Does Repositioning Effect Rates of Pressure Injuries in Elderly People?

This poster presents a literature review on the effectiveness of repositioning in reducing pressure injuries in elderly people. The review shows that mechanical repositioning is more effective than traditional repositioning, and a 30-degree tilt or supine position is more effective than a 90-degree tilt. A person-centered approach is also important for reducing the risk of developing pressure injuries.

Does repositioning effect rates of pressure
injuries in elderly people
Author/Authors
University name
INTRODUCTION
Pressure ulcers or pressure injuries or pressure sores is a
common health problem among the older adults who are bed-
ridden or have restricted mobility. The problem exists under
diverse healthcare settings like hospitals, private homes and
long-term facilities. In some cases, pressure injuries (grade 3
and 4) among the older adults give rise of multi-factorial
pathological conditions like sepsis or osteomyelitis,
hampering the overall quality of life of the older adults (Bell et
al. 2016). Management of the pressure ulcer requires a
comprehensive yet multidisciplinary approach. One such non-
pharmacological approach has been proposed for the
effective management of the pressure ulcer is repositioning of
the patients (Rasero et al. 2015). Thus, the following poster
will conduct a detailed search of the literature review in order
to understand the Does repositioning effect rates of
pressure injuries in elderly people? and this will be helpful
for the generation of evidence-based nursing practice.
METHOD
RESULTS
DISCUSSION
CONCLUSION
REFERENCES
Pressure Injuries can be reduced by the use of the nursing
interventions and these include repositioning of the patients
who are older adults and are vulnerable to develop pressure
ulcers.
The PICO format was used in order to develop the research
questions. The detailed search strategy is highlighted in the
table below. This search strategy was used to perform
systematic search of the research articles from reputed
healthcare databases: CINHAL and PubMed. 12 most
relevant and current articles were extracted from the
databases of them 4 articles from PubMed and 8 articles from
CINHAL were included in the systematic reviews. These
articles were peer reviewed, full-text in length and were
published within the last 8 years
.
Reference for image
Bell, S.P., Vasilevskis, E.E., Saraf, A.A., Jacobsen, J.M.L., Kripalani, S., Mixon, A.S., Schnelle, J.F. and Simmons, S.F., 2016. Geriatric syndromes in hospitalized older adults discharged to skilled nursing facilities. Journal of the
American Geriatrics Society, 64(4), pp.715-722.
Bradford, N.K., 2016. Repositioning for pressure ulcer prevention in adults: a Cochrane review. International journal of nursing practice, 22(1), pp.108-109. DOI: 10.1111/ijn.12426
Gillespie, B.M., Chaboyer, W.P., McInnes, E., Kent, B., Whitty, J.A. and Thalib, L., 2014. Repositioning for pressure ulcer prevention in adults. Cochrane Database of Systematic Reviews, (4). doi:
10.1002/14651858.CD009958.pub2.
Källman, U., 2015. Evaluation of Repositioning in Pressure Ulcer Prevention (Doctoral dissertation, Linköping University Electronic Press). ORCID iD: 0000-0002-2027-1663
Källman, U., Bergstrand, S., Ek, A.C., Engström, M. and Lindgren, M., 2016. Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care. International wound journal, 13(6), pp.1168-
1175. https://doi.org/10.1111/iwj.12435
Kapp, S., Gerdtz, M., Gefen, A., Prematunga, R. and Santamaria, N., 2019. An observational study of the maintenance of the 30° side‐lying lateral tilt position among aged care residents at risk of developing pressure injuries
when using the standard care pillow and a purpose‐designed positioning device. International wound journal. https://doi.org/10.1111/iwj.13142
Krapfl, L.A., Langin, J., Pike, C.A. and Pezzella, P., 2017. Does Incremental Positioning (Weight Shifts) Reduce Pressure Injuries in Critical Care Patients?. Journal of Wound, Ostomy and Continence Nursing, 44(4), pp.319-
323. DOI: https://doi.org/10.1097/WON.0000000000000340
Mallah, Z., Nassar, N. and Badr, L.K., 2015. The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study. Applied Nursing Research, 28(2),
pp.106-113. https://doi.org/10.1016/j.apnr.2014.07.001
Mateo, M.M. and Herrera, D.G., 2018. What is more effective for preventing pressure ulcers: repositioning or support surface?. Gerokomos, 29(3), pp.138-140.
http://www.gerokomos.com/wp-content/uploads/2018/10/29-3-2018-138.pdf
Rasero, L., Simonetti, M., Falciani, F., Fabbri, C., Collini, F. and Dal Molin, A., 2015. Pressure ulcers in older adults: a prevalence study. Advances in skin & wound care, 28(10), pp.461-464.
