Feb 07, 2019

Two-hourly repositioning to prevent bedsores is “abuse”, study says

New research from the University of New South Wales has raised questions about the correct way to care for those requiring pressure area care.

The common practice of repositioning every two hours those at risk of developing bedsores may be interrupting their natural sleep rhythms, causing them to become more agitated and distressed, according to the new study.

The practice of repositioning also fails to prevent bedsores from developing, the researchers say.

The fact that the practice continues is a form of “unintentional institutional elder abuse”, they say.

However, experts we have spoken to say repositioning (and other factors) are required for those assessed as being at risk of developing bedsores. The frequency of repositioning will depend on a number of factors, including the patient’s risk of a pressure injury developing, their comfort, and medical condition.

The study: Two-hourly repositioning does not prevent bedsores

Researchers from the University of New South Wales examined the records of 80 aged care residents who had died. The residents had been living in eight different aged care facilities across Australia.

The researchers looked at whether the residents had been assessed as being at risk of developing bedsores, how two-hourly repositioning impacted them, and whether the residents had bedsores in the final week of their life.

The study found that 91 per cent of the residents considered at risk of developing bedsores were repositioned every two hours, even through the night.

However, more than one-third of them still had one or more of the “excruciating” skin conditions when they died.

In their paper, recently published in Bioethical Enquiry, the researchers Catherine Sharp, Jennifer Schulz Moore and Mary-Louise McLaws wrote, “For decades, aged care facility residents at risk of pressure ulcers have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week. Yet, pressure ulcers still develop.”

What is a bedsore?

Bedsores are also known as pressure ulcers, decubitus ulcers or pressure injuries.

They are injuries to skin caused by ongoing pressure, friction or shear, and particularly effect bony prominence in the body.

Bedsores are common among aged care residents, and occur in one-third of frail people at the end of their lives. They can be extremely painful.

Alternating Pressure Air Mattresses

Rather than two-hourly repositioning, the researchers recommend that those assessed as being at risk of developing bedsores be given alternating pressure air mattresses.

They say APAMs have been shown to prevent bedsores. However, we note that this research dates back to 1967.

“Pressure relief should be provided in the form of an APAM, not waking residents up for the purpose of repositioning,” the researchers say.

“An APAM provides pressure relief to all parts of the body every few minutes throughout the twenty-four hours without waking residents, whereas repositioning for pressure relief is usually only carried out two-hourly.

“It is unacceptable that this prevalence of PUs be allowed to continue.”

Two-hour repositioning is “abuse”

“We believe the practice of 24/7 two-hourly repositioning may be unintentional institutional abuse of elders,” the researchers say.

The practice is not effective in that it fails to prevent bedsores from developing.

It interrupts natural sleep patterns, causing constant tiredness, which the research say can “trigger” the person to acting out their feelings of frustration.

In addition, patients with dementia are often not able to give their consent to the practice, the researchers say.

Sometimes getting access to pressure-relieving equipment can take days, or sometimes it’s not ever provided, the researchers say.

What do the Australian Wound Management Association’s official guidelines say?

Professor Geoff Sussman, Chairman of Wounds Australia, told HelloCare that the Australian Wound Management Association’s ‘Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury’ give the evidence based and the most widely accepted guidelines in the region for preventing pressure sores.

The key recommendations for prevention of pressure injuries for those who have been assessed as being at risk of developing them include:

  • Add high protein oral nutritional supplements to a regular diet.
  • Use a high specification reactive (constant low pressure) support foam mattress on beds, or active (alternating pressure) support mattresses as an alternative.
  • Reposition patients to reduce the duration and magnitude of pressure over vulnerable areas, including bony prominences and heels.
    • Frequency of repositioning will depend on the patient’s risk of pressure injury development, skin response, comfort, functional level, medical condition, and the support surface used.
  • Position patients using 30° lateral inclination alternating from side to side or a 30° inclined recumbent position. Use the prone position if the patient’s medical condition precludes other options.
  • When repositioning the patient in any position always check the positioning of heels and other bony prominences.
  • Use a support cushion for patients at risk of pressure injury when seated in a chair or wheelchair.  Limit the time a patient spends in seated positions without pressure relief.
  • Select and fit devices for heel pressure injuries.

Repositioning is required and has benefits: expert says

Jan Rice, would specialist and Director of WoundCare Services, told HelloCare she believes mattresses can not be the only method used to prevent bedsores as there is no evidence to suggest it is effective.

