Use of Positioning Wedges to Decrease Hospital – Acquired Pressure Ulcers

 Topic: Repositioning is vital for pressure ulcer prevention. It reduces the extent of pressure over susceptible parts of the body, thus lessening the risk of pressure ulcer development. Effective positioning is a clinical challenge, especially in high risk populations such as bariatric, critically ill,  & cardiovascular patients, with differences in quality, effectiveness and availability of pillows to keep the patient in the position of choice.  Literature review revealed limited current information.

Purpose: To determine whether an alternative turning device, such as positioning wedges, would contribute to reducing hospital acquired pressure ulcers in the surgical ICU and the vascular surgery unit and aid in more effective repositioning efforts.

Objective: To determine the efficacy of using positioning wedges in preventing hospital acquired pressure ulcers & maintaining adequate side lying positions. A trial was initiated in the surgical ICU and vascular surgery units. Three foam wedges were trialed on all patients over a 2-week period. Two were reusable and one was disposable. Education was provided to all staff.  An evaluation tool was developed to assess the ease of use, ability to keep patient in the desired position, comfort, efficacy, and if the patient’s skin remained intact.

Outcomes:  39 patients were evaluated using three different wedges.  Two reusable wedges had high scores, while the single use wedge scored very low. Decision was to made to implement the lower cost reusable product due to similar outcomes. Prior to the trial one unit had one facility acquired pressure ulcer, while the second unit had two.  At the completion of the trial, both units had no new facility acquired pressure ulcers.  A plan was developed to implement a hospital wide purchase. Education for use, an algorithm and plan for environmental service cleansing was developed.