Article 1 and 2 Synthesis Summary Reducing the incidence of decubitus wounds is an important goal in patient care. One of the twelve goals set by The Institute for Healthcare Improvement 5 Million Lives Campaign is to reduce pressure ulcers using scientifically based guidelines. It has also become a financial issue as the United States Center for Medicare and Medicaid Services (CMS) guidelines state that hospitals will no longer receive additional payments when patients develop stage 3 or 4 pressure ulcers. It has also become a source of litigation, as pressure ulcers are viewed as preventable complication. An electronic search of PubMed and Cochrane databases was conducted. The following search terms were used: wound irrigation, pressure ulcers, prevention, and dressing change. Article abstracts were then reviewed for randomized control trials (RCTs) comparing turning schedules and peer-reviewed guidelines regarding pressure ulcer prevention. Reddy et al1 conducted a systematic review of fifty nine RCTs to determine what interventions have led to a decreased incidence of pressure ulcers. Consistently effective methods include: repositioning the patient, use of support surfaces, optimizing nutritional status and moisturizing the sacral skin. However, their review demonstrated the lack of good evidence supporting patient repositioning every two hours. The researchers conducted a literature search of MEDLINE, EMBASE, CINAHL, Cochrane databases, UMI Proquest Digital Dissertations, ISI Web of Science and Cambridge Scientific abstracts with no restrictions on language, publication date or clinical setting. Only two published RCTs studied the effect of patient positioning on the incidence of pressure ulcers. The larger RCT by Defloor et al had 884 participants and compared the different repositioning schedules and support surfaces. The smaller RCT by Young et al had only 46 participants and compared 30 degree tilt position with 90 degree side lying position. The overall conclusion of the systematic review concluded that repositioning is
article to use in answering your PICO questions along with the reason(s) you would or would not retrieve it. Indicate the level of evidence.
St-Arnaud D. Paquin MJ. Safe positioning for neurosurgical patients. AORN Journal. 87(6):1156-68; quiz 1169-72, 2008.
Positioning the patient for surgery is an important part of perioperative nursing care that should not be underemphasized. The combined factors of time, mechanical pressure, and immobility increase the risk of tissue damage…