HomeStrategiesSkin HealthReducing risk of pressure injuries through repositioning: Webinar recap
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Reducing risk of pressure injuries through repositioning: Webinar recap

Are your protocols stuck in tradition or following best practices?

Clinician lifts patient with repositioning sheet, while another clinician uses a wedge under the patient.

Pressure injuries affect up to 3 million people in the United States each year, depending on the clinical setting.¹ That’s why it’s important for nursing staff to understand the factors that can contribute to pressure injury formation and follow best practices to help reduce their skin breakdown.

Preventing pressure injuries is top of mind for many healthcare providers. But some prevention strategies have not kept up with evidence. In the Medline Skin Health educational webinar titled, “Does one good turn deserve another: A look at the practice of repositioning,” Catherine T. Milne, APRN, MSN, ANP/ACNS-BC, CWOCN-AP, Advanced Practice WOC nurse and co-owner of Connecticut Clinical Nursing Associates, discusses three key concepts regarding pressure injuries:

  • Physiological impact of body position on skin and soft tissue
  • Common repositioning practices encountered in clinical practice
  • Strategies to optimize repositioning in clinical practice

Didn’t see the webinar?

Access it here and read on for a preview of the discussion.

Watch webinar
Headshot of Catherine T. Milne with three concentric pink circles in background.

It’s time for a new repositioning tradition

Traditions get passed down through the decades often by word of mouth. They often come with history, even nostalgia and baked-in beliefs, and they can become a default for incorporating new staff into an unfamiliar setting.

However, in healthcare settings, traditions may no longer follow evidence-based best practices. In this educational webinar, Milne emphasizes why it’s time to take a fresh look at long-held traditions regarding turning and repositioning.

One common tradition involves the idea of turning patients every two hours. Milne says, it’s time to turn over a new leaf on that.

Origins of the Q2 turning tradition

Turning patients every two hours dates back to 1854 when Florence Nightingale was caring for soldiers in the Crimean War.

Many organizations still stress the Q2 hour tradition as an important patient safety measure, and some nursing schools continue to educate students on it. Unfortunately, evidence doesn’t support the habit any longer. What the evidence does support—and what’s recommended by the National Pressure Injury Advisory Panel¹—is an individualized turning plan.

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What happens when skin tissue is under pressure

Creating an individualized turning plan starts with understanding how pressure injuries can develop because observation alone isn’t enough to know how a patient’s skin is affected by pressure. “We need to think about what’s happening underneath,” Milne says. Tissue compression can lead to negative outcomes such as:

  • Nutrient depletion
  • Inflammation
  • Subepidermal tissue damage
  • Tactile changes to the skin
  • Compression of the lymphatic system

Milne describes a balance between the external mechanical load and the patient’s ability to tolerate it. Longer periods of pressure can carry greater risk, as Milne notes, “Once you sensitize the skin to pressure, you need less of it to the same area for shorter periods of time to cause damage.”

How do you assess tissue tolerance?

Assessment devices can be used, with options such as infrared thermography. But starting with your clinical observations helps determine a patient’s tolerance. The webinar covers three key areas to focus on:

  • What you see—look for persistent redness, for example.
  • What you feel—does the area feel warm to the touch?
  • What do you hear—this is about listening to the patient and how they’re describing their pain

6 Considerations of repositioning

In addition to the risk assessment tools and observations, here are some considerations the webinar discusses in more detail:

  1. Patient’s ability to reposition themselves
  2. Effect of pain medications on self-repositioning
  3. Unconscious bias affecting turning and repositioning frequency
  4. Barriers to lifting a patient
  5. Using the right products as part of a pressure injury prevention program
  6. Proper product training and usage

Key takeaway

Traditions have their place, but sometimes it’s not at the bedside. Be sure your staff is empowered to follow current evidence-based best practices when it comes to pressure injury prevention. Start to look at organizational protocols and, Milne advises, “Get rid of anything that says Q2 hours.”

Explore more content about pressure injuries:
Pressure injury staging is as easy as Apple P.I.E.: download the poster
Prevent pressure injuries: Know the 4 contributing factors
Take an online course on pressure injury prevention
Expert Q&A: Why it’s a good idea to consult with other skin and wound care clinicians

References:

  1. National Pressure Injury Advisory Panel Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline, page 115, www.npiap.com
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