Effect of Varying Repositioning Frequency on Pressure Injury Prevention in Nursing Home Residents: The TEAM-UP Randomized Clinical Trial Results.

To investigate the clinical effectiveness of three repositioning intervals (2-, 3-, or 4-hour intervals) without compromising pressure injury (PI) incidence.An embedded pragmatic cluster randomized controlled trial was conducted in nine nursing homes (NH) that were randomly assigned to one of three repositioning intervals. Baseline and 4-week intervention data were provided. Intervention residents were without current PIs, had PI risk (Braden Scale score) 10 or less (not severe risk), and used viable 7" high-density foam mattresses. A wireless patient monitoring system using wearable single-use patient sensors cued staff by displaying resident repositioning need on conveniently placed monitors. The primary outcome was PI incidence; the secondary outcome was staff repositioning compliance fidelity.Eleven hundred residents from 9 NHs were fitted with sensors; 108 of these were ineligible for some analyses because of missing baseline data. The effective sample size included 992 residents (mean age 78 ± 13 years; 63% women). The PI incidence during the intervention was 0.0% compared with 5.24% at baseline, even though intervention risk scores were significantly higher (P < .001). Repositioning compliance for 4-hour repositioning interval (95%) was significantly better than 2- (80%) or 3- (90%) hours (P < .001).Findings suggest current 2-hour protocols can be relaxed for many without compromising PI development. A causal link was not established between repositioning interval treatments and PI outcome; however, no new PIs developed.