The Elderly and Pressure Ulcer Prevention : PRSS vs. Manual Repositioning Bridget McMahon

1. The Elderly and Pressure Ulcer Prevention: PRSS vs. Manual Repositioning Bridget McMahon

2. What are Pressure Ulcers? • “Areas of localized injury to the skin or underlying tissue that arise when soft tissue is compressed between a bony prominence” (Baumgarten, 2010) • Normal estimates of capillary pressures range from 10-30 mmHg. When interface pressure between skin and supporting surface exceed 32mmhG,tissue hypo-perfusion occurs and results in pressure ulcer formation. (Peterson, 2010)

4. Objective/PICO: • The objective of this integrative literature review is to determine if manual turning and repositioning, when used with elderly patients 65 years of age or older, results in a lower incidence of pressure ulcer formation during one hospital stay when compared to specialty support surface mattresses. •  The Joint Commission recommends, improvement in positioning, repositioning, transferring and turning techniques to reduce skin injury caused by friction and shear force use of repositioning devices, and mechanical loading and support surfaces to reduce skin injury caused by friction or shear force (The Joint Commission, 2014)

5. Elderly Risk Factors for Skin Breakdown • Decreased ease of mobility • Thin/dry/fragile skin • Incontinence • Confusion/Dementia • Medical conditions that decrease perfusion to tissues

6. Method • An integrative literature review was performed to compare the effectiveness of manual turning and repositioning with specialty support surfaces. Online databases including CINAHL, Medline, and EBSCO were used with key searches of ‘pressure ulcer formation’, ‘pressure ulcer prevention’, ‘pressure sores and specialty support surfaces’, ‘pressure sore formation’, ‘elderly and pressure sores’, and ‘pressure sores and turning and repositioning’.

7. Turning and Repositioning • Rotate between left/right lateral and supine positions for patients Q2 hours • Pillows and other body supports may be utilized • Proper use of body mechanics and equipment to protect health care team and patient (Griffiths, 2011). • The method in which patients are repositioned makes a difference. Staff must decrease friction and shear forces (Rich, 2010). • Little evidence to support efficacy

8. Pressure Redistributing Support Surfaces • Designed to prevent pressure ulcers by deforming to distribute the pressure due to a person’s weight over a larger area (Rich, 2011) • Powered vs. Non-Powered (Sprigle, 2011) • Decreases chance of staff injury (Rich, 2010) • Convenient on busy in-patient units • Some PRSS have pressure sensors which alert the health care team of increased pressure points which prompts them to make adjustments to patient positioning (Montamedi, 2012).

9. The Research • Study by Peterson showed 93% of 15 patients had skin interface pressures ≥ 32 mmHg throughout all positions after RN repositioned Q2 hours (2010). • Evidence indicates that the frequency to which patients should be repositioned varies. Assessment upon admission is essential to determine. • A study by Rick High risk patients repositioned ≤ Q2 had decreased incidence of pressure ulcers than lower risk patients repositioned more frequently, ≥ Q2 hours (2010). • Peterson studied “triple jeopardy areas” which are the skin areas that are always at risk for breakdown in the supine, left lateral, and right lateral positions. • Triple jeopardy area increased with use of support wedges when compared to pillow use (Peterson, 2010). • Advances in technology may help prevent pressure ulcer formation • Pressure imaging studies help nurses remember to turn and reposition patients, but needs further research in hospital settings to ensure accuracy (Montamedi, 2012).

10. Conclusion • It is hard to collect data because it is considered unethical to leave a patient in the same position for extended periods of time to conduct a research study. In conclusion further research is needed to determine which is more effective, turning and repositioning or PRSS.

11. Acknowledgements • I would like to acknowledge SUNYIT for allowing me to access my research through their databases, as well as Bassett Medical Center for allowing me to put my research into practice.

12. References • Baumgarten et al. (2010) Use of pressure-redistributing support surfaces among elderly hip fracture patients across the continuum of care: adherence to pressure ulcer prevention guidelines. The Gerontologist, 50(2), 253-261. doi: 10.1093/gerant/gnp101 • Griffiths (2012) Adverse risk: A 'dynamic interaction model of patient moving and handling'. Journal of Nursing Management, 20, 713-736. doi: 10.111/j.1365-2834.2011.01276.x • The Joint Commission. 2014. Pressure ulcers.http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId= 163&ProgramId=47 • Mayo Clinic. 2014. Bedsores risk factors. http://www.mayoclinic.org/diseases-conditions/bedsores/basics/risk-factors/con-20030848 • Motamedi et al. (2012) The effect of continuous pressure monitoring on strategic shifting of medical inpatients at risk for pressure ulcers. Journal of Wound Care, 21(11), 517-527. • Peterson et al. (2010) Effects of turning on skin-bed interface pressures in healthy adults. Journal of Advanced Nursing, 66(7), 1556-1564. doi: 10.111/j.1365-2648.2010.05292.x • Rich et al. (2011) Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients. Wound Repair & Regeneration, 19(1), 10-18. Doi:10.1111/j.1524-475X2010.00644. • Rich et al. (2011) PRSS use and pressure ulcer incidence in elderly hip fracture patients. Journal Of The American Geriatrics Society, 59(6), 1052-1059. doi: 10.1111-j.1532-5415.2011.03446.x • Springle & Sonenblum (2011) Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review. Journal of Rehabilitation Research and Development, 48(3), 203-211. doi: 10.1682/JRRD.2010.05.0102