Pragmatic RCT Evaluating Optimal Patient Turning for Reducing Hospital-Acquired Pressure Ulcers: The LS-HAPU Study

Monday, 30 October 2017: 2:45 PM

David Pickham, PhD
Barbara Mayer, PhD
Stanford Health Care, Menlo Park, CA, USA

Purpose: To evaluate the effectiveness of “optimal” patient turning, defined as turning every 2 hours with at least 15 minutes of tissue depressurization, for reducing hospital acquired pressure ulcers. Surprisingly few randomized controlled trials have been undertaken to evaluate the effectiveness of patient turning on reducing hospital-acquired pressure ulcers. In addition, previous studies have not had a reliable means for continuously monitoring and qualifying patient turns, such as by turn angle, turn period, and tissue-depressurization time. This study compares “optimal” patient turning, achieved with the aid of a proprietary patient monitoring system (Leaf Healthcare, Inc.), to that of traditionally coordinated turning practices (i.e. using manual reminders and documentation), in reducing the incidence of hospital-acquired pressure injuries in subjects admitted to an intensive care unit.


This is a single site, open label, two-arm randomized controlled trial. From September 2015 to January 2016 all patients admitted to one of two ICU’s were enrolled. A patient sensor (Leaf Healthcare, Inc.) was applied to the torso of each patient. This sensor detects, measures and reports variables related to patient turning and provides real-time information to a desktop dashboard application visible at the patient’s bedside and at the central station. Nurses caring for subjects in the treatment arm had full usability of the proprietary patient monitoring system, therefore facilitating the delivery of “optimal” patient turning, while nurses caring for subjects in the control group had the dashboard turned off, relying instead on traditional turn reminders. Ethics review was provided by the organization’s Institutional Review Board and a waiver of patient authorization was granted due to clinical need and the low-risk of the study protocol.


1564 patients were admitted to an ICU during the study period. After exclusions 1226 subjects were analyzed (671 treatment v 555 control), with over 106,000 hours of patient monitoring data collected. Overall compliance to prescribed turning protocols was approximately 20% higher in the treatment group versus control (65% v 47%). Overall 16 patients developed a total of 24 HAPUs related to positioning (1.3%). The incidence of HAPUs varied significantly between groups; 2.3% in the control group versus 0.4% in the treatment group.


This study reveals a 5-fold difference in hospital-acquired pressure ulcer rates in subjects receiving “optimal” pressure ulcer prevention practices coordinated by real-time monitoring technology, versus subjects receiving care coordinated using traditional methods. Delivery of optimal patient turning also increased significantly with the use of real-time monitoring technology. Optimal turning procedures effectively reduce HAPI.