For a study, researchers sought to determine the therapeutic efficacy of three nursing-home-wide repositioning intervals (2-, 3-, or 4-hour) without compromising pressure injury (PrI) incidence throughout the course of four weeks. Nine nursing homes (NHs) were randomly allocated to one of three repositioning intervals in an embedded pragmatic cluster randomized controlled study. During the TEAM-UP (Turn Everyone And Move for Ulcer Prevention) trial, baseline (12 months) and 4-week intervention data were reported. Residents in the intervention group lacked existing PrIs, had PrI risk (Braden Scale score) 10 (not severe risk), and slept on viable 7-inch high-density foam mattresses. During the intervention, each arm contained three NHs with a single repositioning interval (2, 3-, or 4-hour). A wireless patient monitoring system with wearable single-use patient sensors alerted nursing staff to resident repositioning requirements on conveniently located monitors. The primary goal was PrI incidence, while the secondary result was compliance fidelity with staff relocation.
From May 2017 to October 2019, 1,100 residents from 9 NHs were equipped with sensors; 108 of them were excluded from some studies due to lacking baseline data. The effective sample size was 992 residents (average age 78±13 years; 63% female). Even though the intervention residents’ clinical risk ratings were considerably higher (P<.001), the PrI incidence throughout the intervention was 0.0% compared to 5.24% at baseline. Repositioning compliance was substantially higher for the 4-hour repositioning period (95%) than for the 2-hour (80%) or 3-hour (90%) intervals (P<.001).
The findings showed that existing 2-hour guidelines for many NH residents might be modified without jeopardizing PrI prevention. A causal relationship between repositioning interval treatments and PrI outcome could not be established; nevertheless, no new PrIs were formed. Compliance increased as the repositioning interval increased.