Volume 50 Number 4, 2013
Pages 477 — 488
Abstract — Repositioning patients regularly to prevent pressure ulcers and reduce interface pressures is the standard of care, yet prior work has found that standard repositioning does not relieve all areas of at-risk tissue in nondisabled subjects. To determine whether this holds true for high-risk patients, we assessed the effectiveness of routine repositioning in relieving at-risk tissue of the perisacral area using interface pressure mapping. Bedridden patients at risk for pressure ulcer formation (n = 23, Braden score <18) had their perisacral skin-bed interface pressures recorded every 30 s while they received routine repositioning care for 4–6 h. All participants had specific skin areas (206 +/– 182 cm2) that exceeded elevated pressure thresholds for >95% of the observation period. Thirteen participants were observed in three distinct positions (supine, turned left, turned right), and all had specific skin areas (166 +/– 184 cm2) that exceeded pressure thresholds for >95% of the observation period. At-risk patients have skin areas that are likely always at risk throughout their hospital stay despite repositioning. Healthcare providers are unaware of the actual tissue-relieving effectiveness (or lack thereof) of their repositioning interventions, which may partially explain why pressure ulcer mitigation strategies are not always successful. Relieving at-risk tissue is a necessary part of pressure ulcer prevention, but the repositioning practice itself needs improvement.
Key words: decubitus ulcer, interface pressure, patient repositioning, pressure, pressure sore, pressure ulcer, pressure ulcer risk, prevention, standard of care, triple-jeopardy area.
Note: The authors would like to dedicate this article to the memory of their colleague Dr. Schwab.
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Last Reviewed or Updated Monday, July 29, 2013 10:24 AM