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Bergstrom N, Horn SD, Rapp M, et al. Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes. Ont Health Technol Assess Ser. 2014;14(11):1-32
Bergstrom, N., Horn, S. D., Rapp, M., Stern, A., Barrett, R., Watkiss, M., & Krahn, M. (2014). Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes. Ontario health technology assessment series, 14(11), 1-32.
Bergstrom, Nancy, et al. "Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes." Ontario health technology assessment series vol. 14,11 (2014): 1-32.
Bergstrom N, Horn SD, Rapp M, Stern A, Barrett R, Watkiss M, Krahn M. Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes. Ont Health Technol Assess Ser. 2014 Oct 01;14(11):1-32. eCollection 2014. PMID: 26330893; PMCID: PMC4552218.
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Ont Health Technol Assess Ser. 2014 Oct 01;14(11):1-32. eCollection 2014.

Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes.

Ontario health technology assessment series

Nancy Bergstrom, Susan D Horn, Mary Rapp, Anita Stern, Ryan Barrett, Michael Watkiss, Murray Krahn

Affiliations

  1. University of Texas Health Sciences Center at Houston, Houston, Texas, USA.
  2. International Severity Information Systems, Inc. and the Institute for Clinical Outcomes, Salt Lake City, Utah, USA.
  3. Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.

PMID: 26330893 PMCID: PMC4552218

Abstract

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.

References

  1. J Adv Nurs. 2006 Apr;54(1):94-110 - PubMed
  2. J Clin Nurs. 2005 Mar;14(3):373-82 - PubMed
  3. J Clin Nurs. 2008 Mar;17(5):646-53 - PubMed
  4. Adv Skin Wound Care. 2011 Feb;24(2):72-7 - PubMed
  5. J Eval Clin Pract. 2011 Feb;17(1):168-73 - PubMed
  6. JAMA. 2011 Jul 13;306(2):179-86 - PubMed
  7. JAMA. 2011 Jul 13;306(2):211-2 - PubMed
  8. J Clin Nurs. 2011 Sep;20(17-18):2633-44 - PubMed
  9. Adv Skin Wound Care. 2011 Sep;24(9):404-14 - PubMed
  10. J Am Geriatr Soc. 2003 Sep;51(9):1203-12 - PubMed
  11. Nurs Res. 1987 Jul-Aug;36(4):205-10 - PubMed
  12. J Am Geriatr Soc. 1992 Aug;40(8):747-58 - PubMed
  13. Am Fam Physician. 1992 Sep;46(3):787-94 - PubMed
  14. Nurs Res. 1998 Sep-Oct;47(5):261-9 - PubMed
  15. Arch Phys Med Rehabil. 1961 Jan;42:19-29 - PubMed
  16. Arch Phys Med Rehabil. 1961 Nov;42:774-83 - PubMed
  17. Int J Nurs Stud. 2005 Jan;42(1):37-46 - PubMed
  18. J Adv Nurs. 2007 Jan;57(1):59-68 - PubMed

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