Mattresses require that the same parts of the body remain in contact with the bed, and therefore the risk of developing bedsores will remain, she said.

Ms Rice said she trains people to reposition residents every two hours during the day, but to cut it back to every three of four hours at night, so as not to disturb sleep excessively.

She gave the example of repositioning at around 10pm, 2am and 6am during the night.

However, she acknowledged that repositioning people living with dementia can be more complex.

Ms Rice said repositioning also has significant other benefits for older people:

  • It provides human contact and comfort.
  • It allows airflow to the skin, for example if the skin has become sweaty, repositioning will allow that area to dry.
  • Repositioning provides an opportunity for the person to have some fluids. It staff come in and the resident is awake, they should be offering them the opportunity to have a sip of water.

Ms Rice said she also often sees mattresses used incorrectly by staff, which could reduce their effectiveness and make matters even more uncomfortable for residents.

Please note: The image used to illustrate this article does not refer to actual events or people. Image: iStock.

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  1. Hi Caroline,
    I’m glad someone has finally written an article on this issue. I have raised this issue for years. As nurses and healthcare providers, we are supposed to deliver up to date evidence based care and there is no evidence to say that air mattresses or foam mattresses or 2 hourly turns are the way to prevent pressure sores. So why are we doing it?
    I guess it’s because we have to do something! After all, egg yoke and oxygen don’t work anymore apparently.
    In my limited experience and education, I feel that if any person stays in bed or in one position for too long then the skin will be marked, then break down, leading to the awful sores we see in our patients. No person who is mobile and active has pressure sores.
    This leads me to the question (bearing in mind that I might be opening a can of worms here); Are pressure sores inevitable if the person is immobile? Do we have to do all we can to prevent them but, (dare I say it) accept that this is what happens when the body is in this state?

    I do not have the answer but I’d love to.

    What I do know is that I like my sleep, and if any nurse no matter how sweet, woke me up everynight don’t mind every 2-4 hours, I’d be like a demon! And I don’t have any real health issues in comparison to some.

    1. Hi Shirley, Thanks so much for your comment. I have been thinking along the same lines and wondering why do people keep getting pressure sores when so much is done to try to prevent them? Perhaps it is, sadly, inevitable. Could be a good idea for another article… We have been amazed by the interest this article has generated and will write follow up pieces. I thank you for your input, Caroline

      1. I work in an aged care facility. We do turn residents, provide light massage and have correct mattresses, lambs wool underlays/heel booties etc. We do not have residents, even at end of life, with pressure sores. In fact the only time I have seen any of our residents have a pressure sore was when they had an extended hospital stay prior to returning to us. I cared for my father during his end of life, again the only time he developed a pressure problem was after a 2 week hospital stay. I am not meaning to pick on hospitals, however the resident is in hospital for a specific reason and that is treated, the normal personal care is not always able to be provided.
        Yes, skin is breaking down at end of life, or immobility, the same as any other part of a person, however I think what I do is working and so will continue with it until something better is proven. I also agree with what is written here from Jane Rice, I think, particularly in EOL, the physical touch and verbal comfort is extremely important, we are not even necessarily waking a person every turn, the movement and turning is done very gently, however the contact is still nice for our resident in what can be a very long night or lonely time.

        1. I had an experience with a family member who was dying and they insisted that they had to move her every hour or two i told them not to it was causing her too much pain and she had no bed sores. Her last days were spent in agony . And the repositioning had caused her to go into seizure activity. This was at Albany med. Instead of comfort in the last days it was horrible torture abd no one seemed to care. Some care givers even laughed at the elderly patients in pain.

      2. this is a subject i have been interested in for some time, is it possible to have a air mattress that vibrates to stimulate movement and blood flow therefore reducing the effect of lying still for hours, could this be better than turning a resident every two hours.

    2. I do not agree..I think air mattresses have proven benefit and heel and repositioning when done kindly and appropriately are beneficial in allowing ski to heal or preventing pressure sores. need to proof read sguddies & do more. However 4/24 PAC only needed if on air mattress.

  2. As a matter of fact I’m dealing with Alzheimer’s and COPD with my mom right now. She’s 70-75 pounds and will probably not make it through the week(end). They just turned her and she has bed sores starting. She has no padding. How else would you prevent these on a person with no meat on their bones if you didn’t turn them often?

