Pressure ulcers, also known as bed sores, are harmful for patients, providers, and healthcare facilities for several reasons. Pressure ulcers (PUs) and pressure injuries remain a serious health concern, particularly in long-term older adult care. These injuries often develop in areas like the sacrum, buttocks, hips, and heels due to prolonged immobility.

For patients, they cause significant pain, increase the risk of serious infections like sepsis, and lead to longer recovery times and reduced quality of life.

For providers, pressure ulcers can reflect poor care standards and increase clinical workload due to the need for complex wound management. Pressure ulcers can negatively impact patient satisfaction scores and facility reputation, making quality care and compliance difficult.

For facilities, they often lead to higher treatment costs, longer hospital stays, and potential legal liability or penalties from regulatory bodies.

Despite broad awareness and most health centers implementing wound prevention protocols, prevention outcomes in many facilities continue to vary. In this article we will review a recent study that clearly demonstrates the difference a comprehensive pressure injury prevention protocol, including repositioning devices, can make in reducing negative outcomes. 

What a recent study says about pressure ulcer prevention

A recent Finnish study demonstrated that a structured and consistent approach to PU prevention - especially when it includes repositioning devices like the SideLyer- can make a significant difference in prevention and outcomes. [Link to full article]

This study was conducted at two public long-term care facilities in Finland and included 232 residents. One facility implemented a new, evidence-based pressure ulcer prevention practice, while the other continued with their previous standard of care. Both the evidence-based practice and control group compositions are the same in terms of characteristics such as gender, age, height, weight, health condition, and mobility.

The new prevention practice that was implemented focused on improving in six key areas:

Risk assessment: The study used the Braden Scale as the tool for pressure ulcer (PU) risk assessment. This scale looks at things like the patient’s ability to feel (sensation), moisture, activity level, mobility, nutrition, and friction/shear. Each category is scored, and the total helps determine the patient’s risk for developing pressure ulcers. A lower total score indicates a higher risk. It’s one of the most widely used and validated PU risk assessment tools in clinical settings.

Skin assessment and care: Skin assessments at all pressure points were performed as part of routine care, at admission, and during every care session or repositioning. Skin care was also included in the new protocol, though they did not elaborate on the exact skin care protocol beyond gentle handling and regular skin inspections with quick responses to any issues.

Nutrition: Before the intervention, only 15.6% of residents had a nutrition risk assessment. After the new protocol was implemented, 51.1% had nutrition risk assessments performed. Nutritional supplement use rose significantly from 9.8% to 17.4% in the intervention group. This is important because good nutritional status, such as adequate protein and calories, is critical to maintaining skin integrity and supporting tissue repair.

Repositioning: Repositioning was one of the most impactful components of the intervention. Here's how it was done differently in the intervention group compared to the control group: more frequent and consistent repositioning both during the day and night (with median repositioning intervals were every 3 to 4 hours), consistent documentation of repositioning times and techniques, use of repositioning aids, and 52.5% of walking residents were encouraged to move independently (vs only 20% in the control group).

Pressure-relieving devices: The intervention group used pressure relieving devices like pressure-distributing cushions in wheelchairs more consistently.

Documentation: Staff in the intervention group used a written procedure called the “Procedure for PU Prevention in LOPC Facility”, developed specifically for the study to document in more detail and more consistently than the other group.

The aim of this study was to standardize how nursing staff addressed each of these areas using international clinical guidelines, with a strong emphasis on consistency and nursing education.

Assessment

Pressure ulcers were assessed before and after intervention. Each PU was classified into four stages based on their severity. 

Stage I involves non-blanchable redness of intact skin, which may feel warm, firm, or painful, indicating early tissue damage that is still reversible.

Stage II  presents as partial-thickness skin loss, often appearing as a blister or shallow open sore involving the outer skin layers (epidermis and dermis).

For Stage III, the ulcer extends through the full thickness of the skin into the subcutaneous fat, creating a deeper wound that may include tunneling or dead tissue.

For Stage IV is the most severe, with full-thickness tissue loss exposing muscle, bone, or tendons, and carries a high risk of infection and complications such as sepsis or osteomyelitis.

The study assessed residents for presence of pressure ulcers, and characterizes each pressure ulcer for each resident, if they have any, at two different timepoints

In the intervention group, pressure ulcers were assessed before and after the intervention.

In the control group, there was no intervention, but pressure ulcer prevalence was assessed at the same time points as in the intervention group.

Key findings of the study

At baseline (blue), there is no significant differences between the intervention group (left) and the control group (right) in terms of the prevalence of pressure ulcers. In fact, we see that the intervention group had 5% PU prevalence while the control group had 3% prevalence.

After one year, the intervention was administered to the intervention group and the incidence of PU dropped from 5% to 0%. During this same time, the incidence of PU actually increased in the Control group from 3% to 6%.

Which factors impact pressure injury prevention the most

One of the most significant sources of improvements came from the repositioning practices. In the new protocol, time spent repositioning residents increased both during the day and at night in the intervention group.

Importantly, residents were not only repositioned more, but they were also more likely to be repositioned in a way that avoided shearing or skin stretching, both of which are contributors to skin breakdown and injury.

Why repositioning devices matter in preventing pressure injuries

The study found that repositioning devices like lifting belts, pressure-relieving cushions, and sliding sheets help staff safely and consistently shift residents’ positions without causing significant additional strain or friction on their skin.

This is where a device like the SideLyer can come in to take this improvement to the next level. While lifting belts and sliding sheets may make it slightly easier for staff to reposition patients, it still requires significant effort and poses risks to both the patient and the staff members. Musculoskeletal injuries and disorders are high in healthcare staff that reposition patients, in fact nursing assistants have five times the national average for these injuries than all other industries.

The SideLyer does the heavy lifting when it comes to repositioning patients, reducing the rates of injury to staff and making repositioning easier, faster, and also more comfortable for the patient. When repositioning is less of a strain on staff, it can be assumed from the Finish study that it will be done more consistently.

A motorized repositioning device like SideLyer can automatically reposition residents at programmed intervals (e.g., every 2–4 hours), even during overnight hours when manual repositioning by staff is less frequent. Also, fewer staff are needed to safely reposition a resident, which is valuable in understaffed facilities. Motorized systems can also achieve and maintain specific tilt angles, which effectively reduce pressure. Lastly, the gentle, gradual repositioning by a motorized bed is less disruptive to sleep and may reduce agitation or resistance. 

Conclusions from the study

This study confirms that a structured, consistent, evidence-based approach to PU prevention—especially when it includes repositioning devices—can dramatically improve outcomes for older adults in long-term care.

Facilities looking to improve skin health outcomes should consider implementing a bundled intervention that standardizes care and empowers staff through education and the use of repositioning aids such as motorized repositioning devices like SideLyer to make repositioning less of a strain on their time and bodies.