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Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes.

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Turning high-risk residents every 2, 3, or 4 hours on foam mattresses does not significantly impact pressure ulcer incidence. Intervals of 3 or 4 hours are as effective as 2-hour turning for preventing pressure ulcers.

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Area of Science:

  • Gerontology
  • Nursing Science
  • Biomedical Engineering

Background:

  • Pressure ulcers (PrUs) are caused by prolonged pressure occluding blood flow.
  • Support surfaces and regular repositioning are key to preventing PrUs.

Purpose of the Study:

  • To determine the optimal frequency for repositioning at-risk residents in long-term care (LTC) facilities.
  • To evaluate turning schedules (2, 3, or 4-hour intervals) for residents on high-density foam mattresses.

Main Methods:

  • Randomized controlled trial in 27 LTC facilities across North America.
  • Participants were assigned to 2-, 3-, or 4-hour turning schedules for 3 weeks.
  • Weekly skin assessments by blinded evaluators measured PrU development.

Main Results:

  • No significant difference in PrU incidence across the 2-, 3-, and 4-hour turning groups (P=0.68).
  • Superficial pressure ulcers (Stage 1 or 2) were observed in 2.02% of participants.
  • Incidence did not differ significantly between high-risk and moderate-risk residents.

Conclusions:

  • Turning moderate- to high-risk residents every 2, 3, or 4 hours is acceptable on high-density foam mattresses.
  • 3- and 4-hour turning intervals are not inferior to 2-hour intervals.
  • Less frequent turning may improve resident sleep, quality of life, and staff efficiency.