    1. I looked after my Mum for her last 8.5 years with the same issues as you. we bought her an alternating air mattress and it was the only thing that worked. I did not turn her and she never had a bedsore until she had a chest infection and went into hospital.. within 2 days her skin was breaking even with 2 hour turns. they had told me she didn’t need the mattress. I disagreed with the patronising nurse ,asking her why she had a sore after 3 days with them. she got a mattress with hours.

  3. You know what would be nice a link to the actual reserch.

    I find the findings nice and to be frank quite fair. but would like to see how they came to the conclusion or how the reserch was conducted.

    1. Hi Gaz, I have bolded the links in the article so you can go to the actual research. Apologies this wasn’t clear in the first place, Caroline

  4. The fabulous Jan Rice will agree entirely that any degree of malnutrition (whether residents are ‘at risk’, or actually experiencing malnutrition – which is the case in up to 50% of aged care residents!!) is not only a contributor to pressure wounds, but a contributor to delayed healing.
    It beggars belief that dietitians experienced in aged care, who have the knowledge and expertise to identify and treat malnutrition in all it’s forms and to work with aged care providers to prevent it occurring, are not required to be employed in EVERY residential care home. Certainly some do regularly engage dietitians in clinical care as well as staff education and food service, but many either only call a dietitian in following weight loss (when, by definition in a frail older person, they are already either at risk of malnutrition or are malnourished), failing to extend that engagement into food service and staff education, or can demonstrate little or no evidence of dietitian engagement at all.

    Wounds place nutritional demands on an individual far beyond those of residents who do not have wounds and that is poorly acknowledged and supported. Unless that is addressed and managed, not only do residents suffer, but money is wasted on wound care dressings and related necessities and in staff time treating wounds, when that can be reduced with the input of a dietitian implemented nutrition strategy.

    1. Good day ,article was great .
      However as a nurse for almost 20 years and in ICU for more than 8 years.Base in my experience q2hourly is not applicable to all patient and we need to know contributing factors and other problems that the patient is having then we will plan the care needed. For example we have patient who are conscious ,we don’t turn them that much needed q 2hourly but we need to check the skin condition and promote good circulation to the patient .During night time for her we lessen the turning as she will be agitated and restless .However for patient with cases of sensitive skin and prone for redness and pressure we turn them maximum every 2 hourly.
      The study was good but they must include other contributing factors that may indicate the necessity and importance to q 2 hour turning . Designing a plan of care of a patient is important and not all applicable to all thats why standardized practices are there to guide us but doesn’t mean it should be followed to all. In our institutions we discussed with the team shift if we do need to turn q 2 hourly such patient., but have to take a lot of consideration for all factors needed.
      Thanks for the input

    2. Thank thank I have put in that many complaints about the lack of nutritional food. For are residents it doesn’t just affect the skin it affects the mind mood sleep am just over the crap I have sent photo of the food that the residents get but management. Don’t care don’t want to know If they better the food the residents over all health will 100% improve If we feed are kids what residents get we be done of abuse. Kitchens need to get rid of all the frozen crap and use fresh only

  5. 1 in 2 residents in residential aged care homes are malnourished. Malnutrition increases the likelihood of pressure injuries (~2.5 times more likely). The more important question here is how do we nourish residents so mattresses, 2hrly positioning and wound care are less of an issue. We heal from the inside out. Everything else is a side discussion. This is the basis of our discussions and national advocacy work with The Lantern Project (join our free monthly collaboration meetings to learn more). Recommendations for supplements in this article also miss the mark (I heard a nutrition supplement rep quote that 70% of supplements are wasted) – food-first approaches above commercial nutrition supplements improve nutritional status AND quality of life AND reduce risk of pressure injuries/wounds AND are cost effective for the aged care organisation.

    1. Hi Cherie, Thanks for your comment. I’d love to talk to you about how nutrition can help prevent pressure sores. I’ll contact you, Caroline

    2. A lot to be said about the holistic approach isn’t there. A problem I see is the emphasis on providing fat producing foods or supplement drinks rather than nutrician. There is so much research today on the best foods but it doesn’t seem to be getting through does it.

