How to do it... Positioning techniques

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In the wake of recent updates to the National Pressure Ulcer Advisory Panel's wound staging guidelines, providers are re-focusing on prevention. Wound care toolboxes include methods and technology aimed at properly stabilizing residents for effective healing. Experts weigh in here on positioning devices and best practices.

1. Innovations are leading to improved positioning devices and techniques, but do your homework.

Ensure that any newly acquired device redistributes pressure, and look for evidence to back up a manufacturer's claim that pressure is redistributed, advises Mary Madison, RN, RAC-CT, CDP, clinical consultant, long-term care and senior care, for Briggs Healthcare. Also, don't over-buy.

“Remember that each individual and their situation is unique, so purchasing large quantities of a new product may not serve each person who needs a positioning device,” she says. 

Madison recommends involving a trusted DME supplier and a certified wound nurse or an enterostomal therapist in procurement.

Jackie Todd, support surface and heel protection clinical education specialist for Medline, offers a few other criteria to consider, including ensuring positioning devices are: cleanable and reusable (avoid plain foam edges, for example); durable (check for foam density) and strong (weight-bearing); and resilient. Ask questions about lifespan, efficacy testing and the training needed, she adds.

2. Surprisingly, too many providers don't put enough thought into how positioning devices will be used, which could be a costly mistake in more ways than one. It begins with conducting a proper assessment, according to Jeannette Podlogar, clinical support manager for McKesson.

“For me, it's looking at residents' basic needs first,” she says. Also engage staff on their biggest positioning “pain points.”

It's never too late to remind caregivers of basic considerations when doing assessments, says Elaine McGowan, BSN, RN, CWCN, vice president of clinical affairs for DermaRite Industries. These include a device's indications for use and limitations, its potential for harm, level of expertise needed to use it, whether it's rentable, and any need for additional storage space.

3. Proper device useturning and repositioning techniques are critical. 

“A clinician or caregiver cannot simply insert and use a positioning device and walk away,” says Madison. 

He or she should be aware of improper elevation that could distribute a resident's weight toward and impart undue pressure on other body areas, she notes. Be mindful of devices such as “rings or donuts” that have outlived their purpose.

According to OSHA, nursing homes that focus on repositioning methods have significantly reduced work-related injuries and associated workers' compensation costs. 

“Trying to offload the weight of the resident while minimizing the strain on the caregiver is a key consideration,” adds Podlogar, who also urges providers to invest in positioning devices that can accommodate caregivers' and residents' varying body types. “People tend to underestimate the strain and try to lift people who are either taller or shorter than them.” 

4. Wound care specialists and physical therapists will recommend devices for a specific resident's condition, but always keep a good supply of essential positioning devices on hand, Todd advises. These include: positioning wedges, which should come in multiple sizes and shapes; flat bottom chest rolls; good devices for knees and ankles, in addition to lateral positioning and torso support; abduction pillows for proper hip positioning; and off-loading boots.

5. The stability of any positioning device matters. Smaller devices can reliably stay in place, but those that are needed to support large limbs or bariatric residents can slip. Portable positioning devices are popular, but ensure they are secure.