As the Patient Turns

Small Movements + Innovative Resources + High-Performance Staff Apparel = Better Patient Outcomes and Caregiver Support

By Michelle Daniels

Any medical professional involved in bedside care is familiar with the importance of patient positioning. Whether in a hospital or post-acute care facility, patients must be monitored and moved to prevent pressure injuries, enhance their breathing, maintain muscle strength and joint flexibility, and contribute to their overall comfort. It sounds simple, but it is time-consuming and presents risks to both patients and healthcare teams. Having healthcare teams wear apparel that supports function and movement, along with a surface system that works with them as they move, can support injury reduction and overall satisfaction of both the care provider and patient.

Since early 2020, the bedside scenario has changed dramatically. COVID-19 overwhelmed both acute and post-acute facilities and staff. Due to the effects of the virus, moving patients became critical and much more frequent. Patient intubations also soared, and patients declined rapidly, requiring intense bedside care from overextended and exhausted physicians, nurses and other medical professionals. 

Although the pandemic continues its grip on the world, there are tools to reduce the stress and risk of patient positioning for both the patients and their caregivers right now. The equation is simple: use the right care surface, make frequent small shifts in patient positioning and provide your care team with apparel that supports their movement and comfort.

Guidance on Patient Movement

Some patients are able to change their own positions to prevent pressure injuries, but the vast majority of individuals who are at a higher acuity most likely will require assistance to alter the spots where their bodies rest on the support surface. As the result of international collaboration, the National Pressure Injury Advisory Panel (NPIAP) released the third edition of its evidence-based pressure injury clinical guidelines in 2019. It outlined important positioning principles that most facilities have incorporated into their patient care practice:

  • Consider each individual’s activity level, independent repositioning ability and tissue tolerance in determining repositioning frequency.
  • Use manual handling techniques and equipment to reposition patients, to redistribute or relieve pressure.
  • Repositioning should achieve optimal offloading of all bony prominences and maximum redistribution of pressure.
  • Check for uneven distribution of pressure and positioning of medical devices after repositioning.
  • Consider visual cues to guide positioning. such as continuous bedside pressure mapping.
  • Unless required to manage an individual’s medical condition, avoid extended use of prone positioning.
  • Use slow, gradual turns to reposition unstable critically ill patients who can be repositioned, to allow time for hemodynamic and oxygenation status stabilization.
  • Initiate frequent small shifts in body position for critically ill individuals too unstable to maintain a regular repositioning schedule, and as a supplement regular repositioning.

With understandable variations on how often or in what way patients should be moved, the practice of repositioning is widely acknowledged to reduce pressure injuries and benefit overall healing.

The Complications Posed by COVID-19

Along with the need to turn coronavirus patients to avoid pressure injuries, placing them in a prone position is often beneficial to their recovery – whether they’re on a ventilator or not. While patients in respiratory distress have been positioned onto their stomachs in intensive care for many years, the practice of “proning” became widespread as medical teams determined that it could be beneficial for those battling COVID-19.1 For patients not already on ventilators, moving them from a supine to prone position has often delayed or completely avoided the need for intubation or care in the ICU, as found in hospitals such as Rush University Medical Center in Chicago.2

Patients with acute respiratory distress syndrome (ARDS), including those suffering from COVID-19, often are in a prone position for 12 hours or more. For these individuals, NPIAP made specific repositioning recommendations such as:

  • Consider the potential impact of oxygenation deficits on the risk of pressure Injuries
  • Make small shifts in body position and reposition head every two to four hours or as required by the patient
  • Watch for major complications of proning in ARDS such as pressure injuries, loss of venous access and  displacement of endotracheal tube,

Imagine the process of repositioning a very ill COVID patient (who is likely unable to assist their caregivers in moving) from back to front. Between the connections to devices and monitors, which may include a mechanical ventilator, along with the patient’s physical and mental states, medical personnel must be especially cautious and nimble in repositioning.

These are the same caregivers who are physically and mentally overwhelmed themselves. It’s no secret that medical personnel have been pushed beyond their limits to care for surge after surge of coronavirus cases. One study of more than 7,000 Dutch healthcare workers found that those who had direct contact with COVID-19 patients had significantly more physical and mental exhaustion and sleep issues. Physical exhaustion was more prevalent among female healthcare workers and those above age 55, while mental exhaustion was reported by more healthcare employees under age 36.3

Reposition on the Right Surface, Even the Small Movements

So how do you make shifts and turns efficient for both seriously ill patients and fatigued staff? We’ve found the ideal turning scenario for most patients requires the right foundation. Our comfortable Airisana® support surface system safely facilitates bedside therapies and positioning with stable side perimeters and a supportive foam base. It was designed to enable fewer staff members to fully reposition the patient on the surface with bedside oversight and less physical stress.

It’s also an ideal surface for microshifts. While 30-degree lateral turns are considered normal inpatient repositioning, the National Pressure Injury Advisory Panel (NPIAP) advocates for the benefits of minimal adjustments or microshifts.4 When a patient is critically ill or has a complex diagnosis, even a two-to-five degree position change can significantly reduce or prevent pressure injuries. These small, gentle shifts reduce disturbance to the patient, as well as friction and shear risk, and help prevent staff injuries often associated with the pulling and lifting necessary for larger repositioning.

Caregiver Function and Safety Also Support Positive Patient Experience

Besides repositioning, better patient outcomes are also driven by the ease with which nurses and other medical professionals can perform their jobs safely. While functional uniform apparel increases professionalism and satisfaction, it’s equally important to consider the practical benefits it offers your medical professionals whose work includes repositioning and many other physical activities multiple times per shift. Besides surfaces that work with them as they turn patients, wearing the right apparel can make their jobs easier and less risky.

Caregivers should have uniform clothing that helps them do their jobs well without even thinking about it. Being able to stretch and move in all directions, often very quickly, is vital to those providing hands-on care. Medical personnel need useful apparel that fits correctly, and offers multiple style options, like our Jockey® Scrubs. They allow caregivers to be fully present with their patients, rather than struggle with uncomfortable or inflexible uniforms.

Make Working at the Bedside More Efficient for All

Versatility is the name of the game in healthcare, as every patient care plan will be different. With patients on a customizable support surface that promotes greater caregiver safety, coupled with high-performance uniform apparel, healthcare providers can focus their efforts on what they do best. By empowering your healthcare heroes, you also increase the quality of patient care and satisfaction; driving outcomes for those in the beds and beside them!

Michelle Daniels is Vice President – Product Strategy, Development and Administration for Encompass Group, LLC.





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