  6. The claim that second hourly re positioning of older people constitutes abuse indicates a lack of awareness about the residential aged care sector by the authors. Actually having human interaction every two hours would be so welcome and therapeutic to residents who can go for many hours left alone in their single bed room, seeing no-one, talking to no-one, experiencing the absence of contact with another human being and then abused for calling for assistance. One instance I am aware of involved an older man being left without being re positioned for four days. He would have welcomed two hourly contact no matter what time it was. The resultant pressure areas he developed led to his death from septicemia. Publishing this case in a peer reviewed paper resulted in no response from the government or anyone else for that matter. The statement that two hourly position changing is abuse denigrates the actual abuse that occurs in residential aged care – physical abuse, infantalisation, neglect, unrelieved pain, absence of palliative care, chemical and physical restraint inappropriately used, malnutrition, dehydration, psychological abuse, loneliness. How I wish that all we had to be concerned about in residential aged care was the interruption to sleep caused by secondly hourly re positioning! Having a recipe approach to care is not what is needed rather, we need to individually assess care needs and determine interventions based on evidence and in collaboration with the resident and their family. The focus has to be on the whole experience of aged care for older people and their families including having sufficient skilled staff to assess individual needs, mentor care staff and liaise with medical and allied health professionals when appropriate.

    1. YES! Agree with above said! Every case is individual as well. No two patients are alike and none should have the same care plan. We have some who would welcome the every 2 hour turn and position, by making eye contact, smiling etc… some, who seem to not enjoy it are left for 3-4 hours, depending on the case. But to go as far as to say that it is ABUSE is a bit ridiculous. Most residents would need to be changed at any rate, as leaving them in their soiled brief is abuse.
      ASSESS assess assess!

  7. There are occasions where it isn’t possible to have access to Alternating pressure air mattresses and in my opinion the next best thing to do is to reposition the person. Agree with Jan Rice’s recommendations. While I nursed my mother we always checked for discoloring of skin to try and pick early stages of irritation or bed sores. I would then massage that area lightly with essential oils. There is not enough attention given to massaging the elderly or anybody bed ridden to help with Blood flow, Lymph flow and Muscle stimulation besides the fact that it is stimulating to the person.

  8. This is an interesting article and after nursing my own mother (who experienced life through alzheimers) for over 5 years in our family home and tending to her daily in a facility for a following 6 years the idea of using both APAM’s and repositioning as appropriate is an excellent idea. But this does not address the issue that bedsores are more likely when continence aids are not changed as needed. Lying in urine for hours breaks down the skin. This is common. I had constant battles with facility to change my mother more than twice a day. My mother never had bedsores because of my vigilence….she was changed as needed and had an APAM and I reposiitioned as needed. Family members must be tough and vigilent to ensure best care.

    1. You are right, I myself is caring for my mother, who is 90 yr. She have 10 bed sore on her, by not turning and nutrition..
      All this is done to her by a family member. Who claims to be to know about being a care giver.

  9. This is a very interesting article. Would you mind sharing a link to the research article? Thank you very much.

    1. Hello Christine,

      And thank you for your feedback. There is a link to the research in the article. If you click on the word ‘Paper’ near the beginning of the article the link will take you to the research. Take care

  10. Interesting to read this article – I would be really grateful if you could include citation or whether or not publication is pending in your piece please? This is generating a lot of discussion on social media amongst health professionals and working from the evidence base is integral to meaningful debate and critical thinking… st.werburgh@virgin.net

  11. Unbelievable that it takes all this research on how to treat a human being humanly. Please use common sense. You can turn a patient regularly at your discretion and do so in a gentle manner. In that way it is a win win situation. You are better asking people like myself who have been trained properly. I started my training in 1963 and retired in 2008.

    1. Nurses being trained properly should translate into Nurses being educated into the causes & prevention of pressure ulcers. I was a trained nurse from 1966 until 1991, back when we just followed practices from past years with no questions asked. However, when I became an educated registered nurse after upgrading to a University educated RN in 1991 I understood evidence based practice & how research guides practice. I was a Clinical Nurse Consultant in Gerontology/Aged Care & worked closely with Geriatricians & Allied Health Professionals. Malnutrition is a big factor mainly due to the fact that very many older people loose interest in eating. Their sense of taste & smell diminishes & do not enjoy food as much. Also the ability to swallow is impaired in many people & is a side effect of Strokes & other neurological disorders such as Parkinson’s & Dementia. It is important that all residents are assessed by Dieticians as well as Speech Pathologist to determine the causes & best feeding methods. In the final conclusion though, we can do all the right practices but the human body with the progression of disease & immobility starts to shut down as part of the dying process, there is little we can do to when this occurs but keep the person pain-free & as comfortable as possible. There is no point in forcing them to eat or putting them onto enteral feeding regimes. I retired in 2013 at the ripe old age of 68 but still like to keep up to date with latest research.



