197090 Use and effectiveness of frequent manual repositioning for pressure ulcer prevention among bedbound hip fracture patients

Tuesday, November 10, 2009: 12:45 PM

Shayna E. Rich, MA, MS , Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD
David Margolis, MD, PhD , Departments of Epidemiology and Biostatistics, and Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA
Michelle Shardell, PhD , Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD
William G. Hawkes, PhD , Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD
Ram R. Miller, MD, CM , Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD
Sania Amr, MD, MS , Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD
Mona Baumgarten, PhD , Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD
Background:

National clinical practice guidelines for pressure ulcer prevention recommend frequent manual repositioning of bedbound patients, including those using pressure-redistributing support surfaces (PRSS), i.e., mattresses and overlays intended for pressure ulcer prevention. The evidence supporting these recommendations is weak and the extent to which the recommendations are being implemented is not known. This research aimed to examine the effectiveness of repositioning at the recommended frequency and to examine the adherence to these recommendations among bedbound hospitalized hip fracture patients.

Methods:

Eligible patients were age≥65 years who underwent surgery for hip fracture and were bedbound at the time of a study visit in the first five days of hospitalization (n=238). Study nurses assessed the use of PRSS, and information on repositioning frequency for the same day was collected by medical chart review. Study nurses also performed full-body skin examinations to determine the presence and stage of pressure ulcers at study visits two days later. Multivariable regression models using generalized estimating equations were fit to account for within-patient correlation and adjust for hospital, pressure ulcer status, and pressure ulcer risk factors.

Results:

Only 184 bedbound patients (59%) were repositioned frequently (at least every 2 hours). The proportion receiving frequent repositioning was similar for those using PRSS and those not using PRSS, 62% (78/125) and 56% (106/188), respectively. In the multivariable regression, the odds of frequent repositioning were significantly higher for bedbound patients using PRSS than for those not using PRSS (OR 2.7, 95% CI 1.2-6.1).

Eleven percent of bedbound patients developed stage II-IV pressure ulcers, 12% (22/187) of those who were repositioned frequently and 10% (13/130) of those who were not. The rate of incident stage II-IV pressure ulcers per person-day of follow-up did not differ significantly between these two groups of bedbound patients (relative rate 1.2, 95% CI 0.6-2.3) in the multivariable regression that also accounted for the use of PRSS and other pressure ulcer prevention devices.

Conclusions:

This study does not provide evidence that frequent repositioning is associated with lower pressure ulcer incidence in this high-risk group; additional studies are needed to evaluate the validity of these guidelines and determine if the substantial allocation of resources for manual repositioning is warranted. However, because the guidelines represent the current understanding of best practices, it is of concern that ~40% of all bedbound patients were not repositioned at the recommended frequency, suggesting that adherence to recommendations for frequent repositioning is incomplete.

Learning Objectives:
Describe the use of frequent manual repositioning, pressure-redistributing mattresses and overlays among bedbound hip fracture patients. Evaluate the effect of frequent manual repositioning on the incidence of pressure ulcers two days later.

Keywords: Health Care Quality, Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I performed the analysis and wrote the manuscript that this abstract is based on, as part of my dissertation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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