- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02996331
Preventing Pressure Ulcers With Repositioning Frequency and Precipitating Factors
February 22, 2021 updated by: Duke University
The purpose of this study is to determine whether repositioning frequency can be extended for nursing home (NH) residents who are low, moderate, and high risk for pressure ulcer (PrU) development.
The investigators will also determine how changes in medical severity interact with changes in risk level and repositioning schedule to predict PrU development.
This study will advance knowledge about repositioning frequency and clinically assessed PrU risk-level in relation to medical severity.
Outcomes of this research will contribute to future guidelines for more precise preventive nursing practices and refinement of PrU prevention guidelines.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
The purpose of this 9 nursing homes (NH) cluster randomized study is to determine whether repositioning frequency can be extended for NH residents who are low, moderate, and high risk for pressure ulcer (PrU) development and on visco-elastic (VE) high-density foam support-surfaces without compromising PrU incidence.
The investigators will also determine how changes in medical severity interact with changes in risk level and repositioning schedule to predict PrU development.
PrUs result primarily from pressure over bony prominences that occlude blood flow to tissues.
Current PrU prevention protocols recommend repositioning moderate, high, and severe risk residents a minimum of every 2 hours.
The investigators propose to include low risk residents because studies suggest they too develop PrUs.
New pressure redistribution mattresses may make 2 hour repositioning unnecessary, but optimal time between repositioning remains unclear.
Aims are 1) determine differences in incidence of new PrUs in NH residents (low, moderate, high risk level) using VE surfaces and repositioned at 2, 3, and 4 hour frequencies; and 2) determine how medical severity components (measured by a modified Comprehensive Severity Index), changes in clinically assessed risk-level (low, moderate, high as measured by Braden Scale), repositioning schedule, and their interactions are associated with PrU development; and an Exploratory Aim: Evaluate PrU prevention intervention approach between NH groups repositioned at 2, 3, or 4 hour by: 1) comparing the intervention resource costs (VE surfaces, Leaf service/sensor use, fixed and variable labor costs for training and repositioning) and incremental cost-effectiveness ratio of cost per % reduction in PrUs, and 2) exploring staff and resident satisfaction with intervention approach.
The investigators will randomly assign each NH to one of 3 study arms (2, 3, 4 hour) while providing standard nursing care.
Leaf Patient Monitoring System will be used with sensor worn continuously to monitor repositioning.
Periodic safety and care checks will be performed to ensure skin integrity.
Residents admitted to study NHs for at least 3 days during the 6 week intervention, without an existing PrU, not using a specialty support surface, and of low, moderate, or high risk for PrU development will be included in analysis based on intention to treat.
The outcome, no difference in PrU incidence, will determine whether repositioning frequency can be extended for low, moderate, high risk residents.
Medical severity components and clinically assessed risk level will be examined for assessment to assessment change in relation to PrU development, thus identifying severity components associated with new PrUs.
Data will be monitored by investigators daily.
Data analysis and management will be performed by HSIR.
NH staff and resident satisfaction with the intervention approach will be explored using focus groups.
This study will advance knowledge about repositioning frequency and clinically assessed PrU risk-level in relation to medical severity.
Outcomes of this research will contribute to future guidelines for more precise preventive nursing practices and refinement of PrU prevention guidelines.
Study Type
Interventional
Enrollment (Actual)
2113
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Connecticut
-
Wallingford, Connecticut, United States, 06492
- Quinnipiac Valley Center
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- NH residents for a minimum of 3 days who use a VE-surface mattress, are without PrUs and are clinically assessed as low, moderate, or high risk for new PrU development will participate in their respective NH-wide repositioning frequency protocol.
- Participants will include residents at the time of study initiation and any newly admitted residents during the 6-week study period.
Exclusion Criteria:
- Newly admitted residents (less than 3 days)
- resident has been diagnosed with pre-existing pressure ulcer
- PrU Risk is severe (Braden score <= 9)
- the resident is cared for on a specialty bed (such as a bariatric bed)
- "do not turn" orders are present
- Allergy to adhesive
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 2 hour arm
All participants in this arm are assigned a 2-hour repositioning interval.
|
Current PrU prevention protocols recommend repositioning moderate, high, and severe risk residents a minimum of every 2 hours.
We propose to include low risk residents because studies suggest they too develop PrUs.
New pressure redistribution mattresses may make 2 hour repositioning unnecessary, but optimal time between repositioning remains unclear.
Aim is to determine differences in incidence of new PrUs in NH residents (low, moderate, high risk level) using VE surfaces and repositioned at 2, 3, and 4 hour frequencies.
|
Experimental: 3 hour arm
All participants in this arm are assigned a 3-hour repositioning interval.
|
It is expected that repositioning frequency can be extended for NH residents who are low, moderate, and high risk for pressure ulcer (PrU) development and on visco-elastic (VE) high-density foam support-surfaces without compromising PrU incidence.