  12. I’m Interested to know whether this study differentiates between pressure ulcer damage and skin changes at life’s end (SCALE) which would to my mind invalidate the claim that the repositioning schedule does not prevent pressure damage. The differences must be addressed and evaluated before this research can be given any credit

  13. You are assuming these patients were actually repositioned every 2 hours. How do you know that staff didn’t just say they did? Study isn’t controlled enough for my liking. Also extremely poor volume of research in this area. More research needs doing and time lapsed camera recording.

  14. Abuse, to me, is the break down of skin thus allowing foreign bodies (faeces, urine, fabric pilling, crumbs, and nasty necrosing bacteria) and if turning and increasing the blood circulation to an area is not encouraged, what then? Cleaning a showing bone and packing it with the appropriate material is also abuse? I am a restless sleeper and when my time comes, i require frequent turning.

  15. This is exactly the subject which NPUAP and EPUAP should adopt and further research instead of debating over terminology and staging. Do not lose sight of the pioneering work of Ludwig Guttmann in Stoke Madeville spinal injuries between 1950 and 1970!!!

  16. If anyone is unaware of Guttmann and his work on spinal injury patients please let me know and I will share articles.

  17. Been caring for 106 yr old. Unable to walk so pressure cushion & bed which with motors move air around. Started having pressure sores but after using all the recommended cremes which didnt work began COCONUT Oil. am/pm . A miracle never an issues since (18months)
    Thought this may help others.

    1. Thanks for sharing this about the coconut oil. A nurse I know uses it and she said it works! The “un-skilled” nursing facilities that my husband has been in for the past 10 months will not allow anything outside of their protocol, which is understandable.

  18. I think the way people are positioned matters. I am a registered nurse who worked in ICU for many years and recently helped care for my elderly father. I found that aids in his nursing home sometimes repositioned him to an uncomfortable position that was only giving lip service to the term repositioning. If the patient is (gently) turned fully on their side with two pillows supporting the back and one in the front, one between the knees and the caregiver steps back to visualize the body alignment and see that the patient looks comfortable and relaxed it is actually a true reposition. I think letting the patient sleep for longer periods during the night is a good idea as well and having alternating pressure mattress. I agree with the previous writer who said the company of a caregiver should be comforting to an elderly individual. My dad was frail, malnourished, and incontinent at the time of his death but never developed a bedsore.

    1. I read your comment on repostioning. My father inlaw has parkinsons and has had 5 ps in 3 years. He has lost 20kgs over this time, his meals are truly at times putrid, not all. They give fortisip supplement, I argued for ensure 2 cal. They tried to tell me that fortisip had more protein! His wound on his sacrum at the moment he has had for two months, it’s a stage 4 and the preventive antibiotics are not working, doctor has now ceased waiting for swab results, he is on panadol for pain relief. I have also talked to staff about repostioning and when I asked them to go side to side with pillows as you have discussed, they said to me , that would give him more pressure wounds! They have no idea! This anglicare aged care has already had compliance issues in medication, hydration, skin integrity, nutrition. I’m going to be honest here, I put to sleep my dog as she was suffering last month and I would gladly let my father Inlaw go too as his life is a misery. I care for my elderly parents at home and to honest, I would of found another facility along time ago. We protest on the streets for climate change, child abuse, teachers and nurses wages, but no one holds a placard for our dear elderly.

      1. Oh my god this sounds just like my dad at the minute, my heart is broke he is 80 this year and had his second leg amputated on the 23 of January this year. He has always had a sacrum wound but he was moved to another hospital over 3 weeks ago and it has got worse they turn him every 2hours and he had no infection going in but has been on antibiotics constant as infection did set in he HASNT been out of the bed in 3 weeks I have showed concern for his pain and his mental health but it had fell on deaf ears I have asked for him to be got up but they won’t and he is getting worse they say about going by the book ( I have been dealing with my dad for 10 years now I know him inside out ) when he got the second leg amputated they had him out in his wheelchair and he was brilliant but since going to another hospital he has not been let out of bed as tissue viability had said he must remain in bed no other tissue viability nurse has said this in all these years I give them the number for his nurses that have dealt with my dad to get the history of dads wound and they never bothered to ring them. To sum it all up my dad went in for a leg amputation and was doing well now he can’t even read want to write to him and with being totally deaf he has no way of communicating with anyone his world is silent I’m going in today if they can do nothing he will be coming home to me

  19. I’m a nurse. I was also a patient, left on my back on one of those wonderful mattresses for two weeks, unable to move. I developed pressure sores. Try it sometime. You might change your tune. Pressure sores become contaminated with feces and urine, can crater down to bone, become infected, and require packing, turning from side to side, antibiotics, and much stress. Turn your patients! Even if they are on one of those mattresses. Allowing bedsores is abuse.

