Pressure Ulcers: Literature Review Essay

Introduction

The research question for this assignment: does frequent repositioning prevent the likelihood of bedridden patients developing pressure ulcers (PUs)? The initial search was done in Google Scholar by the inquiry “pressure ulcers prevention frequent repositioning” published in 2017 and later. It revealed a significant number of recent studies on the topic, among which three articles were chosen. The second search on the U.S. National Library of Medicine with a similar inquiry and limitations revealed two additional papers that answer the research question. In this literature review, the accumulated knowledge related to the identified problem will be discussed.

Literature Review

The first article is “Review of the current management of pressure ulcers” by Boyko et al. The authors consider repositioning as the primary method of the reduction of PUs and call for the creation of an individual plan for each patient who has a risk of developing it (Boyko et al., 2018). However, they also emphasize the fact that frequent repositioning can increase the rate of PU due to unnecessary stress on the skin (Boyko et al., 2018). The paper describes the growing relevance of the topic, provides an overview of the current methods of treating pressure ulcers and alleviating associated risk factors.

The second article by Gaspar et al. called “Effectiveness on hospital‐acquired pressure ulcers prevention: A systematic review.” It reviews recent studies regarding the occurrence of PUs. The authors conclude that reposition frequency of 2-hour periods, which is a standard of practice nowadays, is an optimal method of prevention of PUs (Gaspar et al., 2019). However, it is linked with high nurse workload, and any changes in frequency will lead to unsatisfactory results due to either negligence or physical exhaustion of personnel (Gaspar et al., 2019). Moreover, preventive device usage can lead to patient traumas due to the actions of staff or patients, although it reduces the rates of PUs (Gaspar et al., 2019).

The third article by Pechlivanoglou et al. is “TURNing high risk patients: An economic evaluation of repositioning frequency in long‐term care.” The paper provides an appraisal of the cost-effectiveness of 2-, 3-, and 4-hour repositioning frequency. The authors conclude that 3-hour periods with the addition of specialized mattresses are the most cost-effective strategy (Pechlivanoglou et al., 2018). Moreover, the article discusses the impact of each repositioning frequency on the quality of life of a patient.

The fourth article, “Pressure ulcers prevention efficacy of an alternating pressure air mattress in elderly patients: E²MAO a randomised study,” by Sauvage et al., focuses on a specific device for repositioning. The study reveals that alternating pressure air mattresses can decrease PU occurrence by up to 50% and reduce nurse workload by allowing an increase in periods of manual repositioning (Sauvage et al., 2017). Frequent repositioning is still a necessity for patients with PU risk factors (Sauvage et al., 2017).

The fifth article, “Two-hourly repositioning for prevention of pressure ulcers in the elderly: Patient safety or elder abuse?” by Sharp et al., discusses the standard recommendation regarding PU prevention methods. The authors reveal that the 2-hour strategy fails for one-third of patients who are in a PU risk group (Sharp et al., 2019). They suggest that restraining patients is one of the primary reasons for the failure of this method and add that an alternating pressure air cushion must be mandatory for such cases.

Conclusion

In conclusion, this literature review reveals that the current standard frequency of repositioning significantly decreases the likelihood of PU development in patients in risk groups. There are findings that suggest that a tailored approach for each patient can be more beneficial than the standard 2-hour repositioning frequency. However, it is necessary to consider nurse workload when increasing it below 2 hours. Moreover, devices may provide additional support in PU alleviation, although they require maintenance and can increase the rate of incidents due to the lack of personnel training.

References

Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in Wound Care, 7(2), 57-67.

Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital‐acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102.

Pechlivanoglou, P., Paulden, M., Pham, B., Wong, J., Horn, S. D., & Krahn, M. (2018). TURNing high risk patients: An economic evaluation of repositioning frequency in long‐term care. Journal of the American Geriatrics Society, 66(7), 1409-1414.

Sauvage, P., Touflet, M., Pradere, C., Portalier, F., Michel, J., Charru, P., Passadori, Y., Fevrier, R., Hallet-Lezy, A., Beauchêne, F., & Scherrer, B. (2017). Pressure ulcers prevention efficacy of an alternating pressure air mattress in elderly patients: E²MAO a randomised study. Journal of Wound Care, 26(6), 304-312.

Sharp, C. A., Schulz Moore, J. S., & McLaws, M. (2019). Two-hourly repositioning for prevention of pressure ulcers in the elderly: Patient safety or elder abuse?Journal of Bioethical Inquiry, 16(1), 17-34.