The Effectiveness of Repositioning in Reducing Pressure Ulcer Incidence and Promoting Healing in Patients

Impact of the Problem on the Patient

Pressure ulcers and bedsores can significantly impact patients’ physical, emotional, and financial well-being. These wounds can cause significant pain and discomfort and take a long time to heal, leading to extended hospital stays and decreased patient quality of life. Additionally, pressure ulcers can lead to secondary infections, which can be severe and even life-threatening. Sometimes, pressure ulcers can result in permanent disabilities, such as mobility loss. The financial impact of pressure ulcers on patients can also be substantial, as the cost of treatment and extended hospital stays can be high. Thus, it is essential to implement effective interventions to prevent and treat pressure ulcers in patients, ensuring they receive the best possible care and experience positive outcomes.

Impact of the Problem on the Organization

Pressure ulcers impact individual patients and the hospitals and institutions of care in which they are treated. The treatment and management of pressure ulcers can be time-consuming and resource-intensive, leading to increased costs and staff workload. Extended hospital stays and increased readmissions due to pressure ulcers can strain healthcare resources and reduce available bed capacity.

Additionally, the risk of hospital-acquired infections and the need for additional wound care can increase the risk of medical errors, potentially leading to adverse patient outcomes and increased liability for healthcare institutions. Furthermore, a high incidence of pressure ulcers can negatively impact the reputation of a hospital or institution, reducing patient trust and confidence in the care being provided. Therefore, hospitals and institutions must implement effective strategies to prevent and manage pressure ulcers, ensuring positive patient outcomes and reducing costs and risks to the institution.

Identify the PICO components

P –  patients with pressure ulcers

I – Repositioning of patients

C – Standard care (no repositioning)

O – Reduction in pressure ulcer incidence and promotion of healing.

Evidence-Based Practice Question

In patients with pressure ulcers, what is the effectiveness of repositioning in reducing pressure ulcer incidence and promoting healing compared to standard care?

Research Article Title

Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomized controlled trials. (Steele, M. et al)

Background Introduction

The research objective was to evaluate the effectiveness of preventative measures to prevent pressure injuries in adults receiving care in ICUs. The results of the study were obtained through a combination of narrative synthesis and random-effects meta-analysis, which showed that only prophylactic dressings applied on the sacral and heel areas were found to be successful in reducing the risk of pressure injury in ICU-admitted adults.

Methodology

The study employed a systematic review and meta-analysis approach, analyzing a set of randomized controlled trials (RCTs) to assess the efficacy of pressure injury preventative measures in adults admitted to acute care hospitals. The researchers conducted a comprehensive systematic review of RCTs to examine the impact of pressure injury preventative interventions. A subset of trials was explicitly selected, focusing on those conducted in ICU settings. These trials were then separated from those conducted in acute settings to undergo a separate, ICU-specific systematic review and meta-analysis.

Level of Evidence

Level 1

Data Analysis

Data analysis followed the screening, which was one of the two phases of the study’s approach to data analysis. Two independent reviewers determined the findings without knowing each other’s conclusions, and a third reviewer acted arbitrarily between them.

Ethical Considerations

Although actual patients were used in the experiments, great care was taken to ensure they were not harmed. It shows that the research may be trusted. Also, all authors involved confirm that they had no personal or professional relationships that could have influenced the results of this study.

Quality Rating

High Quality

Analysis of the Results / Conclusions

This meta-analysis and systematic review of 26 randomized controlled trials (RCTs) aimed to assess the efficacy of therapies designed to reduce the risk of pressure injury (PI) in hospitalized patients. However, the Braden Scale was initially designed for a different demographic. Thus future investigations may want to employ ICU-specific risk assessment measures instead. Most studies had a significant or uncertain risk of bias, often because of poor reporting and incorrect analysis.

Most of the 10 intervention types evaluated had equivocal results. However, the meta-analysis revealed that preventative dressings on the sacrum and heels significantly lowered the risk of PI. Sensitivity studies have shown that these findings are reliable. However, more high-quality research is required to demonstrate the efficacy of various dressing methods since all studies were at high or uncertain risk of bias. In the intensive care unit, few large-scale experiments tested the efficacy of various support surfaces, such as active and reactive surfaces. More study is required to verify their usefulness and evaluate relative surface qualities.

