Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India

Abstract

Purpose Hospital-acquired pressure ulcers are a significant cause of morbidity and consume considerable financial resources. Turn protocols (repositioning patients at regular intervals) are utilized to reduce incidence of pressure ulcers. Adherence to turn protocols is particularly challenging for nursing teams, given the high number of interventions in intensive care unit, and lack of widely available tools to monitor patient position and generate alerts. We decided to develop and evaluate usefulness of a continuous patient position monitoring system to assist nurses in improving turn protocol compliance. Methods We conducted a prospective, non-randomized, multiphase, multicentre trial. In Phase I (control group), the function of the device was not revealed to nurses so as to observe their baseline adherence to turn protocol, while Phase II (intervention group) used continuous patient position monitoring system to generate alerts, when non-compliant with the turn protocol. All consecutive patients admitted to one of the two intensive care units during the study period were screened for enrolment. Patients at risk of acquiring pressure ulcers (Braden score < 18) were considered for the study (Phase I (N = 22), Phase II (N = 25)). Results We analysed over 1450 h of patient position data collected from 40 patients (Phase I (N = 20), Phase II (N = 20)). Turn protocol compliance was significantly higher in Phase II (80.15 ± 8.97%) compared to the Phase I (24.36 ± 12.67%); p < 0.001. Conclusion Using a continuous patient position monitoring system to provide alerts significantly improved compliance with hospital turn protocol. Nurses found the system to be useful in providing automated turn reminders and prioritising tasks.

Factors affecting repositioning policy compliance: an integrative review

“…21 This was also the case as observed in India where approximately only 30% of patients received the required repositioning. 22 Results of studies were similar in Belgium, 23 Sweden, 24 Egypt, 25 China, 26 Australia, 27 Hong Kong, China, 28 Saudi Arabia, 15,20 and the Netherlands. 29 Therefore, low repositioning compliance is an observed phenomenon among nurses in hospitals across cultures.…”

“…This is an electronic system that follows up on repositioning progress by the assigned nurses and presents the repositioning performance on a public screen in the unit. 21,22,49 Thus, repositioning policy compliance for each staff member is in public view and the digital visualization feedback significantly improves compliance. 21,22,49 However, repositioning compliance improved only when nurses were provided with visualizations of their levels of performance in a public place.…”

“…21,22,49 Thus, repositioning policy compliance for each staff member is in public view and the digital visualization feedback significantly improves compliance. 21,22,49 However, repositioning compliance improved only when nurses were provided with visualizations of their levels of performance in a public place. There were no studies in which nurses' compliance levels improved if compliance was not made publicly visible.…”

Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis

“…Four, harmonization is needed when a repositioning practice is done if it takes more than one person to achieve. In some conditions, anchor is used to help facilitate the pressure distribution ( Gefen, 2009 ) and revascularization of the pressed organs ( Schwartz & Gefen, 2019 ).…”

“…Therefore, the anchor is fixing the patient on a specific posture. It allows the revascularization of body organs, which were under pressure ( Schwartz & Gefen, 2019 ). The literature mentioned anchor meaning in 116 different location.…”