Tracey L. Yap, PhD, RN, CNE, WCC, FGSA, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina, United States. Susan D. Horn, PhD, is Adjunct Professor, University of Utah School of Medicine, Salt Lake City. Phoebe D. Sharkey, PhD, is Professor Emeritus, Loyola University Maryland, Baltimore. Tianyu Zheng, MS, is Research Assistant, University of Utah Department of Population Health Sciences. Nancy Bergstrom, PhD, RN, FAAN, is Professor Emeritus, University of Texas Health Science Center at Houston School of Nursing. Cathleen Colon-Emeric, MD, is Professor, Duke University School of Medicine. Valerie K. Sabol, PhD, MBA, ACNP, GNP, FAANP, FAAN, is Professor, Duke University School of Nursing. Jenny Alderden, PhD, APRN, is Associate Professor, Boise State University School of Nursing, Idaho. Winston Yap, MD, Carroll County Memorial Hospital, Carrollton, Kentucky. Susan M. Kennerly, PhD, RN, CNE, WCC, FAAN, is Professor, East Carolina University College of Nursing, Greenville, North Carolina. Acknowledgments: The authors thank Judith Hayes, PhD, RN, and Elizabeth Flint, PhD, for editorial assistance. This project was funded by the National Institutes of Health, National Institute of Nursing Research (R01NR016001; Yap, principal investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have disclosed no other financial relationships related to this article. Submitted December 5, 2021; accepted December 23, 2021; published online ahead of print January 19, 2022.
Adv Skin Wound Care. 2022 Jun 1;35(6):315-325. doi: 10.1097/01.ASW.0000817840.68588.04.
To investigate the clinical effectiveness of three nursing-home-wide repositioning intervals (2-, 3-, or 4-hour) without compromising pressure injury (PrI) incidence in 4 weeks.
An embedded pragmatic cluster randomized controlled trial was conducted in nine nursing homes (NHs) that were randomly assigned to one of three repositioning intervals. Baseline (12 months) and 4-week intervention data were provided during the TEAM-UP (Turn Everyone And Move for Ulcer Prevention) study. Intervention residents were without current PrIs, had PrI risk (Braden Scale score) ≥10 (not severe risk), and used viable 7-inch high-density foam mattresses. Each arm includes three NHs with an assigned single repositioning interval (2-, 3-, or 4-hour) as standard care during the intervention. A wireless patient monitoring system, using wearable single-use patient sensors, cued nursing staff by displaying resident repositioning needs on conveniently placed monitors. The primary outcome was PrI incidence; the secondary outcome was staff repositioning compliance fidelity.
From May 2017 to October 2019, 1,100 residents from nine NHs were fitted with sensors; 108 of these were ineligible for some analyses because of missing baseline data. The effective sample size included 992 residents (mean age, 78 ± 13 years; 63% women). The PrI incidence during the intervention was 0.0% compared with 5.24% at baseline, even though intervention resident clinical risk scores were significantly higher (P < .001). Repositioning compliance for the 4-hour repositioning interval (95%) was significantly better than for the 2-hour (80%) or 3-hour (90%) intervals (P < .001).
Findings suggest that current 2-hour protocols can be relaxed for many NH residents without compromising PrI prevention. A causal link was not established between repositioning interval treatments and PrI outcome; however, no new PrIs developed. Compliance improved as repositioning interval lengthened.
在不影响压疮（压疮）发病率的情况下，调查三种疗养院广泛重新定位间隔（2、3 或 4 小时）的临床效果，为期 4 周。
在 9 家疗养院（NHs）中进行了嵌入式实用集群随机对照试验，这些疗养院被随机分配到三个重新定位间隔中的一个。在 TEAM-UP（翻过来预防溃疡）研究中提供了基线（12 个月）和 4 周干预数据。干预居民没有当前的压疮，压疮风险（Braden 量表评分）≥10（非严重风险），并使用了可行的 7 英寸高密度泡沫床垫。每个臂都包括三个 NH，每个 NH 都有一个单独的重新定位间隔（2、3 或 4 小时）作为干预期间的标准护理。无线患者监测系统使用可穿戴式一次性患者传感器，通过在方便的显示器上显示居民重新定位需求来提示护理人员。主要结果是压疮发病率；次要结果是员工重新定位合规性保真度。
从 2017 年 5 月到 2019 年 10 月，9 家 NH 的 1100 名居民配备了传感器；由于缺少基线数据，其中 108 人不符合某些分析的条件。有效样本量包括 992 名居民（平均年龄，78±13 岁；63%为女性）。干预期间的压疮发病率为 0.0%，而基线时为 5.24%，尽管干预居民的临床风险评分明显更高（P<.001）。4 小时重新定位间隔的重新定位依从性（95%）明显优于 2 小时（80%）或 3 小时（90%）间隔（P<.001）。
研究结果表明，在不影响压疮预防的情况下，许多 NH 居民可以放宽当前的 2 小时方案。虽然没有建立重新定位间隔治疗与压疮结果之间的因果关系，但没有新的压疮发展。随着重新定位间隔的延长，依从性得到了提高。
