Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?

Abstract

For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress.

Nurses’ Management of Patients with Pressure Ulcers in Selected Health Facilities in Murang’a County, Kenya

“…Results from multivariate analyses revealed that respondents-oriented factors are significant in the effective management of pressure ulcers. Sharp et al (2019) noted that Pressure ulcers continue to develop in elderly patients despite the 2-hourly repositioning. The study results agree with a study conducted by Bergstrom et al (2014), whose results found repositioning of patients significant in reducing pressure ulcers.…”

Effect of Varying Repositioning Frequency on Prevention of Pressure Injuries in Nursing Home Residents: TEAM‐UP Cluster‐Randomized Clinical Trial Results

“…7 Assessment of pressure injury risk is standard practice in nursing homes, 8-10 but prevention has proved elusive. 11 There is limited evidence for pressure injury prevention, 12 with support surfaces and manual repositioning having been the focus. Highspeci cation foam alternatives to standard hospital foam mattresses were found to signi cantly reduce pressure injury incidence.…”

Hospital‐acquired pressure ulcer incident rates among hospitals that implement an education program for staff, patients, and family caregivers inclusive of an after discharge follow‐up program in Saudi Arabia

“…Key elements of such preventive program measures should include: implementation of evidence‐based practices, evidence‐based product selection, provision of education to hospital staff by healthcare providers which can be performed through implementing evidence‐based prevention programs 10 . Despite best efforts, pressure ulcers (PUs) do still occur and patients are at risk for PU not only just in hospital but also once discharged home 11 . In the hospital, 89% of PUs occur in the ICU population 12 .…”

“…10 Despite best efforts, pressure ulcers (PUs) do still occur and patients are at risk for PU not only just in hospital but also once discharged home. 11 In the hospital, 89% of PUs occur in the ICU population. 12 While prevalence of category I-IV PUs was 8Á0%, and the overall nosocomial PU prevalence was 4Á5%.…”