Abstract
BackgroundPressure ulcers/injuries (PrUs), a critical concern for nursing homes (NH), are responsible for chronic wounds, amputations, septic infections, and premature deaths. PrUs occur most commonly in older adults and NH residence is a risk factor for their development, with at least one of every nine U.S. NH residents experiencing a PrU and many NHs having high incidence and prevalence rates, in some instances well over 20%. PrU direct treatment costs are greater than prevention costs, making prevention-focused protocols critical. Current PrU prevention protocols recommend repositioning residents at moderate, high, and severe risk every 2 h. The advent of visco-elastic (VE) high-density foam support-surfaces over the past decade may now make it possible to extend the repositioning interval to every 3 or 4 h without increasing PrU development. The TEAM-UP (Turn Everyone And Move for Ulcer Prevention) study aims to determine: 1) whether repositioning interval can be extended for NH residents without compromising PrU incidence and 2) how changes in medical severity interact with changes in risk level and repositioning schedule to predict PrU development.MethodsIn this proposed cluster randomized study, 9 NHs will be randomly assigned to one of three repositioning intervals (2, 3, or 4 h) for a 4-week period. Each enrolled site will use a single NH-wide repositioning interval as the standard of care for residents at low, moderate, and high risk of PrU development (N = 951) meeting the following criteria: minimum 3-day stay, without PrUs, no adhesive allergy, and using VE support surfaces (mattresses). An FDA-cleared patient monitoring system that records position/movement of these residents via individual wireless sensors will be used to visually cue staff when residents need repositioning and document compliance with repositioning protocols.DiscussionThis study will advance knowledge about repositioning frequency and clinically assessed PrU risk level in relation to PrU incidence and medical severity. Outcomes of this research will contribute to future guidelines for more precise preventive nursing practices and refinement of PrU prevention guidelines.Trial registrationClinical Trial Registration: NCT02996331.
Highlights
Pressure ulcers/injuries (PrUs), a critical concern for nursing homes (NH), are responsible for chronic wounds, amputations, septic infections, and premature deaths
Pressure ulcer/injury (PrU) prevention remains a challenge within the nursing home (NH) environment [1, 2]
Residence in a NH puts individuals at risk of developing PrUs [8], and the limited mobility prevalent among NH residents [10] increases the intensity and duration of pressure exposure – two factors leading to PrU development [11]
Summary
Pressure ulcers/injuries (PrUs), a critical concern for nursing homes (NH), are responsible for chronic wounds, amputations, septic infections, and premature deaths. Current PrU prevention protocols recommend repositioning residents at moderate, high, and severe risk every 2 h. The TEAM-UP (Turn Everyone And Move for Ulcer Prevention) study aims to determine: 1) whether repositioning interval can be extended for NH residents without compromising PrU incidence and 2) how changes in medical severity interact with changes in risk level and repositioning schedule to predict PrU development. Most PrUs are avoidable, but those that do develop are associated with complications (e.g., chronic wounds, amputations, septic infections, and premature deaths) [3] and with overall deterioration in prognosis, compromising both a patient’s health status and quality of life. The severity of illness, including signs, symptoms, physiologic parameters, and disease factors, affects the body’s response to pressure exposure and possibly increases risk for PrU development. A universally accepted approach to PrU prevention is to minimize pressure exposure through frequent moving/repositioning (hereafter referred to as repositioning) [12, 13] for residents clinically assessed as at-risk (typically Braden Scale© score ≤ 18)
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