Only dressings for prophylactic use were found to prevent pressure injuries in adults in ICU settings effectively, but only for sacral and heel application. The trials were mostly biased, and more research is needed to confirm these results and explore other intervention types, including nutrition. The subsequent trials should follow guidelines, use an accurate intention-to-treat approach, and consider time to pressure injury in addition to incidence. The ICU is a unique setting that needs separate research evidence. High-quality trials are crucial for improving outcomes and safety for critically ill ICU patients.

Alignment to the EBP question

The study addresses the issue of pressure ulcers in patients admitted to the ICU and aims to find the most effective intervention to prevent their occurrence. The intervention evaluated uses prophylactic dressings, and the comparison is with standard care.

Non-Research Article Title

Background Introduction

The non-research article is by Day et (2022), which illustrates how nurses can perform proper pressure injury prevention operations which support patient treatments. The article explained that the primary nurses’ activities can get regulated regarding the applicable evidence-based guidelines needed to work with proper prevention strategies. Their work processes facilitate comprehensive patient review procedures, collaboration among different healthcare providers, and manage competing factors that promote the proper implementation of health improvement initiatives (Day et al., 2022). All nurse leaders and registered nurses must promote advanced health improvement initiatives that support reliable connections while generating the required health outcomes.

Type of Evidence

The study used a literature review that facilitates different reviews on how nurses can assist in managing pressure ulcers. A reliable study was produced based on an analysis of different nurses involved in an interview which provided accurate data collection after reviewing answers in audio recordings. The researchers found that the main factors influencing nurses’ clinical guidelines that manage risk assessments are working with prevention strategies, correctly repositioning operations, and synthesizing advanced technological operations to promote better health procedures. It was also possible to connect the accuracy of nurse activities in terms of their years of clinical experience and status as registered nurses or nurse leaders.

Level of Evidence

Level-V

Quality Rating

B-good

Author’s Recommendations

The author can review how to generate advanced healthcare management processes without imposing a significant workload on nurses. It can be possible to handle collaboration sessions with nurses since their daily work procedures would focus on adherence to healthcare measures as regulated using a healthcare environment’s resources.

Recommended Practice Change

• Repositioning

Repositioning the patient every 2 hours is a commonly used intervention practice to prevent pressure ulcers in patients. This practice involves regularly adjusting a patient’s position to distribute pressure evenly over the skin and underlying tissues. This reduces the amount of pressure and friction on specific areas, helping to prevent the development of pressure ulcers.

Repositioning can be done manually by a caretaker or with the use of specialized equipment such as air mattresses and repositioning devices. When performed correctly, repositioning can significantly reduce the risk of pressure ulcers in patients who are immobile or have limited mobility.

In addition to reducing the risk of pressure ulcers, repositioning can also improve circulation, prevent contractures and improve comfort for the patient. However, it is essential to note that repositioning should be done with care and not cause further injury to the patient.

• Using a specialized pressure ulcer mattress

A specialized pressure ulcer mattress is designed to reduce the pressure on bony prominences of the body, thus reducing the risk of developing pressure ulcers. The mattress is typically made of a pressure-relieving material such as foam or gel and is designed to redistribute the patient’s weight more evenly over a larger surface area. This reduces the pressure on any one area and helps to prevent the formation of pressure ulcers. The mattress may also be designed with unique features such as alternating pressure, low air loss, and lateral rotation to decrease the risk of developing pressure ulcers. Using a specialized pressure ulcer mattress effectively reduces the incidence of pressure ulcers in patients at high risk for developing them, such as those who are immobile or have limited mobility. By reducing pressure on the skin and underlying tissues, the mattress helps to prevent tissue damage and promotes healing. This intervention is considered an essential aspect of overall wound management. It should be used with other strategies to prevent pressure ulcers, such as repositioning, proper nutrition, and maintaining a healthy skin care regimen.

• Providing proper skin care and hygiene

Proper skin care and hygiene are crucial in preventing pressure ulcers in patients. Maintaining healthy skin is essential in reducing the risk of skin breakdown and promoting the healing of existing wounds. Proper skin care and hygiene practices include:

1. Keeping the skin clean and dry: Regularly cleaning and drying the skin can help prevent infection and reduce the risk of developing pressure ulcers.
2. Moisturizing the skin: Using a moisturizer can help to keep the skin hydrated and reduce the risk of dry, cracked skin, which can lead to pressure ulcers.
3. Avoiding irritating skin products: Some products, such as soaps and creams, can irritate the skin and increase the risk of developing pressure ulcers. It is essential to use gentle products that are appropriate for sensitive skin.
4. Repositioning patients every two hours or as needed helps reduce the pressure on any one area of the skin, which can help prevent pressure ulcers from forming.
5. Inspecting the skin regularly: Regularly inspecting the skin can help identify areas at risk for developing pressure ulcers and prompt early intervention.

