Feb 15, 2019

Two-hourly repositioning disrupts sleep, doesn’t prevent pressure ulcers

There has been a challenge to the conventional belief, held for decades, that those assessed as being at risk of developing pressure sores must be repositioned every two hours.

A paper released last week said two-hourly repositioning is a form of “abuse”, because it interrupts the person’s sleep, causing them to be constantly tired, and possibly contributing to them acting out their feelings of frustration.

Two-hourly repositioning also doesn’t prevent pressure sores from developing, the paper said.

HelloCare published an article about the research last week, and it was read by more than 400,000 people.

HelloCare has spoken to one of paper’s authors, who reiterated the paper’s claim that repositioning those assessed as being at risk of developing pressure sores isn’t necessary.

Catherine A. Sharp, Pressure Ulcer Prevention and Wound Care Consultant, has worked for over 20 years as a wound specialist.

She claims that using an alternating pressure air mattress (APAM) is sufficient to prevent the excruciating wounds from developing.

Ms Sharp recommends the NoDec A APAM, which is manufactured by Pegasus.

“It is the best I’ve seen,” she said, adding that this advice is given completely independently.

“The 10-minute cycle provides wonderful pressure relief and will prevent pressure ulcers,” she said.

The cost of the mattresses would work out to be around $1.40 per day per resident, Ms Sharp said, making it less expensive than manual repositioning.

“Let them sleep”

“I tell aged care staff that if a resident is on a NoDec [APAM] let them sleep. Do not wake them up to reposition. The APAM is providing all the pressure relief necessary to prevent pressure ulcers.

“If the resident is awake, then reposition, change their pad, offer a drink, sit and chat then let them fall asleep again. They will not get pressure ulcers,” she said.

The mattress is simple to operate, Ms Sharp said.

The motor at the foot of the bed has an On/Off switch and is clearly visible, even from a distance. Staff can see through the flashing signs that the cells are alternating.

“Staff do not have to dial up weight/softness etc, using lots of controls,” she said, which is “user error just waiting to happen”.

“The term ‘air mattress’ is thrown around incorrectly without people really understanding what it means,” Ms Sharp said.

“Some staff think that any ‘air mattress’ will do. Not so.”

Integrated side formers are “essential”

“Integrated side formers are absolutely essential to keep the edges of the mattress firm,” Ms Sharp said.

“There are cases in the literature where patients have rolled to the edge of an ‘air mattress’, the edge has deflated, the patient has become trapped when the edge re-inflates and they have asphyxiated,” Ms Sharp explained.

Prompt assessment is vital

Ms Sharp said it is essential that aged care staff assess residents quickly for their susceptibility to pressure sores.

“Staff are given up to eight hours to assess patients for pressure ulcer risk. If the patient is immobile for that eight hours there will, more likely than not, be a deep pressure ulcer developing,” she said.

Ms Sharp said the current recommendation to use low pressure mattresses will not prevent pressure sores from developing.

“When a patient [or resident] is deemed to be at risk of pressure ulcers, the first line management is a constant low pressure mattress which provides NO pressure relief at all. It may reduce pressure a bit but will not prevent pressure ulcers,” she said.

Guidelines are unclear

Ms Sharp said she has “no idea” why the guidelines around pressure sore prevention are unclear in Australia.

Two-hourly repositioning, even though it has been recommended practice, hasn’t actually been happening, Ms Sharp said, even though it is usually marked off on paperwork as being done. Hospital and aged care facilities don’t have enough staff to do it, she said.

It staff don’t have to reposition residents, another benefit will be a reduction in back injuries, she said.

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  1. I work in aged care and Hospital residents and patients are repositioned 4 hourly with or without airmatress 2 hourly puts residents patients under stress and become agitated. Let them sleep in peace.

  2. I also believe we should let people sleep, but also I’d like to see new studies. I don’t see any peer-reviewed articles/studies in this paper.

  3. I do not understand how this practice is not considered and abuse. We are interrupting their sleep again and again.

    Depriving sleep is a type of torture, in addition to negatively affecting mood and cognitive functions. The result is that many times patients fall asleep during the day, altering the biological clock.

    As this website sas, there are beds and mattresses that modify the pressure points without the patient having to be disturbed again and again.

  4. Well, I don’t think nurses should work at night. It is abuse because they are deprived of sleep and having to sleep during the day and this alters their biological clock. How many people sleep in one position during the night? I will try that. A matress may cost $1.40 per night but you would need a bed and a pump which I am sure would increase the cost. Could this article be biased? Has the study been critically analyzed?

  5. Surely a good nurse knows Risk assessments are done on admission to determine a score and care plan based on Ambulation, ability to move in bed. Frailty, cognitive, and skin condition such as turger [elasticity], this care plan then determines the frequency of care, and the nursing interventions. This is basic nursing but there are so many careers with little knowledge in the field today and not enough qualified leaders, this was a government initiative to reduce cost through deregulation . Roper, Logan, and Tierney, Twelve Activities of Living is a good beginning for those in care mode to read. The nursing art science should be taught by good leadership of those trained to do so not fringe health or those not trained.Lastly re-evaluation is undertaken to determine the nursing care plan is updated when required.

  6. Being on a air mattress doesn’t mean the resident won’t get pressure sores. My father was on such a mattress and still managed to develop a sore that in his nearly 2 years of being in the nursing home never healed.
    He wasn’t mobile and I don’t know what the nursing home could have done to prevent the said sore but so called air mattresses don’t prevent bed sores.

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