Pressure injuries are injuries to the skin and deeper tissues that occur due to direct pressure, shear, or friction forces. It is estimated that in the United States, 2.5 million pressure injuries occur yearly in acute care facilities alone.1 The price of managing a single full-thickness pressure injury is as much as $70,000, and expenditures in the United States for pressure injury treatment have been estimated at $11 billion per year.2,3
The exposure of bony prominences to surfaces and the use of pressure-causing medical devices further the risk of injury. Risk factors for pressure injury development include5:
Prevention can be achieved through risk assessment, clinical consultation, and pain management. In addition, proper prevention should combine individualized patient turning timelines and repositioning techniques with offloading products and pressure-sensing technology. Clinicians should also consider widely accepted pressure injury risk assessment tools, which include the Braden Scale, the Norton Scale, and the Waterlow Scale.
The purpose of routinely turning patients is to relieve pressure and ensure adequate blood perfusion to the skin and soft tissues, especially in at-risk areas, such as at the heels, the sacrum, the hips, elbows, ischia, and the base of the skull. The National Pressure Injury Advisory Panel (NPIAP) had historically recommended turning patients every 2 hours. In 2019, the guidelines were updated to suggest that turning schedules should be based on a patient’s overall medical condition, skin condition, activity level, and ability to reposition themselves. Patients who are critically ill, cognitively or motor impaired, obese, immobilized, or require mechanical ventilation may typically require aid.6
Variability exists in how well patients are turned, and patients and support devices can shift, affecting how desired positions are achieved. For this reason, pressure-monitoring devices have become more popular. Pressure sensors can be positioned over specific at-risk locations on the body or can come in the form of mattress or wheelchair seat covers. Most pressure sensors are designed to monitor pressure and send alerts when repositioning is indicated. Sensors can even help assess and manage healing parameters. These devices are emerging as a critical, cost-effective alternative to previous standards of care.7
Safety and ergonomics are paramount in patient turning techniques. To avoid work-related injuries, the clinician should recruit assistance when necessary. While turning the patient, the wound care professional should maintain head, neck, and back alignment, refrain from twisting, and only bend at the knees or waist—never at the back. The clinician should adjust the bed to match the center of gravity and stand as close to the patient as possible before turning to avoid undue strain. Inflatable sheets, patient lifts, and flex tilt chairs can help ease the burden of repositioning.4 Preceding turning, clinicians should explain what to expect and why the maneuver is essential. This process may require encouragement. You may want to follow the following steps for this process4:
To ensure correct positioning, one should consider the “Rule of 30 Degrees.”4 This rule reminds caregivers to elevate the head of the bed no more than 30 degrees and to place the body at a 30-degree, laterally inclined position with hips and shoulders 30 degrees from supine, using pillows or wedges for support as necessary. Caregivers should always lift versus drag patients (to minimize skin shearing), ensure that patients’ ankles, knees, and elbows are not resting on each other, and refrain from positioning patients on bony prominences with existing nonblanchable skin.4
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Once a patient is successfully turned, products designed to relieve pressure and prevent skin breakdown should be used according to protocol. These products can include the following2:
To prevent skin breakdown and reduce shearing, daily moisturizers and barrier creams should be used after proper cleansing, especially when incontinence is a factor.
Prevention efforts are essential in reducing the morbidity, mortality, and exorbitant unnecessary costs associated with pressure injuries and require multi-specialty collaboration, individualized care plans, monitoring, adherence to protocols, and re-evaluation as necessary.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.