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Does Regular Repositioning Prevent Pressure Ulcers?

Krapfl, Lee Ann; Gray, Mikel

Journal of Wound, Ostomy and Continence Nursing: November-December 2008 - Volume 35 - Issue 6 - p 571–577
doi: 10.1097/01.WON.0000341469.33567.61
EVIDENCE-BASED REPORT CARD
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BACKGROUND Prolonged exposure to pressure is the primary etiologic factor of a pressure ulcer (PU) and effective preventive interventions must avoid or minimize this exposure. Therefore, frequent repositioning of the patient has long been recommended as a means of preventing PU.

OBJECTIVES To review the evidence on the efficacy of repositioning as a PU prevention intervention.

SEARCH STRATEGY A systematic review of electronic databases MEDLINE and CINAHL, from January 1960 to July 2008, was undertaken. Studies were limited to prospective randomized clinical trials or quasi-experimental studies that compared repositioning to any other preventive interventions or any study that compared various techniques of repositioning such as turning frequency. Only those studies that measured the primary outcome of interest, PU incidence, were included in our review.

RESULTS Limited evidence suggests that repositioning every 4 hours, when combined with an appropriate pressure redistribution surface, is just as effective for the prevention of facility- acquired PUs as a more frequent (every 2 hour) regimen. There is insufficient evidence to determine whether a 30° lateral position is superior to a 90° lateral position or a semi-Fowler's position.

IMPLICATIONS FOR PRACTICE The current regulatory and legal environment has focused increased attention on PU prevention. Pressure redistribution methods and the frequency of application are among the first factors scrutinized when a PU develops. Our clinical experience validates that regular movement of the immobilized patient is important, but evidence defining the optimal frequency of repositioning or optimal positioning is lacking.

Lee Ann Krapfl, BSN, RN, CWOCN, Wound/Ostomy Department, Mercy Medical Center, Dubuque, Iowa.

Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville.

Corresponding author: Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, PO Box 800422, Charlottesville, VA 22908 (mg5k@virginia.edu).

Does Regular Repositioning Prevent Pressure Ulcers?: Erratum

In the article that appeared on pages 571–577 of the November/December 35(6) issue, in the Key Points on page 575, the numbers 308 and 908 should read 30° and 90°. This erratum is published in the January/February 36(1) issue

Copyright © 2008 by the Wound, Ostomy and Continence Nurses Society