  20. Thank you for discussing our research and I read the comment threads have focused on our objective – the human rights and unintended consequences of the two-hourly repositioning practice. Although we mentioned that the evidence for this practice to prevent pressure ulcers is poor we would hope that clinicians should now engage in a discussion with residents and their families the potential consequence of the practice (disturbed sleep for days, weeks or months) versus a trial of AMP for tolerance and sleep disturbance.

    1. I believe the author is right. Its all about using common sense. If you are on a good APAM then the patient can be left longer, they are still turned. Its also a joke nurses dont get time to do 2hrly turns tney are often left for hours with no intervention.

  21. I wish we could get our amazing residents float tank pods so they would just be suspended in water and not have to deal with any pressure at all!! Sadly though, that would have its drawbacks as well.

  22. How can they be certain that the residents really were repositioned every 2 hours? I’ve worked in both an aged care facility and now in a hospital and I’ve seen many people avoid the practice of 2 hourly repositioning but their patients still develop pressure ulcers. I think they’re inevitable no matter what interventions we put in place.

  23. Very interesting article. However, I don’t think it’s appropriate for a scientific study to come to moral and ethical conclusions. This study should have concluded with the finding that repositioning doesn’t prevent bedsores. To abuse someone implies the intentional infliction of cruelty, and to call repositioning “abuse” is inflammatory, judgemental, and just plain incorrect.

  24. I cared for my mother when she had dementia. We found full medical sheepskins (Merino wool) under her body and sheepskin protectors under her heels prevented pressure sores.

  25. What a great paper. After reading all the comments I feel that some are missing the main point. I read it and agree that it is very cruel and unnecessary to wake a person up who is fast asleep and that a person ‘at risk’ of a pressure injury should be placed on a good alternating pressure air mattress as soon as possible, They are not saying don’t reposition if they are on the APAM we can let them sleep longer. Use our common sense.
    Authors please keep this good work up us as the guidelines out are flawed. They do not protect our patient or nurses. Changes need to be made as I believe pressure injuries are preventable.

  26. I cared for my frail mother until she died at 95. Fortunately she was still active, though she did have some falls. She got bedsores while in hospital, recovering from a fall. She didn’t get one at home. Whilst it was sometimes difficult, I encouraged her to be active to prevent the types of ailments that occur to the inactive elderly. If she was too tired to walk I would hold her up and we would ‘dance’ at regular intervals. Anything to relieve pressure. While I don’t doubt that diet and nutrition is vital to ‘heal from within’ etc. diet and nutrition will not save someone, nearing the end of life, from bedsores as their food intake and desire for food wanes, and so too does their nutritional intake.
    My experience with nursing home care was that they actively discouraged the elderly to be active because they would then have to be supervised and it became too labour intensive. Their objective seemed to be to turn people into invalids for better management.

    1. Hi Christine, I often check this site to see if there are any new comments. You did a great job with your mother
      You have got it right. Its pressure that causes the injuries. Nutrition is important but if a patient is not mobile and not repositioned as soon as possible then the injuries can start. the sicker you are the quicker it can happen.
      (often the injury can start from within to without). so its often too late when the person is actually put on the alternating pressure air mattress. I know that one of the authors and another excellent clinician have been fighting this for years sadly not recognized. The guidelines for the prevention of pressure injuries are flawed. it states you have up to 8 hrs to assess the patient which is not true the are using numerical tools that never worked in the 80’s modified or what are still not working. I cannot understand why these top clinicians don’t get it.. They are not protecting our patients or nurses.

  27. I think it is very good to have discussion about best practice care but this assumption that it may be “abuse” to actually turn someone is ridiculous. It seems the research is lacking good controls, as we simply do not leave people unturned on mattresses to see if their pressure ulcers get better or worse, and obviously if they are being turned , they must be at risk of pressure ulcers. Then it makes sense that “at least a third” they may have them when they die. Thank you Jan Rice ( who has been very helpful to us over the years) to add some common sense into the argument.

