Pressure Ulcer Prevention
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FAILURE TO TARGET SERVICES CAN ALSO SHORT-CHANGE RESIDENTS IN NEED
From a staffing standpoint, overestimating dependency levels, and thus service needs,
can be a costly mistake. From a clinical standpoint, it can be disastrous, for it means that most nursing homes will have targeted more residents than they can provide proper care for. The usual upshot for those who truly need repositioning is that most will receive substandard care; only a minority will receive services at the level needed.
Our PU care evaluation study bore this out (2). We identified a subsample of 98 PU risk residents who were unable to reposition themselves independently, based on our performance assessment. All these residents then were in need of two-hour repositioning to prevent PU development. And all had medical record documentation that they were receiving it. But when we used wireless thigh movement monitors to detect actual repositioning, we found that only 26% of these residents were repositioned an average of every three hours or less. Moreover, their average longest time in one position was 5.6 hours, and ranged from 4 to 12 hours.
Could it be that by trying to do too much for too many, nursing home staff were short-changing those most in need? We think it's likely.
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