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One study found that the practice of repositioning elderly nursing home residents every two hours to prevent pressure ulcers should be stopped immediately and replaced by the use of alternating pressure air mattresses (APAMs).
Researchers at NSW University (UNSW) found that repositioning was not only ineffective, but could be abusive by disrupting residents' sleep patterns.
In an article recently published in Bioethical survey, the authors stated that the accepted practice of repositioning every two hours was not only ineffective in preventing pressure ulcers, but was suspected of causing behavioral problems by disrupting residents' sleep patterns.
And in a disturbing flag for the Royal Commission on the Quality and Safety of Elder Care currently underway, the study concluded that far from being a preventative security measure, the Ritualized repositioning of residents could be a form of involuntary institutional abuse.
The study examined the medical and nursing records of 80 deceased residents of eight licensed elderly care facilities (RACFs) in Australia to determine the number of residents badessed as being at risk for developing pressure ulcers, as well as the consequences of repositioning every two hours. and if residents had these ulcers during the last week of their lives.
She revealed that despite the fact that 91% of residents considered likely to develop pressure ulcers physically reposition themselves in their bed every two hours, 24 hours a day, 7 days a week, more than a third of them. Among them presented at least one of these atrocious cutaneous affections.
Harmful
Pressure ulcers can occur on bony areas of the body, such as the sacrum or heels, in people who are bedridden or confined in a wheelchair or wheelchair. A 1994 study revealed that they can develop after only half an hour of constant pressure of immobility.
Mary-Louise McLaws, author of the UNSW School of Public Health and Community Medicine, says that although RACFs are required to reposition themselves every two hours with the best intention, this practice is ineffective and ultimately harmful to elderly residents.
"My first thought was that repositioning every two hours would cause sleep deprivation and that it would simply be torture," said Professor McLaws.
"It was not surprising that residents were clbadified as having" worrying behaviors "and then subjected to chemical or physical stress.
The solution
Professor McLaws and her co-authors say the best proven method of pressure ulcer prevention 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 up sleep or disturb sleep – at a frequency that can not be repositioned," said Professor McLaws.
Until now, the issuance of APMs to at-risk residents was minimal to non-existent, and the study indicates that nurses and caregivers do not have the power to order such equipment, while RACF managers can be convinced that MAAP is expensive. .
However, the study showed that the actual cost of these devices was about US $ 1.40 per day per resident and revealed that they were available on government contract.
"Alternating pressure pneumatic mattresses have limited published evidence for the prevention of pressure ulcers and are considered originally an expensive expense," said Professor McLaws.
"However, a study several decades ago showed that APAMs were more profitable than the practice of repositioning. And when you look at the costs of prevention, they are significantly lower than those needed to treat severe pressure ulcers. "
Professor McLaws and her co-authors recommended that repositioning should be stopped immediately every two hours and 24 hours a day, and that each RACF bed be badigned an APAM, or at least residents at risk of being badigned one without delay.
Another recommendation was that chemical and / or physical constraints, which are used to reduce "behavior of concern", should also be removed as they can lead to pressure sores due to forced inactivity. The worrying behaviors themselves could even be the result of sleep disturbances, according to the authors.
"We agree with other international authors who have shown that the ritual practice of waking up residents every two hours contributes to severe sleep deprivation and worrying behaviors," they explain.
The powers of coroners
The authors also called for an amendment to the legislation relating to the powers of the Coroners Court. As they pointed out in a related article recently published, only four known cases have been referred to the coroner regarding the possible role of pressure ulcers in the death of elderly people.
Coroners currently make few recommendations regarding best practices in the care of the elderly, and the authors suggest that they routinely collect and discuss information on pressure ulcer prevention and management.
"Australian coroners may consider making recommendations referring to Section 3 of the Australian Principles of Quality of Care. [2014]. These principles recommend that RACFs provide MAAPs to residents at risk of developing pressure ulcers, "said co-author Jennifer Schulz Moore of the UNSW School of Law.
Royal Commission
Professor McLaws recently presented to the Royal Commission on Care of the Elderly a dissertation including the two recently published articles on pressure ulcers.
This followed the testimony of co-author Catherine Sharp, who drew on her experience in clinical nursing.
"It was a great opportunity to share our knowledge of pressure ulcer management with the commission," said Sharp.
"We are very optimistic that we will see the repositioning after two hours of residents in favor of the use of APAM technology. This will not only improve the well-being of our elderly residents and seniors in hospitals and the community, but will also reduce unnecessary costs and stress levels experienced by residents, school staff and families. . "
