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Study: Mattresses may prevent pressure ulcers with fewer turns

Monday November 18, 2013
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If nursing homes use high-density foam mattresses, residents might no longer need to be turned every two hours to avoid pressure ulcers, according to a three-week study.

The practice of turning residents every two hours to prevent pressure ulcers has been used for more than 50 years. But a new randomized controlled study showed no difference in the incidence of pressure ulcers for residents using high-density foam mattresses turned every two, three or four hours. The study was led by Nancy Bergstrom, RN, PhD, associate dean at the University of Texas Health Science Center at Houston School of Nursing, and was published in the October 2013 Journal of the American Geriatric Society.

“We are very interested in preventing pressure ulcers,” Bergstrom said in a news release. “It’s a serious health problem. Also, we’re interested in improving care for nursing home residents. Turning residents every two hours throughout the night awakens them, and many people can’t go back to sleep, therefore decreasing their quality of life.”

The Turning for Ulcer ReductioN study, or TURN study, followed 942 nursing home residents ages 65 and older who were at moderate or high risk of developing pressure ulcers according to the Braden Scale, and had limited mobility. The study was conducted in 27 nursing homes in the U.S. and Canada. Researchers decided on a three-week study length based on a past study showing 90% of pressure ulcers formed in the first three weeks.

Participants were mostly female (77.6%) and had an average age of 85.1, with the most common diagnoses cardiovascular (76.9%) and dementia (72.5%). Study participants were randomly assigned to turning intervals of two (321 patients), three (326) or four hours (295) for three weeks, and CNAs turned them according to the randomized schedule.

A nurse, unaware of turning frequency, documented each patient’s skin condition every week. A checklist was used to document type of reposition, heel position, incontinence brief condition and skin care at each turn.

During the study, incidence of pressure ulcers was low (2%). Nineteen participants developed superficial pressure ulcers, with two Stage 1 ulcers recorded and 19 Stage 2 ulcers. No serious (Stages 3 and 4) pressure ulcers developed during the study.

Overall, the study found no statistically significant difference in pressure ulcer incidence between the groups. Patients turned every two hours had a 2.5% incidence rate, compared with the groups turned every three hours (0.6%) or every four hours (3.1%).

“The findings of the TURN study highlight that turning residents every two hours may no longer be necessary when high-density mattresses are in place and nursing time can be used to attend to other resident needs, such as feeding, assisted mobility and ultimately develop a stronger relationship with their residents,” Susan Horn, PhD, co-principal investigator at the Institute for Clinical Outcomes Research, said in the news release.

In the past, nursing homes used mattresses made of spring coils and covered in thick plastic. These exposed the residents to more pressure, which required frequent turning. Newer high-density foam mattresses expose residents to less pressure, and according to the study, might allow for less frequent turning.

“We hope using high-density foam mattresses and being very much aware of resident’s skin at every turn will decrease the necessity of turning residents every two hours to prevent pressure ulcers and allow residents to sleep more, improving quality of life,” Bergstrom said in the release. “Of course, clinical judgment is necessary when implementing results of this study; these findings do not mean that turning is unnecessary.”

The TURN study was funded by the National Institute of Health’s National Institute of Nursing Research and the National Institute on Aging.

Study: http://onlinelibrary.wiley.com/doi/10.1111/jgs.12440/full


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