Sharp, C.A., Moore, J.S.S. and McLaws, M.L., 2019. Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?. Journal of bioethical inquiry, 16(1), pp.17-34.
https://doi.org/10.1007/s11673-018-9892-3
Stinson, M., Ferguson, R. and Porter-Armstrong, A., 2018. Exploring repositioning movements in sitting with ‘at risk’groups using accelerometry and interface pressure mapping technologies. Journal of tissue viability, 27(1),
pp.10-15. https://doi.org/10.1016/j.jtv.2017.11.001
Woodhouse, M., 2016. Are strategies, including mechanical and traditional repositioning, effective for pressure ulcer prevention? University of Southampton
Woodhouse, M., Worsley, P.R., Voegeli, D., Schoonhoven, L. and Bader, D.L., 2015. The physiological response of soft tissue to periodic repositioning as a strategy for pressure ulcer prevention. Clinical Biomechanics, 30(2),
pp.166-174. https://doi.org/10.1016/j.clinbiomech.2014.12.004
Population (P) Interventions (I) Co (Comparison and Outcome)
Older Adults Repositioning Decrease in the rate of pressure
injuries
OR OR OR
Elderly patient positioning pressure injury prevention
OR OR OR
elderly turning pressure injury prevention and
management
OR OR
geriatrics pressure ulcers and prevention
Results for P [AND] Results for I [AND] Results for Co
Table 1: PICo search strategy for electronic databases
12 peer reviewed journal articles were appraised critically in order to
address the research questions. Among the 12 reviewed articles,
there were primary studies and there are secondary studies. All the
primary studies selected for the review have obtained their ethical
approval for incorporating human participants in the study. Table 2
provides a summative overview of the selected articles.
Article no. Author and year Study design Aim of the search Selected group of population Outcomes
1 Gillespie, B.M., Chaboyer, W.P.,
McInnes, E., Kent, B., Whitty, J.A.
and Thalib, L., 2014
Systematic Review of the
randomized control trial
To access the effectiveness of repositioning
for the reduction of pressure ulcers
regardless of the vulnerability and
Ascertain the most effective repositioning
schedules for the older adults
RCTs published till 2013 and at
last a total of 3 RCTs of a total
of 502 randomised patients
were reviewed
Repositioning is effective for the reduction of the pressure
ulcers among the older adults irrespective of the
vulnerability. The study also showed that there are no
significant differences in the development of the pressure
ulcers with 30 degree or 60 degree tilt
2 Bradford, N.K., 2016 The review considered RCTs
(RCT) with two and more
alternative repositioning
interventions for PI
To access the effect of repositioning among
the pressure injury (PI) patients
To ascertain the effective repositioning
schedules for prevention of PI
To ascertain the incremental resources
consequences and the overall cost associated
with the implementation of different
reposition regimes in comparison with the
alternate or standard practice
3RCTs were included in the
study
Repositioning helps to reduce the chances of developing
PI
Lack of robust evidence in order to support the
effectiveness of 30 or 90 degree repositioning for PI
prevention
The economic implications of repositioning for the
prevention of PI is unclear
3 Sharp, C.A., Moore, J.S.S. and
McLaws, M.L., 2019
Cross-sectional survey To determine the number of residents at risks
of PIs and to use two-hourly repositioning for
reduction of the vulnerability of PI
Patients who are 65 years and
above were selected
randomly from eight
Australian Residential Aged
Care Facilities (RACFs)
Two-hour gap of repositioning failed to reduce the
chances for the development of the PI among the at risk
patients
4 Mallah, Z., Nassar, N. and Badr,
L.K., 2015
Case-control study To determine the effectiveness of the multi-
disciplinary interventions to reduce PI under
tertiary healthcare settings
A total of 468 patients
admitted to the hospital
during 2012 January 2012 and
2013 April
As per the Braden scale, the prevalence of PI reduced
significantly upon the use of repositioning of the patients
5 Källman, U., Bergstrand, S., Ek,
A.C., Engström, M. and Lindgren,
M., 2016
Observational Cross-sectional
study
To investigate the effectiveness of the nursing
staff induced repositioning and patient
spontaneous improvement in the PI among
the immobile patient
52 patients were observed
with the help of the
MovinSense monitoring
systems.