Key Stakeholders

The role of key stakeholders in addressing the effectiveness of repositioning in reducing pressure ulcer incidence and promoting healing in patients can be described as follows:

• Doctors:

Doctors have a crucial role in educating patients and their families about the importance of repositioning and its impact on reducing pressure ulcers. They also play a crucial role in ensuring that patients receive regular repositioning as part of their care plan and in monitoring the effectiveness of repositioning in reducing pressure ulcers.

• Government:

The government plays a role in establishing policies and guidelines for pressure ulcer prevention and management, including repositioning. They can also provide funding for research and education programs to improve the effectiveness of repositioning in reducing pressure ulcers.

• Family members:

Family members play a critical role in advocating for the needs of their loved ones and ensuring that they receive proper care and attention. They can also be trained in repositioning techniques and assist with repositioning their loved ones.

• Nurses:

Nurses have a critical role in implementing repositioning as part of a patient’s care plan and ensuring that it is carried out effectively. They also play a crucial role in educating patients and families on the importance of repositioning and can monitor its effectiveness in reducing pressure ulcers.

Barrier to Implementation

Lack of resources is a significant barrier to implementing repositioning to reduce pressure ulcer incidence and promote patient healing. Repositioning requires staff time, equipment, and materials to be implemented effectively. Healthcare facilities may need more resources to allocate additional staff time for repositioning or access to specialized equipment such as pressure-relieving mattresses and lifting devices. This can make it difficult for healthcare providers to implement repositioning consistently and effectively, especially in underfunded or understaffed facilities.

A limited understanding of the importance of repositioning is another barrier that can hinder pressure ulcer incidence and promote healing in patients. Both healthcare providers and patients may need help understanding the role that repositioning plays in reducing pressure ulcer incidence and promoting healing. This can lead to resistance and lack of adherence to repositioning protocols. For example, healthcare providers may prioritize other aspects of patient care over repositioning, or patients may resist being repositioned due to discomfort or fear.

Strategy to Overcome the Implementation Barrier

The barriers of lack of resources and limited understanding of the importance of repositioning can be tackled by taking the following steps:

• Resource allocation:

Healthcare facilities can allocate the necessary resources to implement repositioning, such as investing in specialized equipment, allocating staff time, and providing staff training. This will ensure that repositioning is consistently and effectively implemented in patient care.

• Education and training:

Healthcare providers can educate themselves and their patients on the importance of repositioning and its role in reducing pressure ulcer incidence and promoting healing. Staff can also be trained on repositioning techniques and the proper use of equipment, which will improve adherence and consistency.

Indicator to Measure the Outcome

The following indicators can be used to measure the successful outcome of the effectiveness of repositioning in reducing pressure ulcer incidence and promoting healing in patients:

• Reduction in the incidence of new pressure ulcers:

This is one of the most important indicators of the success of repositioning in reducing pressure ulcer incidence. If there is a decrease in the number of new pressure ulcers, it can be concluded that repositioning effectively reduces pressure ulcer incidence.

Improved healing of existing pressure ulcers: If existing pressure ulcers show improvement in size, depth, and overall healing, it can be concluded that repositioning effectively promotes healing.

• Patient comfort:

If patients report improved comfort and reduced pain levels, it can be concluded that repositioning effectively reduces pressure on sensitive areas and reduces discomfort.

• Increased mobility:

If patients show improvement in mobility and can move around more freely, it can be concluded that repositioning effectively reduces pressure on bony prominences and improves overall mobility.

• Reduced length of stay:

Suppose patients can be discharged from the hospital or rehabilitation facility sooner. In that case, it can be concluded that repositioning effectively reduces pressure ulcer incidence, promotes healing, and improves overall health and well-being.

References

Day, E. S., Koirala, B., & McIltrot, K. (2022). Repositioning strategies to prevent pressure injuries in the ICU: Integrative Review on Implementation Factors. Advances in Skin & Wound Care,35(6), 344-351. DOI: 10.1097/01.asw.0000821772.03685.77

Lovegrove, J., Fulbrook, P., Miles, S., & Steele, M. (2022). Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomized controlled trials. Australian Critical Care, 35(2), 186-203.