Does Regular Repositioning Prevent Pressure Ulcers?

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 degrees lateral position is superior to a 90 degrees 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.