Abstract
For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress.
Highlights
Pressure ulcers (PUs), known as decubitus ulcers, pressure sores, pressure injuries or bedsores, are Blocalized injuries to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear^ (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance 2014, 12)
Pressure ulcers are a common condition at the end of life for residents in residential aged care facilities (RACFs) (Doupe et al 2016; Jaul 2010; Jaul and Calderon-Margalit 2015)
We sampled legal and policy materials such as cases, legislation, government reports, guidelines, regulations, and principles that were relevant to aged care and elder abuse. These materials broadly fall into an area of law called Belder law.^ We included secondary source commentary on the legal and policy documents that we subsequently identified. We reviewed these documents to assess the legal implications of two-hourly repositioning and the use of restraints
Summary
Pressure ulcers (PUs), known as decubitus ulcers, pressure sores, pressure injuries or bedsores, are Blocalized injuries to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear^ (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance 2014, 12). Pressure ulcers are a common condition at the end of life for residents in residential aged care facilities (RACFs) (Doupe et al 2016; Jaul 2010; Jaul and Calderon-Margalit 2015). They can be extremely painful (Ahn, Stechmiller, and Horgas 2013; Pieper, Langemo, and Cuddigan 2009; Kwong et al 2011) and the pain is often unrelenting (Woo et al 2017; Gorecki et al 2009; Bliss 2009). Many nurses do not use screening tools (Samuriwo and Dowding 2014; Sharp et al 2005; Wann-Hansson, Hagell, and Willman 2008; Defloor and Grypdonck 2004; Webster, Gavin, and Nicholas 2010; Sharp et al 2000) but screen residents using clinical judgement to determine PU risk (Sharp and White 2015; Sharp and McLaws 2006; Anthony et al 2010; Sharp et al 2005, 2000)
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