Home | Industry+Policy | Experts question mandated two-hourly repositioning

Experts question mandated two-hourly repositioning

Alternating air pressure mattresses (APAMs), not two-hourly repositioning, is the key to preventing bed sores.

What’s more, the constant mandated repositioning of residents in aged care could be a form of unintentional abuse and ultimately unlawful.

This is according to a new study coming out of UNSW. Published in Bioethical Enquiry, it found that far from preventing sores, the repositioning practice can cause behavioural problems because of the sleep interference.

“My first thought was that the practice of two-hourly repositioning would cause sleep deprivation and that it is simply torturous,” said study author Professor Mary-Louise McLaws of UNSW’s School of Public Health and Community Medicine.

“It wasn’t a surprise when residents were classified as having ‘behaviours of concern’ and then chemically or physically restrained.”

McLaws and her co-authors suggest that a better and cost-effective alternative would be the APAMs.

Originally thought to be an expensive outlay, and without substantial evidence into the effectiveness of the mattresses, the new study found the actual cost of these devices to be around $1.40 a day per resident and pointed out that they are available on Government contract.

“A study carried out decades ago showed that APAMs were more cost-effective than the practice of repositioning. And when you look at the costs of prevention, they are substantially lower than those required to treat severe pressure ulcers.

“These mattresses relieve pressure all over the body every few minutes, continuously and gently so as not to wake or disturb the sleeper – at a frequency that human repositioning cannot match,” said McLaws.

The authors also recommended cessation of chemical and physical restraints as the resultant inactivity also leads to ulcers. They also made submissions to the forthcoming Royal Commission on the findings of their work.

Co-author UNSW’s Catherine Sharp said: “We are very optimistic that we will see two-hourly repositioning of residents stopped in favour of using APAMs. This will not only improve the wellbeing of our elderly aged care residents and elderly in hospitals and the community, but it will reduce costs and levels of unnecessary stress experienced by residents, facility staff and families alike.”

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  1. To my knowledge since i started nursing in 1978 it has never been a practise to turn a resident on an air mattress every 2 hrs. It was every 4hrs. The resident gets turned due to double incotinence or after 4 hrs they get repositioned as they can’t turn themselves.. haven’t come across too many residents that don’t resettle. I would argue that even people on air mattresses still get pressure areas due to frailty

  2. As a nurse I would agree that 2 hourly turns of patients I suggest could be painful to patient as you hardly turn a patient before you begin again and they might also be incontinent which takes time to perform this task or perhaps they may have an IDC . This 2 hourly nursing function hardly gives a patient rest.
    The alternating air pressure mattresses would be a lot more gentle on the fragile patient than sometimes rough handling of patient doing 2 hourly turns.

  3. Whilst I do not refute the findings; the causation of a pressure injury is more than just pressure alone. The causative factors are skin integrity, dry skin usually caused by medications; dehydration caused by the inability of the person to remember to hydrate; lack of mobility, increase cerebral irritation could be caused by numerous factors; incontinence and the inability to void and defecate. Other such factors as weight, nutrition, psychological and multi varied physiological factors all contribute to pressure injury.
    I suppose my question concerns itself with all the other multitude of variables. If staff do not attend the care recipient 2nd to 4th hourly, providing comfort care, continence care, offering hydration, giving emotional and psychological support, ensuring their basic human needs are met; then why have staff at all?
    I am concerned that some in our industry will apply the phrase “set and forget” to the most vulnerable. May I take this opportunity to remind us that people are not appliances.
    I am a great advocate for alternating pressure relief devices as a means to help prevent pressure injury but not as an end in itself. While I agree that one causative factor of behaviour of concern is being woken up from a deep sleep; perhaps the question is what techniques do we employ to reorientate and decrease the stress to the care recipient and assist in settling; given behaviour is an ‘unmet’ need?
    Pressure injuries are multivaried and alternating pressure relief devices certainly have their place; but who is checking the device during the night, or when there is a power outage and the generator does not kick in?