Abstract
The universally accepted approach to pressure ulcer/injury (PU) prevention is to minimize pressure exposure through frequent repositioning intervals; however, optimal repositioning intervals have yet to be determined. Current PU prevention protocols recommend repositioning nursing home (NH) residents every 2 hours. Turn Everyone and Move for Ulcer Prevention (TEAM-UP) is a cluster randomized clinical trial (National Institute of Nursing Research/National Institute of Aging R01 NR016001-01A1) investigating whether repositioning intervals times can be safely extended by examining 2, 3, and 4-hour assigned NH-wide intervals and nursing staff compliance with on-time resident repositioning for a 4-week period. Preliminary results are presented for one 3-NH cluster (2, 3, and 4 hour). Each NH used resident activity monitoring technology to determine repositioning interval compliance, and this technology also visually cued nursing staff and scheduled and documented repositioning occurrence; furthermore, standardized protocols for risk assessment (Braden Scale Score > 10) and visco-elastic mattress surface were used. Residents at low, moderate, and high risk for PU development (n=321) with varied levels of medical severity who were repositioned at 2, 3, or 4-hour intervals experienced no PU development in contrast to each NH’s 12-month pre-intervention PU prevalence of 2.7–6.2% for the 2, 3, and 4-hour facilities, respectively. Nursing staff on-time repositioning compliance ranged from 93% to 99% with every 4-hour compliance consistently achieving the highest percentage of on-time repositioning. Focus group results revealed a positive experience. Clinical implications of findings thus far will be discussed along with strategies for addressing barriers to effective resident repositioning.