Page 18 - From Good Sleep to Wellness

Knowing the resident’s usual routine will help them reestablish their normal sleep pattern.
Not every resident who triggers the pressure ulcer CAA needs to be repositioned by caregivers every two hours. The resident should be assessed to determine if they reposition themselves. Residents who do not reposition themselves can be repositioned by using weight- shifting technique. Be sure that when a resident is positioned on their side, they are at a 30-degree position rather than 90-degree. See pages 34 and 35 of the NPUAP manual.
Below are excerpts from a statement on the Borun Center website.
“Should we automatically schedule for repositioning any resident who triggers the pressure ulcer Resident Assessment Protocol (RAP)?
No. We've seen evidence that this is a common practice in some nursing homes, but it's not recommended.
Routine repositioning . . . is recommended in best practice guidelines for pressure-ulcer (PU) risk residents who are bedfast or who are unable or have limited ability to reposition themselves. Many of the estimated 60% of nursing home residents who trigger the PU RAP are capable of independently repositioning themselves, and thus do not need staff assistance with this task.
The best way to determine who needs repositioning is to conduct a performance assessment that evaluates a resident's ability to reposition him- or herself. Residents who are capable of independently repositioning themselves are at lower risk of developing PUs. Our performance assessment can be used to determine who needs routine repositioning.
The assessment takes about three minutes per resident to complete, but in the long run can save staff time. The reason is that, in the absence of an objective assessment, nursing home staff tend to overestimate the number of residents who are unable to reposition themselves, thus creating more work for themselves. In a recent study, for example, we found that, of 144 residents whom nursing home staff had identified as in need of repositioning, 46 residents-about 32%--could in fact independently reposition themselves.”(1)
A resource for the steering team to use to work with nursing staff on changing their practice of waking residents every two hours for repositioning and incontinence care is “Change Idea for Sleeping and Waking”. This document will guide team members through the issues and practices they need to consider to ensure adequate sleep for their residents.
Communities that have adopted the Promoting Adequate Sleep procedure have reported positive responses from residents. Residents appreciate being able to follow their own sleep pattern.
In one community there was a gentleman who became very agitated when the nurse aides tried to get him up for breakfast. The family attended the care plan meeting. The family shared that when this gentleman retired the previous year, he had told his family that he planned to sleep until 10 AM each morning. During the work week he had had to arise at 4:30 in the morning. The team allowed this gentleman to wake up naturally. His medication regimen was modified. The aggressive behavior was significantly decreased. Many communities report similar stories about improvement in resident mood by allowing them to follow their own sleep pattern.
www.geronet.med.ucla.edu/centers/borun/modules/Pressure_ulcer_prevention/faqs.htm#part www.primaris.org/sites/.../3ChangeIdeas_SLEEPINGANDWAKING.pdf
National Pressure Ulcer Advisory Panel & European Pressure Ulcer Advisory Panel (2009). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines
Long-Term Care Facility Resident Assessment Instrument User’s Manual, Version 3.0, effective 10/1/2010. Retrieved May 16, 2011