  28. I have seen the tragic result of not properly caring for a patient also. Sores that are as big as your fist deep to the bone. A result of lacking many things – proper nutrition/hydration, proper mattress, diligent incontinence care, proper wound care, etc. It may be inevitable as I have seen sheets draped over the toes of a patient creating sores. I didn’t read all the replies but interesting to me that frequently turning a patient to prevent bed sores may be considered abuse and I didn’t see anyone with an objection to the term. But let someone talk about the lack of oral care and the horrific conditions created from this as abuse and people get offended by the term. Let’s connect THAT disconnect too! Thanks on behalf of those with decayed teeth and oral infections from lack of care.

  29. All that I read was very interesting. Being a retired clinical nurse, I have seen and been through the gamit of a miriad different treatments for pressure care, bed sores, and mattresses,. I have used so many different mattresses, toppers, egg crate mattresses, air beds, so it goes on.
    One thing I will say is that, to treat the elderly, one has to understand the elderly, and to understand the elderly, one has to be one of the elderly !!!
    Younger minds see things differently, and sometimes detrimentally.
    Turning people in beds; well, ask one who is only skin and bone- sore joints; ask someone who has rheumatoid arthritis- sore joints; ask one who has osteoarthritis- sore joints; etc.
    I have osteo and I need to change my own position in bed, regularly, because if I don’t, I suffer the next day with aches and pains and severe stiffness. The air beds are useful if you stay on your back most of the time. Pressure sores have a myriad of causes, but prevention by relieving constant pressure is the key. One day we may have antigravity, floating mattresses!!!.

  30. Hi,
    What do you all think about an automatic repositioning system, which is capable of laterally tilting the patients whenever a pressure buildup is detected. Iam trying to build one. I started this work because of the suffering i saw the nurses were having because of the 2 hourly repositioning and the patients developing pressure sore, when they adequately dont receive the repositioning. I would love to hear from you all, which will help me in bringing the solution to you all, if it helps.

  31. There is such a mix of responses here. Whatever way we look at it there is no one size fits all.

    Something we really don’t talk a lot about is skin failure. At end of life or as the result of serious illnesses our organs fail. Our skin being the largest organ in the body can do the same thing….fail.

    How do we assess for this? Im not entirely sure myself but certainly something one of the doctors who posted earlier talked about quality of nutrition. Which I am sure makes a difference. But so does the quality of our care and every detail about the care we provide.

    This is a good topic to unpack gently because its unpacking many years of nursing care and the way we have done things. Certainly if we are doing things that could constitute ‘abuse’, then this needs to be delivered in a very gentle way so that it encourages open conversation with everyone and an open way in which care is delivered.

    Given this I don’t think much of the headline.

  32. All valid points, but there is a solution to a lot the issues raised. Have a read of the article done by Jakob Neeland under ïnnovations”. He talks about the Freedom Bed. A fully automated turning bed avaiable in Australia.

  33. I found this very interesting to read. I have spoken to the r.n for my dads private hospital about this article because they are repositioning him every two hours and I can see it is making him very tired. He isn’t awaking up till nearly ten am to eat his breakfast cause I feel it is to much for him been reposition every two hours. He has pressure sore already maybe from sitting in a lazy boy all day without any proper padding. My dad has currently come out of hospital from Pneumonia and urine infection and he was in a diabetic coma and he also had pressure sores. He has had three Strokes in the past an also has Dementia and can’t talk so I was wondering is it still considered abuse if they are repositioning him every two hours?

  34. This has been a concern of mine for years!, I think common sense really needs to be used certainly repositioning has a place but how often and when is I believe an individual case, I work in aged care and even with all the aids available skin breaks down, good nutrition is vital and I firmly believe that during the night if a resident has finally managed to get to sleep and is deeply asleep then another hr of sleep is far more beneficial to their health than being turned right on the 2hr mark again common sense and understanding, EOL again requires common sense and understanding, trigger point therapy is a great tool to have as well, it is non invasive and helps with blood flow and pain management and is non invasive, we need to keep our minds open to all sorts of practice to help our residents and to beat in mind when working with cognitive residents ASK them as well!, I have found even dementia residents will sometimes let you know yes move me or noo let me rest, this is an issue with lots of ideas!

  35. What is the research showing about multiple pillaging used under patients on alternating pressure Mattresses?

  36. I have worked in Aged Care for many years. It would be rare for a resident to be repositioned 2nd hourly on Night duty.

    On the topic of Air mattresses. I challenge the person who wrote this article to try repositioning a heavy person on a air mattress. Using a slide sheet.

    The risk of shoulder injuries to staff is very high.

