Turning for Ulcer ReductioN: a multisite randomized clinical trial in nursing homes.
OBJECTIVE
To determine optimal repositioning frequency of nursing home (NH) residents at risk for pressure ulcers (PrUs) when cared for on high-density foam mattresses.


METHODS
Multisite, randomized, clinical trial, known as Turning for Ulcer ReductioN (TURN Study).


METHODS
NHs in the United States (n = 20) and Canada (n = 7) using high-density foam mattresses.


METHODS
Consenting residents (N = 942) aged 65 and older without PrUs at moderate (scores 13-14) or high (scores 10-12) risk of PrUs according to the Braden Scale.


METHODS
Participants were randomly allocated using risk stratification (moderate vs high) to a repositioning schedule (2, 3, or 4 hour) for 3 weeks. Blinded assessors assessed skin weekly.


METHODS
PrU incidence (coccyx or sacrum, trochanter, heels).


RESULTS
Participants were mostly female (77.6%) and Caucasian (80.5%) and had a mean age of 85.1 ± 7.7. The most common diagnoses were cardiovascular (76.9%) and dementia (72.5%). Nineteen (2.0%) participants developed superficial PrUs. There was no significant difference (Wilcoxon test for ordered categories) in PrU incidence (P = .68) according to repositioning group (2 hour, 8/321, 2.5%; 3 hour, 2/326, 0.6%; 4 hour, 9/295, 3.1%), nor was there a statistically significant difference in the incidence of PrU between the high and moderate-risk groups (P = .79). Also, PrU incidence was not statistically significantly different between high-risk participants based on repositioning schedule (6/325, 1.8%, P = .90) or between moderate-risk participants based on repositioning schedule (13/617, 2.1%, P = .68).


CONCLUSIONS
There was no difference in PrU incidence over 3 weeks of observation between those turned at 2-, 3-, or 4-hour intervals in this population of residents using high-density foam mattresses at moderate and high risk of developing PrUs when they were repositioned consistently and skin was monitored. This finding has major implications for use of nursing staff and cost of NH care.
School of Nursing, University of Texas Health Science Center at, Houston, Houston, Texas.
Nancy
N
Bergstrom
Susan D
SD
Horn
Mary Pat
MP
Rapp
Anita
A
Stern
Ryan
R
Barrett
Michael
M
Watkiss
D000368:Aged; D000369:Aged, 80 and over; D001513:Beds / Q000009:adverse effects* / Q000592:standards; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes / Q000600:supply & distribution*; D009864:Ontario / Q000453:epidemiology; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology / Q000451:nursing*; D011379:Prognosis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
Turning for Ulcer ReductioN Study; nursing home; pressure ulcer prevention; repositioning