title: A Prospective, Descriptive, Quality Improvement Study to Investigate the Impact of a Turn-and-Position Device on the Incidence of Hospital-acquired Sacral Pressure Ulcers and Nursing Staff Time Needed for Repositioning Patients.
abstract: Patients in critical care areas are at risk for developing hospital-acquired pressure ulcers (HAPUs) due to their physical conditions and limited ability to reposition themselves. A prospective, 2-phase quality improvement study was conducted from September to November 2011 and from February to April 2012 in 1 medical and 1 surgical ICU to investigate the impact of a turn-and-assist device on the incidence of HAPUs and the time and personnel required to reposition patients reported as person/minutes (staff x minutes). A consecutive, convenience sample of patients was selected from newly admitted ICU patients who were at least 18 years old, nonambulatory, and required 2 or more people to assist with turning and repositioning. Sociodemographic data (patient age, gender, height, weight, body mass index, incontinence status); total Braden score and subscores for Activity, Mobility, and Moisture on admission; length of ICU stay and ventilator days; and sacral pressure ulcer incidence and stage and turn-and-assist data were collected. Fifty (50) patients participated in each phase. In phase 1, standard care for positioning included pillows, underpads, standard low-air-loss beds and additional staff as required for turning. In phase 2, the study product replaced standard care repositioning products including pillows; and a larger disposable moisture-wicking underpad (included as part of the turn study project kit) was substituted for the smaller, standard moisture-wicking disposable underpad. Turning procedures were timed with a stopwatch. Data were collected for a total of 32 hours during the observation periods; all patients were followed from admission until discharge from the ICU for a maximum of 14 days. T-tests were used to compare patient characteristics and person-minutes needed for repositioning differences, and Fisher's exact test was used to compare the incidence of sacral HAPUs during phase 1 and phase 2 of the study. No statistically significant sociodemographic or clinical differences were noted between the 2 groups. During phase 1, 14 patients (28%) developed a Stage 2 sacral HAPU. During phase 2, no patients developed a sacral HAPU (P <0.0001). The average time spent for repositioning was 16.34 person/minutes (range 4-60, SD 10.08) during phase 1 and 3.58 minutes (range 1.12-8.48, SD 2.31) during phase 2. The mean difference between person/minutes for the 2 phases was 12.76 minutes (P = 0.0006). In this population of ICU patients, the rate of sacral HAPUs and person/time needed for repositioning were significantly lower following implementation of a turn-and-assist product. Future research is indicated on the effect of this type of product on improving outcomes for patients and making the work of patient care safer and more efficient.
authors.affiliation: Nursing Research and Evidence Based Practice, Carilion Clinic, Roanoke, VA.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Hall
authors.affiliation: Nursing Research and Evidence Based Practice, Carilion Clinic, Roanoke, VA.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001513:Beds / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D015994:Incidence; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000295:instrumentation* / Q000379:methods; D003668:Pressure Ulcer / Q000517:prevention & control*; D011446:Prospective Studies; D058996:Quality Improvement; D012445:Sacrococcygeal Region / Q000293:injuries / Q000503:physiopathology; D013997:Time Factors; D014549:Urinary Incontinence / Q000150:complications; D014768:Virginia