To reposition or not to reposition during lateral rotation . . . that is the question

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To reposition or not to reposition during lateral rotation . . . that is the question

Cynthia J. Sylvia, MSc, MA, RN, CWOCN, Gaymar Industries, Inc., Program Manager, Educational Development, 335 Locust Knoll Drive, Charles Town, WV 25414 and Jeanne Perla, PhD, RN, Gaymar Industries, Inc, Senior Medical Research Scientist, 10 Centre Drive, Orchard Park, NY 14127.

Pressure ulcers are one clinical indicator of quality patient care. One of the components of pressure ulcer prevention and treatment is the implementation of support surfaces. A support surface is defined as a specialized device for pressure redistribution designed for management of tissue loads, microclimate and/or other therapeutic functions. When a patient who is at risk for the development of pressure ulcers, is also at risk for pulmonary deficits, the use of a support surface that offers lateral rotation is indicated. Lateral rotation is a feature of a support surface that provides rotation about a longitudinal axis as characterized by degree of patient turn, duration and frequency. Since the WOC nurse is instrumental in coordinating the complex care plan of patients with both skin integrity and pulmonary issues, it falls to this clinical expert to direct the execution of the care plan. Putting the plan into practice involves staff development so that bedside care is operationalized for optimal outcomes. An often repeated question by caregivers when laterally rotating a patient is ‘Do I still need to reposition the patient? They are being turned by the bed.’ The purpose of this abstract is to appraise the evidence related to repositioning of patients during lateral rotation and construct a guideline based on the evidence. A feature that ventilates dependent areas of the lungs and mobilizes pulmonary secretions simultaneously has the potential to impact skin integrity. While providing for pressure redistribution, the side to side motion of the tissue load on the surface is further impacted by the mechanical forces of friction and shear. The challenge is how to integrate the time honored gold standard for patient repositioning while the patient is a moving target. The outcome of this abstract is a concise evidence based recommendation for patient repositioning during lateral rotation.

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