Pickham David, Pihulic Mike, Valdez Andre, Mayer Barbara, Duhon Patrice, Larson Barrett
Office of Research, Patient Care Services, Stanford Health Care, Stanford, CA; Division of Primary Care and Population Health, Stanford University, Stanford, CA; Leaf Healthcare, Inc, Pleasanton, CA; Patient Care Services, Stanford Health Care.
Leaf Healthcare, Inc, Pleasanton, CA.
Wounds. 2018 Aug;30(8):229-234. Epub 2018 May 29.
Compliance with turning protocols in the intensive care unit (ICU) is low; however, little is known about the quality of turning, such as turn angle magnitude or depressurization time. Wearable sensors are now available that provide insight into care practices.
This secondary descriptive study describes the turning practices of nurses from 2 ICUs at an academic medical center among consecutive ICU patients.
A wearable patient sensor was applied to patients on hospital admission. The sensor continuously recorded position data but was not visible to staff. A qualified turn was one that reached > 20° angle and was held for 1 minute after turning. The institution's clinical research repository provided clinical data.
A total of 555 patients were analyzed over a 5-month period (September 2015-January 2016); 44 870 hours of monitoring data (x- = 73 hours ± 97/patient) and 27 566 individual turns were recorded. Compliant time was recorded as 54%, with 39% of observed turns reaching the minimum angle threshold and 38% of patients remaining in place for > 15 minutes (depressurization). Turn magnitude was similar for medical and surgical patients. Factors associated with lower compliant time included male sex, high body mass index, and low Braden score. Patients were supine for 72% of the observed time.
The investigators found dynamically measured turning frequency, turn magnitude, and tissue depressurization time to be suboptimal. This study highlights the need to reinforce best practices related to preventive turning and to consider staff and patient factors when developing individualized turn protocols.
重症监护病房（ICU）中翻身方案的依从性较低；然而，对于翻身质量，如翻身角度大小或减压时间，了解甚少。现在有可穿戴传感器可用于深入了解护理操作。
这项二次描述性研究描述了一所学术医疗中心2个ICU的护士对连续入住ICU患者的翻身操作情况。
在患者入院时应用可穿戴患者传感器。该传感器持续记录位置数据，但工作人员不可见。一次合格的翻身是指翻身角度达到>20°并在翻身后保持1分钟。该机构的临床研究资料库提供临床数据。
在5个月期间（2015年9月至2016年1月）共分析了555例患者；记录了44870小时的监测数据（平均=73小时±97/患者）和27566次个体翻身。记录的符合要求时间为54%，观察到的翻身中有39%达到最小角度阈值，38%的患者保持同一姿势>15分钟（减压）。内科和外科患者的翻身幅度相似。与较低符合要求时间相关的因素包括男性、高体重指数和低布拉德恩评分。观察期间患者72%的时间处于仰卧位。
研究人员发现动态测量的翻身频率、翻身幅度和组织减压时间并不理想。本研究强调需要加强与预防性翻身相关的最佳实践，并在制定个性化翻身方案时考虑工作人员和患者因素。