Nurse based re-positioning is more effective than patient
spontaneous based repositioning for the reduction of
severity of PI
6 Krapfl, L.A., Langin, J., Pike, C.A.
and Pezzella, P., 2017
Evidence-based report card
reviews
Incremental positioning and/or weight shifts
decrease hospital-acquired buttocks pressure
injuries among the critical care patients in
the hospital
Scoping review of the
literature was conducted
Incremental positioning and/or weight shift is helped for
reducing buttock PI among critical care patient
7 Källman, U., 2015 Review study To reduce the risk of PI with the help of
repositioning
Review of the four
quantitative studies
Repositioning in the 30-degree supine position is more
beneficial in reducing PI among the older patients in
comparison to the 90-degree lateral position
8 Stinson, M., Ferguson, R. and
Porter-Armstrong, A., 2018
Quantitative review To explore the importance of the
repositioning as target intervention for
reducing the PI
Review of two recent studies The personalised intervention like repositioning must be
done depending upon age and the severity of the patient
in order to reduce PI.
9 Woodhouse, M., 2016 Experimental study Mechanical and traditional repositioning for
the reduction of PI
The study was conducted over
the older adults
Mechanical repositioning is helpful for reducing PI in
comparison to traditional repositioning
10 Kapp, S., Gerdtz, M., Gefen, A.,
Prematunga, R. and Santamaria,
N., 2019
Observational study 30-dree lateral tilt re-positioning for the
reduction of PIs among older adults
The study was conducted over
12 older adults who are over
83 years old
Lateral tilt is effective in reducing PI
11 Mateo, M.M. and Herrera, D.G.,
2018
Quantitative review To perform a comparative study between
repositioning and support surface for the
prevention of the PIs
The papers were collected
from the PubMed and Scopus
Repositioning after every 3 to 4 hours in comparison to 2
hours of interval is effective to reduce PI in comparison to
the support surface
12 Woodhouse, M., Worsley, P.R.,
Voegeli, D., Schoonhoven, L. and
Bader, D.L., 2015
Observational study Effectiveness of 30 degree tilt for the
reduction of PIs
The observation was
conducted over 10
participants
Repositioning helps to position the soft tissue and thus
helping to reduce the severity of PIs
The review of the literature showed that repositioning is effective in
reducing the development of the PIs among the vulnerable older
adults. Among the repositioning, the mechanical repositioning is
effective in comparison to the traditional repositioning. Whereas 30
degree tilt or in the supine position was effective in comparison to
the 90 degree tilt for the reduction of the pressure injuries among the
older adults. However, person-centred approach must be
undertaken for the reduction of the risk of the vulnerability of
developing PIs.
Article no. Author and year Effectiveness of Repositioning Non-effectiveness f repositioning
1 Gillespie, B.M., Chaboyer, W.P., McInnes, E., Kent, B., Whitty, J.A. and Thalib, L., 2014
2 Bradford, N.K., 2016
3 Sharp, C.A., Moore, J.S.S. and McLaws, M.L., 2019
4 Mallah, Z., Nassar, N. and Badr, L.K., 2015
5 Källman, U., Bergstrand, S., Ek, A.C., Engström, M. and Lindgren, M., 2016
6 Krapfl, L.A., Langin, J., Pike, C.A. and Pezzella, P., 2017
7 Källman, U., 2015
8 Stinson, M., Ferguson, R. and Porter-Armstrong, A., 2018
9 Woodhouse, M., 2016
10 Kapp, S., Gerdtz, M., Gefen, A., Prematunga, R. and Santamaria, N., 2019
11 Mateo, M.M. and Herrera, D.G., 2018
12 Woodhouse, M., Worsley, P.R., Voegeli, D., Schoonhoven, L. and Bader, D.L., 2015