A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers

Abstract

Background. Pressure ulcers are common, costly and impact negatively on individuals. Pressure is the prime cause, and immobility is the factor that exposes individuals to pressure. International guidelines advocate repositioning; however, there is confusion surrounding the best method and frequency required. Design. A pragmatic, multi-centre, open label, prospective, cluster-randomised controlled trial was conducted to compare the incidence of pressure ulcers among older persons nursed using two different repositioning regimens. Method. Ethical approval was received. Study sites (n = 12) were allocated to study arm using cluster randomisation. The experimental group (n = 99) were repositioned three hourly at night, using the 30°tilt; the control group (n = 114) received routine prevention (six-hourly repositioning, using 90°lateral rotation). Data analysis was by intention to treat; follow-up was for four weeks. Results. All participants (n = 213) were Irish and white, among them 77% were women and 65% aged 80 years or older. Three patients (3%) in the experimental group and 13 patients (11%) in the control group developed a pressure ulcer (p = 0AE035; 95% CI 0AE031-0AE038; ICC = 0AE001). All pressure ulcers were grade 1 (44%) or grade 2 (56%). Mobility and activity were the highest predictors of pressure ulcer development (b = À0AE246, 95% CI = À0AE319 to À0AE066; p = 0AE003); (b = 0AE227, 95% CI = 0AE041-0AE246; p = 0AE006). Conclusion. Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30°tilt, reduces the incidence of pressure ulcers compared with usual care. The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines. Relevance to clinical practice. An effective method of pressure ulcer prevention has been identified; in the light of the problem of pressures ulcers, current prevention strategies should be reviewed. It is important to implement appropriate prevention strategies, of which repositioning is one.

The impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage

“…There is extensive recognition that the vast majority of pressure ulcers are avoidable, when targeted preventative measurements are implemented (Moore et al, 2011 andSkerritt and. Many healthcare settings have developed and introduced guidelines to prevent pressure ulcer damage from occurring (HSE, 2009).…”

“…(Moore andCowman, 2014, andDoH, 2014). Therefore, the principal focus concerning pressure ulcers should be on prevention, which is naturally less costly and less distressing for the patient (Schuurman et al, 2009 andMoore et al, 2011). The key focus in pressure ulcer prevention rests primarily on identifying risk, reducing pressure and minimising shear (Brem et al, 2010).…”

“…Pressure ulcer prevention and management remains at the forefront of today's health care system, where there is an expectation of high quality care combined with value for money (NPUAP, EPUAP andPPPIA, 2014 andMoore et al, 2011). In order to gain an insight into pressure ulcer prevention it is necessary to clarify what exactly constitutes a pressure ulcer.…”

INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk patients: A protocol for a cluster randomised trial

“…A Cochrane review on support surfaces reporting a meta-analysis of five studies indicated a reduction in PI in at risk patients (RR 0.40, 95% CI 0.21 -0.74) (McInnes et al, 2012). In our sample size estimate we have taken a conservative approach of incidence of 10% HAPI (control) with an expected reduction of 50% or an absolute reduction of 5% (from 10% to 5%) in the intervention group and an intra-class correlation of 0.001, the actual intraclass correlation in another c-RT of a PIP strategy (Moore et al, 2011). To obtain 90% power with a two-sided α level of 0.05, 8 hospitals with 169 patients per hospital are required (PASS -Power Analysis and Sample Size system, NCSS, Utah).…”

Impact of Educational Video Film for Nurses Caring Elders Suffering From Pressure Ulcer about Applying Cutimed Sorbact Dressing On Wound Healing

“…In addition study done in Ireland by Moore and Cowman (2011) (43) , reveals that Fifty-six percent of the pressure ulcers occurred in participants who were in the 80-89 age groups. Older individuals are statistically more likely to develop pressure ulcers compared with their younger counterparts.…”