COMPARATIVE EFFECTIVENESS OF 2-HOURLY VERSUS 4-HOURLY REPOSITIONING FREQUENCIES IN REDUCING PRESSURE ULCER INCIDENCE AMONG ADULT PATIENTS AT RISK

Abstract

Background: Pressure ulcers, also known as bedsores, are a common and serious complication among immobilized patients, particularly those in intensive care units (ICUs). Frequent repositioning is considered a standard preventive measure; however, its effectiveness and optimal frequency remain topics of debate.

Objective: This evidence-based project aimed to evaluate the effectiveness of different repositioning frequencies in preventing the development of pressure ulcers among adult ICU patients.

Methods: A quality improvement project was conducted at the adult ICU of Shifa International Hospital (SIH), involving nine purposively selected high-risk patients. An observational checklist was used to monitor patients' positioning practices, skin integrity, and clinical parameters. Patients were grouped based on repositioning frequency: every two, three, or four hours. Data were collected until discharge, transfer, or development of bedsores. Ethical approval and informed consent were obtained prior to the intervention.

Results: The findings revealed that 80% of patients were repositioned every two hours, while 10% each received repositioning every three and four hours. Despite the high adherence to two-hour repositioning protocols, 45% of pressure ulcers developed within 6–8 hours of admission, 33% within 24–48 hours, and only 22% after 72 hours. These results challenge the assumption that more frequent repositioning is always more effective and suggest the need for individualized preventive strategies.

Conclusion: The project highlights that early-onset pressure ulcers can occur despite standard repositioning protocols. It underscores the importance of context-specific interventions, comprehensive patient assessments, and possibly re-evaluating repositioning intervals based on patient condition rather than fixed schedules. Further research with a larger sample size is recommended to validate these findings and guide clinical practice.