This intervention will include a 3 hour repositioning interval.
|
Experimental: 4 hour arm
All participants in this arm are assigned a 4-hour repositioning interval.
|
It is expected that repositioning frequency can be extended for NH residents who are low, moderate, and high risk for pressure ulcer (PrU) development and on visco-elastic (VE) high-density foam support-surfaces without compromising PrU incidence.
This intervention will include a 4 hour repositioning interval.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Determine differences in PrU Incidence among NH in study arms.
Time Frame: 4 weeks
|
Determine differences in the incidence of new PrUs in NH residents at low, moderate, and high risk using VE surfaces and repositioned at 2, 3, or 4 hour frequencies, in nine randomly assigned NHs over a 4-week period.
We hypothesize that there will be no significant difference in PrU incidence between the 3 treatment arms in the study using three risk level groups: high risk (Braden Scale Score, 10-12), moderate risk (Braden Scale Score, 13-14), and low risk (Braden Scores >14).
The hypothesis of no group-difference will be tested by examining whether the 95% confidence intervals of the rates of PrU and the 2-hour repositioning overlap.
If they do, the hypothesis for no group-difference will be confirmed.
Cumulative Incidence rate = [(# of residents with 1 or more new PrUs during intervention period) ÷ (# of residents participating in intervention for 3 or more days)] x 100; calculated for the full 4-week intervention period.
|
4 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Determine how medical severity components, changes in clinically assessed risk level, repositioning schedule, and their interactions are associated with development of PrUs.
Time Frame: 4 weeks
|
Calculated severity score resulting from distillation of over 2,000 potential elements using the modified Comprehensive Severity Index (CSI) risk adjustment system.
The more abnormal the signs/symptoms, the higher the severity score: Level 1 (normal to mild) - Level 4 (catastrophic, life-threatening, or likely to result in organ failure).
PrU development will be examined and the PrU incidence rate will be modeled as a binary outcome.
Additionally, generalized estimating equations (GEEs) will be used with model fit assessed using the quasi-likelihood information criterion (QIC).
Robust standard errors, clustered at the facility level, will be employed to account for covariance among residents within facilities over time.
To test the robustness of models, non-linear mixed models using PROC GLIMMIX will be employed as another option for modeling the data.
|
4 weeks
|
Evaluate cost-effectiveness of PrU prevention intervention approach between NH groups repositioned at 2, 3, or 4 hour intervals.
Time Frame: 4 weeks
|
Comparing the intervention resource costs and incremental cost-effectiveness ratio of cost per % reduction in PrUs.
Intervention cost will include labor cost, such as training time multiplied by wage & fringe rates of training participants and number of repositionings for each NH and study arm and time to conduct repositioning collected by Leaf system; multiplied by nurse wage & fringe rate.
Non-labor cost inputs will include market prices paid fully depreciated over their respective useful life will be used to calculate daily equipment cost rates.
Intervention cost by NH and study arm and incremental cost-effectiveness ratios (ICERs) will be calculated and compared for cost per % reduction in PrUs.
Sensitivity analysis will be conducted with the range of observed repositioning times, nurse salaries, and market prices for non-labor inputs to assess the robustness of the ICERs and their sensitivity to labor and non-labor input prices.
|
4 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Tracey Yap, PhD, RN, Duke University School of Nursing
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Yap TL, Alderden J, Sabol VK, Horn SD, Kennerly SM. Real-time Positioning Among Nursing Home Residents Living With Dementia: A Case Study. Wound Manag Prev. 2020 Jul;66(7):16-22.
- Sabol VK, Kennerly SM, Alderden J, Horn SD, Yap TL. Insight Into the Movement Behaviors of Nursing Home Residents Living With Obesity: A Report of Two Cases. Wound Manag Prev. 2020 May;66(5):18-29.
- Yap TL, Kennerly SM, Horn SD, Bergstrom N, Datta S, Colon-Emeric C. TEAM-UP for quality: a cluster randomized controlled trial protocol focused on preventing pressure ulcers through repositioning frequency and precipitating factors. BMC Geriatr. 2018 Feb 20;18(1):54. doi: 10.1186/s12877-018-0744-0.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 16, 2017
Primary Completion (Actual)
October 10, 2019
Study Completion (Actual)
October 11, 2019
Study Registration Dates
First Submitted
October 6, 2016
First Submitted That Met QC Criteria
December 14, 2016
First Posted (Estimate)
December 19, 2016
Study Record Updates
Last Update Posted (Actual)
February 24, 2021
Last Update Submitted That Met QC Criteria
February 22, 2021
Last Verified
February 1, 2021
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PRO00069413
- 1R01NR016001-01A1 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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