Wireless system prompts turning patients at risk for bedsores

A wireless system that continuously monitored patient movement significantly increased the frequency of turning patients in bed at an adult medical unit. This system also improved caregivers’ adherence to turning protocols and enhanced staff efficiency, according to results of a study published in Nursing Open.

Turning patients in bed is “one of the most basic nursing care interventions to improve oxygenation, help prevent skin breakdown, and improve circulation,” wrote Suann Cirigliano Schutt, MSN, RN-BC, CEP, and colleagues at El Camino Hospital, Mountain View, CA.

Despite the importance of this practice, current devices intended to help staff remember to turn patients—such as “turn clocks” and timers—haven’t resulted in high compliance with turning protocols, the authors noted. Also, 2-hour reminders (such as turning patients on “even hours”) don’t take into account that patients may turn over by themselves.

Previously, researchers in the UK found that only 42% of 393 ICU patients were turned every 2 hours or less, and that the average time between turns was 4.85 hours. Turning patients regularly provides a number of potential benefits, including less muscle wasting, better lung capacity, and fewer pressure-related skin issues, these researchers noted.

In this study, Schutt and colleagues tested the use of a wireless continual position monitoring system (Leaf Patient Monitoring System) to determine if it would increase staff compliance with a predetermined turn protocol. The system included a small disposable sensor (adhered to the patient’s skin over the sternal area) as well as a computer, a server, and monitor display. The monitor was set up at the nurses’ station and indicated when a patient needed to be turned.

The researchers collected 4,322 hours of position monitoring data on 75 patients during the baseline phase, during which the nursing staff used their standard 2-hour turning protocol without the monitoring system. They collected another 3,532 hours of data on 63 different patients during which nurses used the wireless position monitoring system to identify patients who needed turning.

Results showed that use of the position monitoring system significantly increased the rate of patients who were turned every 2 hours, from 64% at baseline to 98% after intervention (P < 0.001). This increase was even higher in a subset of isolated patients, whose 2-hour turning percentage rose from 48% to 99% (P=0.030).

In an informal questionnaire at the end of the study, 87% of the nursing staff felt the continual position monitoring system was helpful.

“The nurses said the system helped them prioritize patient care and avoid unnecessary tasks,” the researchers noted. “Given that the system continually tracks patient movement, credit is given for any adequate patient self-turns; thus, the system may prevent unnecessary work and patient disruptions and improve staff efficiency.”

Researchers also discovered one serendipitous finding: A morbidly obese patient, who needed more pillows to stay in the side-lying position, had sunk back so far into the pillows that the system indicated the patient’s offloading turn wasn’t maintained. “This finding suggests knowledge could be gained through future study of continual positioning monitoring of morbidly obese patients,” the authors observed.

Schutt said, “Enhanced understanding of patient movement will lead to benefits in patient safety, the prevention of falls and pressure injuries, and knowing when to avoid disturbing patients who do not need to be turned.”

She and her fellow researchers called for further studies with a larger sample size to evaluate patient care and outcomes other than turning compliance, such as pressure ulcers, clot formation, and respiratory status. Although no patients in this study developed a pressure ulcer, a larger sample size would better evaluate their incidence when using a monitoring system, the researchers said.

This study received no specific funding from any public, commercial, or not-for-profit organization. Leaf Healthcare provided hardware, software, research assistants, and statistical support.