A recent study published in the Journal of the American Geriatrics Society, “Turning for Ulcer Reduction: A Multisite Randomized Clinical Trial in Nursing Homes,” was conducted to determine the optimal repositioning frequency of nursing home residents who were at moderate risk or high risk of developing pressure ulcers. Specifically, the study was conducted on residents who were cared for on high-density foam mattresses, and repositioned at either 2, 3 or 4 hour intervals. Reporting requirements for the study included documenting the skin changes, care provided for incontinence at the time of turning, meals and bathing for each resident.
The outcomes of the TURN study showed that pressure ulcers were limited to superficial Stage 1 or Stage 2 pressure ulcers no matter what schedule the turning frequency of the residents was set for. These pressure ulcers developed in only 2% of the study’s participants. The authors of the study noted that the incidence of pressure ulcers was lower than they had anticipated, but attributed it the use of high density foam mattresses, the consistent turning schedules and the specific documentation recorded. They noted that “when high-density foam mattresses effectively redistribute pressure, less-frequent positioning may be possible without increasing PrU incidence.”
While the use of these mattresses has been shown to help prevent pressure ulcers, staff attention is also critical to pressure ulcer care. The study provides good evidence that focus by caregivers on specific documentation of pressure ulcers may help to reduce their incidence since the staff is more aware of monitoring and tracking.
Turning and repositioning of a resident is a big key in the prevention of pressure ulcers. However, also key to prevention are other components such as skin checks, timely incontinence care to keep a resident’s skin dry, assessing and meeting nutritional needs, as well as general Pressure Ulcer Care and Prevention education to heighten staff awareness of a facility’s protocols related to pressure ulcers. Documentation related to routine skin checks, completion of risk assessment tools as per a facility’s defined schedule and completion of weekly skin tracking sheets also factor in. All of this documentation affords the Wound Nurse/Physician/Clinical Team with data that can be used to initiate a plan of care to prevent a pressure ulcer from developing or, if a pressure ulcer develops, the ability to monitor what care/treatment was being provided and to revise the plan of care to promote healing and prevent deterioration of the ulcer. Lastly, consideration also needs to be given to the need for the staff responsible for an individual resident to be aware of the plan of care and their responsibility to carry it out.