction Glide Sheet with grip surface and integrated handles to reduce the effort needed to turn patients, as well as a built-in Anti-Shear Strap to prevent patients from sliding in bed; (2) disposable Microclimate Body Pads to control heat and the many "sources of moisture" on the skin, and (3) two 30° Body Wedges to facilitate turning and positioning of patients at the recommended 30° angle." (Baldwin, nd, p.

1) In conclusion, while regularly scheduled turning and positioning is believed to prevent pressure ulcers, research studies have not yet been conclusive on the precise scheduling of.