Common pressure ulcer prevention practice is “torturous” and could lead to early death, new study finds

The practice of two-hourly repositioning of patients in care facilities to prevent pressure ulcers could be causing more problems than it solves, research from the University of New South Wales (UNSW) in Australia has revealed.

According to the university, physically repositioning patients does not prevent pressure sores and can cause behavioural problems associated with interfered sleep.

UNSW proposes that people should not be repositioned every two hours and has described the practice as a form of “unintentional institutional abuse.”

The university’s study examined the medical and nursing records of 80 deceased residents from eight Registered Aged Care Facilities (RACFs) in Australia to determine the number of residents who were assessed as being at risk of developing pressure ulcers, how the use of two-hourly repositioning impacted them, and whether the residents had these ulcers in the last week of life.

It found that despite 91 percent of the residents who were deemed at risk of developing pressure ulcers being physically repositioned in their beds every two hours, more than a third of them had one or more of the excruciating skin conditions when they died.

Study Author Professor Mary-Louise McLaws of UNSW’s School of Public Health and Community Medicine said that while RACFs are required to practise two-hourly repositioning and do so with the best intentions, the practice is ineffective and ultimately harmful to patients.

“My first thought was that the practice of two-hourly repositioning would cause sleep deprivation and that it is simply torturous,” Professor McLaws commented. “It wasn’t a surprise when residents were classified as having ‘behaviours of concern’ and then chemically or physically restrained.”

As a solution, Professor McLaws and her co-authors say that the best proven method of preventing pressure ulcers is the use of alternating pressure air mattresses (APAMs).

“These mattresses relieve pressure all over the body every few minutes, continuously and gently so as not to wake or disturb the sleeper – at a frequency that human repositioning cannot match,” added Professor McLaws.

The study also states that despite the common misconception that APAMs are too expensive, the mattresses are actually more cost-effective than physical repositioning.

In conclusion, Professor McLaws and her co-authors recommend that the practice of two-hourly repositioning stops immediately and that each bed in an RACF be allocated an APAM.

It should be noted that Aquila cushions use the same alternating therapy as the alternating mattresses so the therapeutic benefits can continue during sitting.