RESUMO
OBJECTIVE: Pressure injuries are a significant problem for critically ill patients; they increase morbidity, cost, and duration of hospitalisation. Prolonged immobility is a major risk factor, but evidence guiding how frequently patients should be turned to prevent this complication is limited. We aimed to determine the impact of changing from 5-hourly to 3-hourly turns on pressure injury incidence in critically ill patients. DESIGN: We conducted a pre-post intervention evaluation study, comparing a 6-month period during which patient turns were 5-hourly (1 July 2015 - 31 December 2015) with a 6-month period during which turns were 3-hourly (1 February 2016 - 31 August 2016). These periods were separated by a 3-week wash-in period. SETTING: Intensive care unit in a metropolitan tertiary referral hospital. PARTICIPANTS: All patients admitted during the pre-intervention and post-intervention periods were included. INTERVENTION: A change in turn frequency for critically ill patients from 5-hourly to 3-hourly. MAIN OUTCOME MEASURES: The primary outcome was the number of patients diagnosed with a pressure injury. Secondary outcomes were the total number of pressure injuries, and the number of decubitus injuries. RESULTS: In the pre-intervention period, 1094 patients were admitted; in the post-intervention period, 1165 were admitted. Thirty-eight pre-intervention patients (3.5%) and 23 post-intervention patients (2.0%) developed a pressure injury (P =0.028). The incidence of decubitus injuries was markedly reduced in the post-intervention period (36 v 8 injuries, P < 0.001). After adjusting for Acute Physiology and Chronic Health Evaluation (APACHE) III score, duration of intubation and age, the odds ratio for developing a pressure injury in the post-intervention period was 0.51 (95% CI, 0.27-0.97) (P =0.041). For mechanically ventilated patients, the adjusted odds ratio for developing a decubitus pressure injury in the post-intervention period was 0.22 (95% CI, 0.06-0.85) (P =0.029). CONCLUSIONS: A change in turn frequency from 5-hourly to 3-hourly was associated with a halved incidence of pressure injuries. Critically ill patients may benefit from more frequent turns.
