Pressure injury prevention protocols should be tailored to obese patients, according to a new study.

Two residents — with body-mass indexes of 39 and 51 — were tracked over 10 days as part of a larger study of pressure injury development at nine U.S. nursing homes. Chest sensors detected movement among all participants, with the two residents selected for a deeper case study based on their BMI class.

Researchers at Duke University and three other schools looked at the role staffing and equipment play in meeting existing turning and movement protocols for pressure injury prevention. They also sought to assess risk based on behaviors rather than BMI alone.

A 71-year-old resident, for instance, had lost weight since a fall and admitted movement was easier, though she never left her bed during the study period. She could assist in turns, but she often paused in doing so and didn’t initiate movement on her own. The second resident, 76, was heavier but more mobile, which presented its own challenges as she propelled her wheelchair.

The researchers said Braden scores alone shouldn’t be the only information considered when assessing risk and prevention in bariatric patients.

“Wearable technology that cues nursing staff may be a feasible and long-term strategy,” Duke nursing professor Tracey Yap, Ph.D., RN, wrote in Wound Management and Prevention