"When you do it, you need to pay attention and make sure it's working for you," Bergstrom says.
Considerations for less-frequent patient turning:
1. Residents "need to have a high density foam mattress on the bed," Bergstrom says, not an overlay or pad on top of another type of mattress.
2. Use a safety checklist. Bergstrom's team developed a safety checklist, "which was almost an unintended consequence" of the study, she says.
The checklist took one minute for nurses to complete; they did it every time they turned a patient. It asked: What time was the patient was turned, and what position was he/she put in?; Were the patient's heels up (yes or no)?; Was the skin normal, red, bruised, or open?; Were the patient's briefs dry, wet, or soiled?; What was the brief care: washed, barrier cream, clean briefs? (check all that apply).
"It goes back to one of the first things I know; if you're going to turn people it's wise to look at the skin at every turn," Bergstrom says. "Everybody was rated on this checklist every time, and we believe this became a major safety factor in the study."
3. Be systematic. Facilities "need to teach the nurses to do these observations; they need to monitor."