The practice of turning and repositioning ergonomics

 

“The trick is to get the pressure off”

Pressure Injury is not the problem. It is the result. The problem is pressure. We all agree that repositioning is the cornerstone of pressure injury prevention. Turning 30 degrees can be effective to reduce PI incidence and prevalence of sacral/coccyx pressure injuries.

So why are sacral/coccyx pressure injuries still so common? Because turning is a problem. Or more specifically achieving a truly offloaded 30 degree turned and supported position for an extended period of time is a problem. There are many physiological and process factors that affect our ability to provide effective turning and repositioning for pressure reduction.

Patient shifting

Natural patient movement will tend toward a “neutral” position of least resistance, most stability and best comfort. That position is either supine or 90 degree lateral, with supine being more likely. Shifting can be intentional or reflex. Shifting will be a physical necessity when support is inadequate in terms of ergonomics, comfort or stability. The time and potential to shift to “neutral” is directly proportional to the level of mobility.

Efficiency of support ergonomics

There are 4 ergonomic elements that must be considered for repositioning to adequately offload and sustain a 30 degree turn.

1. Balanced Rigidity:
A support must be firm enough to not “bottom out”, but not so firm that the patient wants to shift off of it because it is too hard.

2. Uniform Weight Distribution:
A device must distribute support pressure and lift across the maximum body surface possible, especially the back and hips. The more body surface supported, the better the ergonomic support will be to minimize patient shift.

3. Body Conformity:
The support must conform to natural spinal curvatures, or it will not support a predictable or stable angle. A flat rigid surface placed against a curved surface will push at an angle greater than that of the flat surface, and tend to push the 2 surfaces away from each other.

4. Horizontal Slope:
The lift slope must be such that it can lift in a horizontal, or under the body as opposed to vertical, or the side of the body. Horizontal support contributes to uniform weight distribution, stability and comfort.

Practice compatibility
Turning protocols are most effective when compatible with nursing practice in terms of effectiveness, practicality, convenience and cost. Increasing turning schedule frequency is expensive and dangerous to the caregiver, and cannot compensate for inadequate offloading and unstable support. A positioner that is convenient and reliable to use is safer, will reduce costs, improve patient care quality, and most importantly, lower pressure injury rates!