Nursing homes may not need to turn residents every 2 hours to prevent pressure ulcers

University of Texas Health Science Center at HoustonNov 13 2013

A study led by Nancy Bergstrom, Ph.D., associate dean at The University of Texas Health Science Center at Houston (UTHealth) School of Nursing, found that nursing homes that utilize high-density foam mattresses may not need to turn residents every two hours to prevent pressure ulcers, a practice that has been used for over 50 years. A randomized controlled trial of at-risk residents demonstrated that there was no difference in the incidence of pressure ulcers for residents turned at intervals of two, three or four hours.

"We are very interested in preventing pressure ulcers. It's a serious health problem. Also, we're interested in improving care for nursing home residents," Bergstrom said. "Turning residents every two hours throughout the night awakens them, and many people can't go back to sleep, therefore decreasing their quality of life."

The Turning for Ulcer ReductioN (TURN) study, with nursing home residents at moderate or high risk of developing pressure ulcers, randomly assigned participants to turning intervals of two, three or four hours for three weeks. Certified nursing assistants turned residents according to the randomized schedule.

A nurse, blinded to turning frequency, documented skin condition every week. A checklist was used to document type of reposition, heel position, brief condition and skin care at each turn. No serious pressure ulcers developed during the study.

"The findings of the TURN study highlight that turning residents every two hours may no longer be necessary when high-density mattresses are in place and nursing time can be used to attend to other resident needs, such as feeding, assisted mobility and ultimately develop a stronger relationship with their residents," said Susan Horn, Ph.D., co-principal investigator at the Institute for Clinical Outcomes Research.

Previously, mattresses exposed residents to higher pressure, requiring more frequent turning to relieve pressure. Nursing homes formerly used mattresses that were made of spring coils and covered in thick plastic. Newer high-density foam mattresses expose residents to less pressure, and as this study shows, two-hour turning may no longer be necessary.

"We hope using high-density foam mattresses and being very much aware of resident's skin at every turn will decrease the necessity of turning residents every two hours to prevent pressure ulcers and allow residents to sleep more, improving quality of life," Bergstrom said. "Of course, clinical judgment is necessary when implementing results of this study; these findings do not mean that turning is unnecessary."