Pressure Ulcer Prevention and Person Centered Care

Background: Traditionally, soft surfaces over mattresses and repositioning individuals every 2 hours to relieve pressure have been the gold standard of care to prevent ulcers. Recent improvements in support surfaces may reduce the need for 2-hour repositioning and allow individualized repositioning based on pressure ulcer risk.

Objectives:  The specific aims of this multisite randomized controlled trial are to determine if : 1) there is a significant difference in the incidence of pressure ulcers for both short stay [length of stay less than 7 days]  and long stay [length of stay more than 90 days] residents when in-bed repositioning and associated incontinence care procedures are individualized to: a) moderate risk (Braden Scale Score, 13-14) residents being repositioned every 2-, compared with every 3- or 4- hours; or b)  high risk (Braden Scale Score, 10-12) residents being  turned every 2- compared with every 3-hours.

Methods: Nursing facility residents [n = 66] ages 65 – over 100 years old were randomly assigned to a repositioning schedule by Braden Scale risk category; High risk every 2 hours [n = 18] or every 3 hours [n = 12]  and Moderate Risk every 2 hours [n = 10], 3 hours [n = 14] or every 4 hours [n = 11].
Results: The average length of time in one position for the 2-hourly turn was 2.3 hours, for 3-hourly turn was 2.9 hours and for 4-hourly turn was 3.8 hours. Continence associated skin erosion occurred in 2 participants on 3-hourly turns and 5 participants on 2-hourly turns. No pressure ulcers occurred related to the study intervention.

Conclusions: Preliminary results suggest that nurse’s aides are able to individualize in-bed repositioning intervals based on the level of pressure ulcer risk and that allowing residents to remain in one position for 2, 3 or 4 hours is safe.