Bedsore prevention is a primary focus of aged care facilities and hospitals across Australia. But research from the University of New South Wales has found that the common practice of repositioning residents every two hours to prevent bedsores is both ineffective and causes significant sleep-deprivation.
Two-hourly repositioning is a widely accepted and used bedsore prevention practice in aged care facilities. Yet the resulting interruptions to residents’ normal sleeping patterns may cause behavioural problems, such as agitation and heightened distress.
Among the study’s recommendations is the replacement of this practice with alternating pressure air mattresses for at-risk residents.
A red flag for patient quality care
The study examined the medical and nursing records of 80 deceased residents from eight Registered Care Facilities around Australia. It aimed to determine the number of residents who had been assessed as being at risk of developing pressure ulcers, and to then examine how effective the use of two-hour repositioning was in preventing the sores.
It found that 91% of the ‘at risk’ patients were physically repositioned in their beds every two hours, 24/7. Despite this, a third of those residents were still enduring significant pressure ulcers up to their deaths.
What is a pressure ulcer?
Pressure ulcers, also known as bedsores, are localised injuries to skin caused by ongoing pressure, friction or shear. They usually occur on bony prominences such as the sacrum or heels in people who are bedridden or wheelchair-confined.
Although anyone can develop a pressure ulcer if they are bedridden for too long, they are most often found in the elderly.
Pressure ulcers can vary in severity from a red or bruised area, an oozing sore, to an open wound exposing bone. They are extremely painful, and contribute to reduced quality of life and even deaths of many frail patients who are already struggling with their wellness.
Pressure ulcers and aged care: the challenge
The study found that painful pressure ulcers were identified in 70% of the residents within the study. It also found that 21% of residents developed new pressure ulcers despite being routinely repositioned every 2 hours.
Sadly, behavioural changes were observed particularly in patients with dementia who also were restrained for periods of time in an effort to save them from self-harm. Not being able to physically move and reposition themselves led to worsening of their pressure ulcers, which in turn resulted in behavioural changes such as:
- Becoming aggressive at night when woken to be repositioned
- Hitting and kicking staff and refusing care
- Yelling and screaming for help during repositioning and when staff performed wound care
The conclusion is that the majority of residents with pressure ulcers, particularly those physically or chemically restrained, experience serious sleep-deprivation on top of the pain from their wounds.
Pressure ulcers and aged care: the solution
In light of the problems highlighted around past practices outlined in the study, there is a new way forward. The use of alternating pressure air mattresses (APAMs) has been recommended as a better approach for patients deemed at-risk of developing a bedsore.
Pressure sores can begin developing in as little as half an hour in at-risk patients. An alternating pressure air mattress provides relief to all parts of the body every few minutes throughout every 24 hours. Best of all, they do this without waking residents.
Alternating pressure air mattresses are filled with channels that routinely fill and empty to keep pressure off of bony areas in patients unable to reposition themselves.
They are placed on top of a regular bed, and can be programmed on cycles suitable for each patient. This promotes patient comfort, quality of care, and also eases the workload of nursing staff.
The way forward
As Australia’s aged care royal commission recently highlighted the strain the aged care sector is under, the need for better bedsore prevention measures are becoming increasingly apparent.
At Keystone Healthcare, our mission is to minimise the incidence of preventable injuries in healthcare settings. We’ve been promoting patient safety through better technology for over 20 years.
Click here to view our range of alternating air pressure mattresses. Alternatively, give us a call on 1300 547 877 to discuss solutions for your facility.