Repositioning for pressure injury prevention in adults: a commentary on a Cochrane review
Repositioning is regarded as an important intervention to prevent the development of pressure injuries in patients who are immobile. However, there is uncertainty as to the optimal regimen in terms of frequency and method of repositioning. This commentary summarises and critically appraises a Cochrane systematic review that assessed the clinical and costeffectiveness of different repositioning regimens on the prevention of pressure injuries in adults in any setting.
A pressure injury is defined as a soft tissue injury to a localised body part, which is caused by prolonged pressure and/or friction to the skin and is often caused by extended periods spent in bed or by using a medical device (Edsberg et al, 2016). Pressure injuries have an impact on both the physical and mental health of patients (Galhardo et al, 2010; Lala et al, 2014). Having a pressure injury has been shown to be a predictor of longer hospital stays in elderly patients (Theisen et al, 2012) and patients with pressure injuries have a higher risk of mortality compared to those who do not (Song et al, 2019). Elderly patients and those with mobility problems are at particular risk of developing pressure injuries (Kim et al, 2022). Repositioning—where patients are regularly turned or moved into different positions to relieve pressure on one area of the body—is regarded as a key intervention to prevent pressure injury development and is recommended in clinical guidelines such as the National Institute for Health and Care Excellence (NICE) guidance on pressure ulcer prevention and management (NICE, 2014). However, the optimum regimen for frequency (how often patients are repositioned) and method of repositioning (for example, using tilt and/or lateral, supine, prone body position) is uncertain (Yap et al, 2022). Repositioning is also not without negative consequences. For patients, frequent repositioning has the potential to cause discomfort and to disrupt sleep (Langemo et al, 2022). For healthcare staff, repositioning requires substantial time to deliver and may result in musculoskeletal injuries (Weiner et al, 2015). It is therefore important to establish the optimal repositioning regimens that will be clinically effective whilst minimising negative effects on patients and staff. This Cochrane systematic review aimed to assess the clinical efficacy and cost-effectiveness of different repositioning regimens on the prevention of pressure injuries in adults in any setting.
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