Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes.
BACKGROUND
Pressure at the interface between bony prominences and support surfaces, sufficient to occlude or reduce blood flow, is thought to cause pressure ulcers (PrUs). Pressure ulcers are prevented by providing support surfaces that redistribute pressure and by turning residents to reduce length of exposure.


OBJECTIVE
We aim to determine optimal frequency of repositioning in long-term care (LTC) facilities of residents at risk for PrUs who are cared for on high-density foam mattresses.


METHODS
We recruited residents from 20 United States and 7 Canadian LTC facilities. Participants were randomly allocated to 1 of 3 turning schedules (2-, 3-, or 4-hour intervals). The study continued for 3 weeks with weekly risk and skin assessment completed by assessors blinded to group allocation. The primary outcome measure was PrU on the coccyx or sacrum, greater trochanter, or heels.


RESULTS
Participants were mostly female (731/942, 77.6%) and white (758/942, 80.5%), and had a mean age of 85.1 (standard deviation [SD] ± 7.66) years. The most common comorbidities were cardiovascular disease (713/942, 75.7%) and dementia (672/942, 71.3%). Nineteen of 942 (2.02%) participants developed one superficial Stage 1 (n = 1) or Stage 2 (n = 19) ulcer; no full-thickness ulcers developed. Overall, there was no significant difference in PrU incidence (P = 0.68) between groups (2-hour, 8/321 [2.49%] ulcers/group; 3-hour, 2/326 [0.61%]; 4-hour, 9/295 [3.05%]. Pressure ulcers among high-risk (6/325, 1.85%) versus moderate-risk (13/617, 2.11%) participants were not significantly different (P = 0.79), nor was there a difference between moderate-risk (P = 0.68) or high-risk allocation groups (P = 0.90).


CONCLUSIONS
Results support turning moderate- and high-risk residents at intervals of 2, 3, or 4 hours when they are cared for on high-density foam replacement mattresses. Turning at 3-hour and at 4-hour intervals is no worse than the current practice of turning every 2 hours. Less frequent turning might increase sleep, improve quality of life, reduce staff injury, and save time for such other activities as feeding, walking, and toileting.
University of Texas Health Sciences Center at Houston, Houston, Texas, USA.
Nancy
N
Bergstrom
International Severity Information Systems, Inc. and the Institute for Clinical Outcomes, Salt Lake City, Utah, USA.
Susan D
SD
Horn
University of Texas Health Sciences Center at Houston, Houston, Texas, USA.
Mary
M
Rapp
Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.
Anita
A
Stern
International Severity Information Systems, Inc. and the Institute for Clinical Outcomes, Salt Lake City, Utah, USA.
Ryan
R
Barrett
International Severity Information Systems, Inc. and the Institute for Clinical Outcomes, Salt Lake City, Utah, USA.
Michael
M
Watkiss
Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.
Murray
M
Krahn
D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes; D056888:Patient Positioning / Q000379:methods*; D003668:Pressure Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors