Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose‐designed positioning device and usual care equipment: An observational feasibility study

Abstract

The prevalence of pressure injuries in the intensive care unit (ICU) setting is high with rates ranging from 13.1% to 45.5%. Evaluation of interventions to prevent pressure injuries should be informed by preliminary research to identify factors that should be considered during the design of future trials. The study objectives were to evaluate the process of participant recruitment and monitoring in the ICU; measure the maintenance of body angle (in the side‐lying lateral tilt position) and head and neck alignment angle (in the supine position) among immobile critically ill patients when using a purpose‐designed positioning device and usual care equipment, and; ascertain the time required to position patients with the purpose‐designed positioning device and the usual care equipment. A prospective, observational, feasibility study was conducted in an ICU in Victoria, Australia. The sample was immobile critically ill adults at high‐risk of developing pressure injuries. The usual care interventions were pillows, foam wedges, and rolled towels, and the intervention device was the Z‐Flo Fluidized Positioner. The body angle and head and neck alignment were measured on six occasions (at baseline, 1 hour, and 2 hours). The time required for positioning was also measured. The sample was predominately male (n = 5, 62%) with a mean age of 59 years. The majority of patients (n = 106, 92.2%) were not immobile and therefore were ineligible to participate. A total of 48 turning and positioning interventions were observed. For the side‐lying lateral tilt position, the degree of difference from baseline to 2 hours was no more than three degrees for all the devices (the Fluidized Positioner 25°‐26°, the foam wedge 29°‐27°, and the pillow 23°‐21°). For the head and neck position, the degree of difference from baseline to 2 hours was the greatest for the pillow and rolled towel (78°‐71°, a difference of 7°) and the pillow alone (79°‐74°, a difference of 5°). The degree of difference was the lowest for the Fluidized Positioner (84°‐86°, a difference of 2°). Future research to evaluate positioning equipment in the ICU should consider patient eligibility characteristics, particularly immobility. The conduct of preliminary studies to inform the design of larger pressure injury prevention trials is recommended.

The prevention of pressure injuries in the positioning and mobilization of patients in the ICU: a good clinical practice document by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

“…A positioner made of a viscofluid material provided better maintenance of head and neck position and the lateral decubitus position [ 49 ]. In another comparison study with a historical cohort, head positioning of 127 patients on ECMO with the Z-Flo device significantly reduced the incidence of occipital injury [ 50 ].…”

Sustainable pressure injury prevention

“…With the decrease in PI rates, there is a ripple effect in decreasing operational burden which includes direct and indirect costs 4 7 10–16. Indirect costs include the time spent investigating and reporting HAPIs 25.…”

“…The PIPB itself consists of evidence-based nursing interventions with a rich history of successful interventions 7 10–18 23 26–36. The PIPB addresses early identification of at-risk patients, protecting boney prominences, intrinsic and extrinsic moisture, prolonged exposure to pressure from devices or surface 10–18 23 26–36. Each well-known risk factor is addressed with nursing interventions that are simple and quick to implement.…”

“…The process easily identifies which patients benefit from the products and nursing interventions that are part of the pressure injury prevention bundle (PIPB) 3 5 7 8. The PIPB consists of appropriate pressure relieving support surface, turn and position overlay, foam bordered dressings, moisture management with moisture wicking fabric, peri-care and attention to devices and implementation timeline 3–17. Products to offload pressure and protect from shear, friction and moisture were standardised throughout the organisation and made available on all units as part of the PIPB (table 2).…”

Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital‐acquired pressure injuries. A randomised controlled trial

“…Our second study reported the feasibility of positioning immobile, critically ill patients at risk of PIs using the fluidised positioner, focusing on head and neck alignment of immobile patients. 20 Conducted in the same ICU as the RCT reported in this paper, the study identified factors of relevance for future trial design. The processes for screening patients for eligibility were successful (and this informed the screening processes for the RCT).…”