    Repositioning a resident must not only be safe for the resident but also the staff.
    In my personal experience Air Mattresses are not always a safe option.

    Currently The greatest concern in many Nursing Homes is the lack of staff.

    I would be very surprised if residents in most Nursing Homes were repositioned every two hours.

    Throw on a Air Mattress, pressure care dealt with. Looks good..

    Cares should be based on an individual basis. What works for one does not necessarily work for the next person. There are many contributing factors when it comes to skin integrity.

    I have had many residents who absolutely hate trying to sleep on Air Mattresses. The mattresses can be noisy and hot. For some the sound of the pump keeps them awake, not the 2nd hourly turns.

  37. April 5, 2022
    Jessie /Theresa Baker

    On April 17th I brought my mother into the emergency room On the contingency of her pulmonologist Dr Ahn. . the week of March 7, 2022 Jessie had chest That showed on her left low along there was some shadowing some indication of something that was going on Dr.Ahm felt like I should go in and check it out, I told her absolutely I’m interested in exploring that March 10th I’ve seen her other pulmonologist for her trach Doctor Parek
    He did not change her trach because she was on the ventilator that day but he also told me that he took a look at her chest x-rays and they did not look alarming to him
    Both of Jesse Baker’s pulmonologist reside at Beth Israel hospital Both
    So I continue to watch her, On March 15th I took her to Boston medical to meet her Geriatric’s doctor She took some blood cultures And the CBC came back that my Jessie level was low that Indication her needing a unit of blood, so I brought Jessie to the emergency room ( Mass GENERAL ) they proceeded to take their own cultures which indicated her white count was elevated 16-18
    Then Out of nowhere she had Jessie had very large BM loose stools
    That’s when her wound starts to look inflamed,the nurse and I was able to give the wound a thorough clean overall her wounds look great, When I talk to the wound care nurse the next day she said my mom wound look smaller and the look Good
    I stated on numerous occasions that I was not pleased with the wound care that my mother was getting, I didn’t understand why they was not turning her and taking her off her wounds, it took them a few days to get the HILLROM SAND BED BUT BY NO MEAN THIS DOES NOT MEAN SHE DON’T HAVE TO BE TURNED.They was giving her a lot of laxatives which I told them that my mom goes to the bathroom on her own, I’ve never gotten stool in and my mother’s wounds , The wound care doctor at mass general told me that my mom’s wounds look very bad they were never gonna get better and they were at stage 4 down to the bone this is something that happen on mass general Watch and they were tunneling I was very surprised to hear that The wound care doctor at mass general told me that my mom’s wounds look very bad they were never gonna get better and they were at stage 4 and they were tunneling I was very surprised to hear that I was not happy and I told him I was not happy with the care that they were giving as far as wound care to my mom they indicate it if I didn’t like it I can always go somewhere elseI didn’t like that either, My mom had respiratory issues I understand that but her wound care was also a priority I’ve asked him a numerous times To put her on her side ask, giving juvent But the wound care doctor kept assisting that that nothing that I put on her wound or do for her is going to make her wound better I disagree My mom’s wound was not looking like this And because I’m advocating for her Mass general nurse’s and doctor don’t like that My mom also indicated to me that she was getting her head banged against a rail That’s uncalled for My mom’s pain medication was changed without even consulting me I spoke with nurse practitioner and the doctor to let them know my mother’s Head pain is chronic she gets her pain scheduled
    On Saturday March 26th I kept indicating that my mom needed a section and they need to do sideline with her to get this mucus out of her CHEST I waited for the few hrs for the respiratory to the point my mom had so much mucus in her in her that she almost desat , That night they want to do a broncoscopy but they waited for the next day, I talk to the Pulmonologist I was not surprised for him to tell me that my mom had a lot of mucus lot of mucus and her lungs , Like I indicated to him She needs to be on her side to do chest compressions to get the mucus out of her lungs I was not surprised to see infection disease Because everything I asked to do they was not implemented They heard me but they was not listening So we went back to square one of my mom pneumonia I became very concerned I don’t like my mom on all of these antibiotics because when she truly needs them they won’t be acceptable for her her body will refuse them, I asked him on numerous occasions do sideline with her, Put her up in a chair Do her vest with her. I tried to put my mom on Her side Her side To get off a wound The nurse tells me as long as she’s sitting in the middle and she’s on that sand bed she’s OK Just because you’re on these special beds you still need to be turn, I called to social worker no help patient advocacy no help


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