Does Repositioning Matter?

The current emphasis on healthcare quality and patient safety has drawn attention to the links between nursing care practices and rates of hospital associated pressure ulcers (HAPU).  As HAPU is often preventable, low incidences are regarded as the outcome of excellent nursing practice. This premise was examined in research on the effectiveness of repositioning (Sania et al., 2011). The results found no association between frequent repositioning and the incidence of pressure ulcers, raising provocative questions about the allocation of resources required for repositioning.

The Skin Wound Assessment Team (SWAT) at a 510 bed, level one trauma center, reviewed the care provided to patients who developed HAPUs.  The data revealed that patients developed pressure ulcers despite consistent documentation of repositioning. This finding motivated a deeper appraisal that revealed large variations in what is conveyed when repositioning is documented.  A refined documentation system was developed, expanding the simplistic yes/no notation into a documentation system that indicates the degree of change  and specifics of patient's new position.

HAPUs decreased by 30% with the implementation of the new system. Gaps in documented repositioning were identified in 7 of 8 patients with sacral pressure ulcers. The documentation system identified unanticipated variations: 20% of patients with HAPUs refused repositioning and 38% were reported as self-positioning.

Repositioning remains an important component of pressure ulcer prevention.  Increasing emphasis on healthcare quality and safety highlights the need for innovative strategies to assess and communicate the importance of repositioning. This study has identified areas for nursing intervention and ongoing evaluative studies.  Clearer understandings of the nuances surrounding repositioning will help nurses to design patient-specific interventions that minimize HAPU risks.