PROTECT - Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance
- PMID: 30549321
- DOI: 10.1111/jan.13932
PROTECT - Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance
Abstract
Aim: To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses' compliance to repositioning frequencies; (b) body posture of patients after repositioning; (c) incidence of pressure ulcers and incontinence-associated dermatitis; (d) nurses' and patients' preferences, comfort and acceptability; and (e) budget impact.
Background: Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking.
Design: Multicentre, cluster, three-arm, randomized, controlled pragmatic trial.
Methods: Two hundred and twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group.
Results: Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group.
Conclusion: This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education.
Trial registration: This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.
目的: 研究个性化换位和转弯换位系统的有效性:(1)护士对换位频率的依从性;(b)患者复位后的身体姿势;(c)压疮和尿失禁相关皮炎的发生率;(d)护士和病人的偏好、舒适度和接受度;(e)预算影响。 背景: 患者个体化体位调整是预防压疮的关键。 迄今为止,缺乏临床决策工具,对压力性溃疡预防指南的依从性较低。关于商业上可用的转向的研究和重新定位系统还很缺乏。 设计: 多中心、聚类、三步走、随机、对照、实用试验。 方法: 2016年2月至2017年12月,在16家医院的29个病房招募了227名有压力溃疡发展风险的患者。病房随机分为两组实验组和一组对照组。 结果: 实验组患者卧床治疗后,护士对复位频率的依从性显著提高(94.6% vs. 69%, 84.9% vs. 71.4%)。使用转弯和重新定位系统可以显著提高患者的定位正确率(30-45°倾斜侧卧位)(69.6%对34.6%)。很少发生压疮和尿失禁相关的皮炎事件。患者和护士对干预均持积极态度。 在对照组中,与床上重新定位有关的劳动力成本较高。 结论: 这是第一个研究量身定制的重新定位的效果和使用重新定位援助,以增加护士的依从性重新定位。调查结果支持这些干预措施,但也表明了跟进和教育的重要性。 临床试验注册: 本研究注册于https://clinicaltrials.gov/NCT02690753.
Keywords: cluster randomized trial; compliance; medical device; nursing; pressure ulcer; prevention; repositioning; tailored.
© 2018 John Wiley & Sons Ltd.
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