No abstract

Risk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.

Studies related to the treatment of pressure sores have appeared in the literature. Questions remain regarding both the etiology and treatment. This article presents a conceptual schema within which current knowledge can be organized and examined and further study facilitated. The critical determinants of pressure sores are primarily the intensity and duration of pressure. A second critical concept, the tolerance of the tissue for pressure, is also discussed. Conditions contributing to prolonged and intense pressure are included within the concepts of mobility, activity, and sensory perception. Tissue tolerance for pressure is influenced by both extrinsic and intrinsic factors. Extrinsic factors such as moisture, friction, and shear impinge on the skin and underlying tissues, while the multiple influences of nutrition, the physiologic effects of stress, aging and alterations in cellular respiration are intrinsic factors which influence the architecture and integrity of the skin and supporting structures. The schema provides broad categories capable of organizing existing knowledge and new findings.

OBJECTIVES:To determine optimal repositioning frequency of nursing home (NH) residents at risk for pressure ulcers (PrUs) when cared for on high-density foam mattresses. DESIGN: Multisite, randomized, clinical trial, known as Turning for Ulcer ReductioN (TURN Study). SETTINGS: NHs in the United States (n = 20) and Canada (n = 7) using high-density foam mattresses. PARTICIPANTS: 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. INTERVENTION: 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. MEASUREMENTS: 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 AE 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). CONCLUSION: 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.

Risk assessment, rather than diagnoses or demographic characteristics, is recommended as the basis for prescriptive decisions. Risk assessment should cue health care providers to make more judicious use of turning and support surfaces to prevent pressure ulcers. Persons who are at risk for pressure ulcers should have turning and pressure reduction surfaces consistently prescribed and implemented. The costs and goals of preventive prescription for those not at risk for pressure ulcers should be considered.