Posts Tagged ‘tissue tolerance’

Wound Care: Turning Frequency for At-Risk Patients

Friday, September 18th, 2015

What’s the right frequency for turning and repositioning your at-risk patients? Turns out, there’s more than one answer.

Patient Turning FrequencyIf you ask most clinicians what the correct frequency for turning at-risk patients is, the answer is probably going to be an automatic, “Every two hours!” Clinicians seem to have been born with that guideline ingrained in our heads.

But we know that when it comes to proper turning frequency, there is actually quite a bit more involved when finding the best solution.  Some of our patients’ tissue would break down if left in the same position for that length of time. So if two hours isn’t appropriate for some, how do we go about determining the correct turning frequency for at-risk patients?

Official Guidelines Say …

According to the 2014 International Guidelines on the Prevention and Treatment of Pressure Ulcers, turning frequency should be determined by considering your patients tissue tolerance, level of activity and mobility, general medical condition, overall treatment objectives, skin condition and comfort. The frequency of turns should be individualized to your patient, so the standard belief that q 2 hour turns is going to work for all your patents is false.

How do you determine tissue tolerance?

Assessing tissue tolerance allows clinicians to determine how long the skin can tolerate pressure without showing negative impacts in the form of reddened skin. It is done by implementing a step-by-step procedure where the clinician incrementally increases the amount of time the patient is left in the same position until reddened skin is detected, and recording these findings. Once the length of time it takes to see the skin redden is determined, you set the turning frequency to 30 minutes less than that time interval.

For example, if a patient shows reddened skin after 90 minutes, then turning frequency would be each hour. Tissue tolerance results will vary for each patient. The other factors mentioned above (mobility, medical condition, etc.) should also be considered, as they can impact your decisions with turning frequency.

There’s no definitive answer.

What this means for clinicians is that we need to change our thinking about how often our patients should be turned.  The answer to the question “How often do you turn and reposition your patient?” should now be, “At a minimum of 2 q hours and more often if needed.”

What do you think?

Do you currently test for tissue tolerance on your patients?  If so, do you record the results of these trials in the medical record? In Long Term Care, have you had surveyors ask about the method you use to determine turning frequency for your patients? We’d love to hear about your experiences with this topic – please leave your comments below.