Providing healthcare today has never been more complicated and full of opposing ideals.
The complexity of healthcare has evolved and increased over the years. The governments of Canada and healthcare leaders have recognized that there is a nursing crisis: ‘There simply are too few funded nursing care hours for too many nursing care needs. As a result, the nursing positions that are available for duty are overworked and strained. That, in a nutshell, is the problem.’12
Healthcare workers are expected to perform tasks, that have a potential high risk for injury, with the possibiltiy of being understaffed or not having the proper equipment. This leads to consequences for both the patient and the healthcare professional.
Healthcare facilities need to control rising costs, yet not having the proper equipment could prove more costly in the long term. In an industry that is chronically understaffed nationwide, the more staff injured and not working the higher the payout and replacement costs.
One of the most common examples of this is the need to turn and position immobile patients. The formation of pressure sores is a risk for all immobile patients. The patent needs to be moved, and it doesn’t matter if they are 100 lbs. or 300 lbs. Unfortunately, Canada is also seeing a rise in the national obesity rate8; and as such, the rotation of patients in and out means that healthcare professionals are going to see a wide variety of shapes and sizes but with a slightly better chance of encountering a heavier set patient.
According to nursing guidelines4, immobile patients are supposed to be turned every 2 hours. If a patient is a higher risk for developing pressure sores, they must be turned and positioned even more frequently.
Much has changed in the last 40 years, such as quality of bedding material, hygenic products, mattresses and hospital beds, amongst other personal factors that may influence skin durability. While it may remain that two hours between turns is sufficient, we need to ask ourselves, is it really?6
Combining the aging population with increasingly fragmented care and a nationwide nurse shortage, pressure sores rates are likely to continue to increase.9
Here are some ways to prevent pressure sores:
- Turn and position patients at least every 2 hours
- Provide good skin care
- Keep the skin clean and dry
- Use a turning sheet to keep track of your positioning
- Observe and report the condition of the skin
- Encourage mobility
- Provide for toileting needs
- Encourage and provide nutrition and fluids
- Use pressure reducing cushions, mattresses, beds, booties, elbow pads, etc
- Do NOT elevate the head of the bed more than 30 degrees, unless ordered
- Do NOT use any donut type devices
- Do NOT allow a patient to remain on a bedpan for a long period of time
- Document and report all your patient observations and care
The frequent need to turn and reposition patients creates a potentially high risk situation for healthcare professionals. Not all patients are created equal and some may be more difficult to maneouver than others.
In an industry that is not promoted as physically demanding, as compared to the mining and petroleum industry in Alberta for example, research found that about 3% of health care workers are at risk of a disabling injury in 2012, compared with 1.45% of workers in the latter.7
The force it takes to turn a patient depends on multiple factors.
- The patient’s body weight and height
- Mental, neurological and/or physical problems
- How far you have to extend your arms
- The height at which you have to extend your arms
- The position of the patient and the position of the healthcare professional
Lifting and turning patients acts as a fulcrum and lever system where a caregiver’s back is the fulcrum. The stress generated on the lower back is multiplied many times when bending and lifting at the same time, such as during a patient turn.5
Here are some figures on how you are stressing your lower back when turning a patient*:[testimonial_rotator id=12532 hide_title=”true”]
* Assuming a 150 lb. caregiver turns a patient to their side with a reach between 34 and 36 inches. Data obtained from www.CDC.gov—NIOSH. 2013.
The more our arms are extended, the less weight we can carry while minimizing risk of injury.
- When our hands are 10” from our ankles, about 1/3 of the worker’s body weight is ideal. On average, this amounts to approximately 51 lbs.
- When our hands are 16” from our ankles, the weight should be reduced by 40%. This means that about 30 lbs. would be ideal carry weight.
- When our hands are 25” from our ankles, the ideal carry weight should be around 20 lbs. It is highly recommended that no weight should be carried when arms are extended more than 25”.
Although the standard accepted guideline is to turn patients every two hours, there remains a few questions about the validity of this guideline. For example, a patient on a standard mattress may need to be turned more frequently than a patient on a viscoelastic foam mattress.
Even though very little research has been done to investigate this guideline further, one study showed that 80-90% of respondents identify that the two hour guideline is what they should go by.9
However, of those same respondents, only 50.7% of patients were being turned every two hours. 9
With that being said, only 57% of respondents believed pressure sore prevention was being achieved.9
Providing healthcare to Canadians is an endless endeavour. Management has to balance the budget between wages, equipment, infection control, and countless other factors. With so many things going on, it may be safe to assume that pressure sore prevention is not a hot topic around budget time.
However, there are many reasons to incorporate pressure sore prevention into the budget.
- Pressure sores can lead to serious complications, including death
- Once formed, pressure sores will lengthen the time of stay, which means that there is one less bed available for new patients
- The average length of hospital stay to treat pressure sores was 12.2 days in 200610
- Patients with hospital-acquired pressure ulcers, on average, cost the healthcare system an additional $13,50011
- Cost of litigation and liability
While guidelines have remained the same over the last four decades, technology has changed drastically.
Healthcare equipment manufacturers have started to take notice of the issues surrounding the challenges faced by facilities and healthcare professionals. In a world where healthcare technology is rapidly evolving, it is important to give the end user a product that they have a hand in developing, as well as giving the facility the realistic opportunity to buy en masse.
One such manufacturer is Linet. Taking first hand experiences from front line healthcare professionals, Linet developed a bed that incorporates Automatic Lateral Therapy (ALT). The bed can be pre-programmed to automatically turn the patient over a specific time period, thus making sure that every patient gets turned.
The ALT also makes it easier for nurses to turn the patient. As the bed is already tilting the patient, turning the patient the remainder of the way is very minimal. Apart from assuring that the patient gets turned, the next biggest benefit is the reduction in potential injuries to staff.