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Pressure Injury Prevention Practices in the Intensive Care Unit: Real-world Data Captured by a Wearable Patient Sensor.

BACKGROUND
Compliance with turning protocols in the intensive care unit (ICU) is low; however, little is known about the quality of turning, such as turn angle magnitude or depressurization time. Wearable sensors are now available that provide insight into care practices.


OBJECTIVE
This secondary descriptive study describes the turning practices of nurses from 2 ICUs at an academic medical center among consecutive ICU patients.


MATERIALS AND METHODS
A wearable patient sensor was applied to patients on hospital admission. The sensor continuously recorded position data but was not visible to staff. A qualified turn was one that reached > 20° angle and was held for 1 minute after turning. The institution's clinical research repository provided clinical data.


RESULTS
A total of 555 patients were analyzed over a 5-month period (September 2015-January 2016); 44 870 hours of monitoring data (x- = 73 hours ± 97/patient) and 27 566 individual turns were recorded. Compliant time was recorded as 54%, with 39% of observed turns reaching the minimum angle threshold and 38% of patients remaining in place for > 15 minutes (depressurization). Turn magnitude was similar for medical and surgical patients. Factors associated with lower compliant time included male sex, high body mass index, and low Braden score. Patients were supine for 72% of the observed time.


CONCLUSIONS
The investigators found dynamically measured turning frequency, turn magnitude, and tissue depressurization time to be suboptimal. This study highlights the need to reinforce best practices related to preventive turning and to consider staff and patient factors when developing individualized turn protocols.