Two Methods for Turning and Positioning and the Effect on Pressure Ulcer Development A Comparison Cohort Study

PURPOSE: We evaluated 2 methods for patient positioning on the development of pressure ulcers; specifically, standard of care (SOC) using pillows versus a patient positioning system (PPS). The study also compared turning effectiveness as well as nursing resources related to patient positioning and nursing injuries. DESIGN: A nonrandomized comparison design was used for the study. SUBJECTS AND SETTING: Sixty patients from a trauma/neurointensive care unit were included in the study. Patients were randomly assigned to 1 of 2 teams per standard bed placement practices at the institution. Patients were identified for enrollment in the study if they were immobile and mechanically ventilated with anticipation of 3 days or more on mechanical ventilation. Patients were excluded if they had a preexisting pressure ulcer. METHODS: Patients were evaluated daily for the presence of pressure ulcers. Data were collected on the number of personnel required to turn patients. Once completed, the angle of the turn was measured. The occupational health database was reviewed to determine nurse injuries. RESULTS: The final sample size was 59 (SOC = 29; PPS = 30); there were no statistical differences between groups for age (P = .10), body mass index (P = .65), gender (P = .43), Braden Scale score (P = .46), or mobility score (P = .10). There was a statistically significant difference in the number of hospital-acquired pressure ulcers between turning methods (6 in the SOC group vs 1 in the PPS group; P = .042). The number of nurses needed for the SOC method was significantly higher than the PPS (P = 0.001). The average turn angle achieved using the PPS was 31.03 degrees, while the average turn angle achieved using SOC was 22.39 degrees. The difference in turn angle from initial turn to 1 hour after turning in the SOC group was statistically significant (P < .0001). No nurse injuries were reported for either group during the study. CONCLUSIONS: Findings suggest that assistive devices such as a PPS can be effective in achieving proper positioning of patients to prevent development of pressure ulcers.