Transcript

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Key In terms of repositioning, it's interesting. In many previous years of the international guidelines, the National Pressure Injury Advisory Panel, the European, and the Pan-Asia, they had removed timing on the repositioning and talked about repositioning the patient based on the patient's condition, so all of those risk factors in premorbid condition and their acute illness, the surface that they were on. played a role in it as well. But from a practical perspective, if I have a 600-bed hospital and I have 350 nurses and maybe 120 assistants, the concept of creating individualized positioning schedules for every immobile patient in the building, the process variation around that is massive. 

So with that said, the guidelines put a timing back in. It's a conditional recommendation of every 2 to 3 hours. And that was based off a very large study. And what was exciting about this study, it was about a thousand patients. They were residents. It was in long-term care facilities. So that plays a role in it. What they did is they controlled for the surface. So they ensured they had a pressure redistribution surface, the same one on everybody. And so therefore, and then they broke up the timing of the schedule of Q2, Q3, and Q4. And they had a wearable sensor to determine the frequency of the turn and the accuracy of the turn. And to me, it really is about offloading the sacrum and I'll get to that in a second. But what they found is none of the immobile patients develop pressure injuries versus 5.4% before they implemented this. And there was 90% compliance at Q4, 80% at Q3, and I think it was 70 or 80% at Q2.* And so the guidelines put that Q2 to 3. 

But here's where it differs. Guidelines also talk about, and this is where we can work to get at the tissue loading, is to ensure that they have a good pressure redistribution surface underneath the patient. And there are international guidelines that are called the S3 guidelines that talk about having surfaces that are immersing the patient, enveloping the patient, and managing the patient microclimate. The second thing is there is no human—and I don't know if the video is going to show it—that turns like this, where we are in a straight line. But when you talk with staff about turning, that's how the patient is turned. The guidelines basically talk about we need to change the way we laterally turn by putting that upper leg and crossing it and putting a pillow underneath so that you are lifting the sacrum up and truly offloading. 

So to me, instead of using the word tissue tolerance or turn, I like to use the word offload because it really talks about relieving that pressure as a part of that component. 

* Kathleen Vollman clarifies that Q4 compliance is 90%, Q3 is 85%, and Q2 is 80%. (Reference: Yap TL, Horn SD, Sharkey PD, et al. Effect of Varying Repositioning Frequency on Pressure Injury Prevention in Nursing Home Residents: TEAM-UP Trial Results. Adv Skin Wound Care. 2022;35(6):315-325.)